The Physical Exam: Thighs Matters

One of my favorite series of posts I did on my old blog was a run-down of the physical exam.  Some might say I ran down the physical exam as one might run down a pedestrian, I suppose, but it was a fun series to write.  If you didn\’t get the chance to read it (or don\’t remember the trauma of first reading them) go here.  If you do, please make sure to do the following:

  • Have bucket handy
  • Buy a bottle of strong liquor
  • Stay away from sharp objects.

Trust me on this.

So, I have decided, I will once again inflict share this series with the readers of this blog.  Feel free to flee in terror.

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My last writing on this subject was on the exam of the hip joint, which is, as I pointed out, a very confusing topic.  What most people call \”hips\” are not actually hips, but the outside portion of the thigh.  To clear this up, I now turn to the subject of the thigh.  The thigh, which is just south of the hip (but is not the hip), is that portion of the leg the spreads out when you sit down, causing many to go on diets and compulsively buy strange products when watching late night TV shows.

 

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Underneath the spreading tissue is the largest bone in the body, known as the femur.  The femur connects the knee to the groin. Now, my use of the phrase, knee to the groin has probably brought out one of two responses in my readers:

  1. A dull moan accompanied by cold sweats from male readers who had PTSD flashbacks to middle school
  2. A desire to watch the popular TV show, America\’s Funniest Videos, which has built an empire on traumatic groin injuries.
It is interesting that two totally-opposite reactions would happen from the use of one phrase: \”knee to the groin.\”  I would speculate that it was a male traumatized in middle school who chose the name \”femur\” was chosen instead of \”humerus\” or \”funny bone.\”  Clearly the people who make the show America\’s Funniest Videos are the ones in middle school who were associated with kneeing, not groining.  Either that, or they have exceptionally good therapists.
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Double-entendres aside, there is one thing about the femur none can deny: it\’s big.  Orthopedists, who definitely were the doctors doing the kneeing and not the groining during medical school, go one step further, calling the femur a big honking bone.  Paleontologists (who were more likely on the receiving end of the knee/groin transaction) also are prone to use the word \”honking\” (or it\’s language equivalent) in reference to the femurs found as dinosaur fossils.
\"\"This is a paleontologist next to the femur of a dinosaur.
I think the sign he\’s holding says \”this is a huge honking bone.\”
There is some controversy, however, as to the nature of one specimen discovered that dates back to the yabba-dabba-dithic period:
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Some scientists believe that the bone in the hair of this child (nicknamed \”Pebbles\” for unknown reasons) is a femur, noting the similarity to the big honking bone the paleontologist with the sign is standing next to.  Others eschew this theory, pointing the lack of the ball-shaped portion of the bone (acetabulum) that inserts into the hip. The first scientists call the second group a bunch of smart-acetabulums, leading to some more knee/groin interactions.  Despite the acrimony of this debate, all scientists agree on one thing: that\’s one darling little girl.

(Note, astute reader Ngsurgery corrected me on this one, as the ball portion is actually the head of the femur, while the acetabulum is the socket the head goes into.  I won\’t change it, as it would make the smart-acetabulum pun drop in its funniness quotient.  I appreciate sharp readers pointing out my brain farts).

The femur isn\’t the only part of the thigh with size as it\’s claim to fame.  The sartorius muscle, in its circuitous course from outer pelvis to inner knee, is the longest muscle in the body.

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The sartorius muscle gets its name from the Latin word sartor, which means \”tailor,\” and hence it gets the nickname, \”the tailor\’s muscle.\”  Just why someone chose to name this muscle after a profession not quite known for its physicality is cause for discussion.
There are four hypotheses as to the genesis of the name: One is that this name was chosen in reference to the cross-legged position in which tailors once sat. Another is that it refers to the location of the inferior portion of the muscle being the \”inseam\” or area of the inner thigh tailors commonly measure when fitting a pant. A third is that the muscle closely resembles a tailor\’s ribbon. Additionally, antique sewing machines required continuous cross body pedalling. This combination of lateral rotation and flexion of the hip and flexion of the knee gave tailors particularly enlarged sartorius muscles. (from Wikipedia)
I personally think these people have too much time on their hands.
So what\’s the use of the sartorius muscle?  Again, from Wikipedia:
Assists in flexing, abduction and lateral rotation of hip, and flexion of knee.  Looking at the bottom of one\’s foot, as if checking to see if one had stepped in gum, demonstrates all four actions of sartorius.
Stepping on gum, a fact of modern life, is not something others have experienced through history. I\’ve uncovered a new possibility for the word origin of sartorius, coming from an Indo-European expression shouted out when people stepped in dog feces.  This sculpture, found in the Metropolitan Museum of Art, depicts such a misadventure.\"\"So what about the exam of the thigh?  How did this post devolve to a discussion of people stepping in dog poop?  What about the quadriceps muscles?  What about the hamstrings?  What about Suzanne Summers?I gave you the chance to flee in terror.  Now look what you\’ve stepped in: a bunch of yabba-dabba-doo.

10 thoughts on “The Physical Exam: Thighs Matters”

  1. I enjoyed the post. And I assumed you did know that and it was just an honest mistake!

  2. Afterthought: (back to penance mode) Those who’ve stepped right into the yabba-dabba-doo might’ve thought at the time that it was preferable to going through the desert. They were wrong. It only made the desert bigger, and the burden of offenses exponentially larger. Back to the penitential caravan…. Accountability for wrongs I’ve inflicted has gotten a lot heavier than it once was. My own fault, obviously. But, my guidebook says the Guide will get me through the wasteland I created, and that those whom the Law entitles to throw stones (if they so choose) are equally entitled to God’s mercy – a severe mercy at times (cf. CS Lewis) but mercy nonetheless, and greatly preferable to the alternative. — Bye; take care.

  3. Funny! Very good point about orthopods being the knee-ers, not the groiners (and I’d definitely include a PT who supervised my post-big-honking-knee-surgery rehab.) But yeah, what happened to the thigh exam? The gracilis, for instance, is pretty darn important to anyone who strains it. Walking with a badly strained gracilis looks decidedly ungraciliful.
    There’s another work of art at the Met featuring the gracilis in action — the curators evidently have a tradition of being “leg-men” — that gets a lot of attention from guys who, I guess,  just sort of absent-mindedly survey the painting while rethinking their decisions not to go into orthopedics or physical therapy. Their wives say things such as,”What’s the big deal, Harry? It’s just a picture of a naked woman toweling off her foot. Now move it, I wanna get through this museum sometime before midnight….” [overheard while checking out the big honking Met on a road trip to the Big Honking Apple]. )

    Thanks for the link to previous entries on How Not to Perform the Physical Exam. Now I have another excuse to put off reading The Collected Essays of Dry Eighteenth-Century Philosophers. (As if….) *exits laughing*

  4. Love the post ! ( note – the sculpture depicts medial rotation of the thigh vs lateral rotation)

  5. I don’t know if you’re aware, but the links on the Overview of the Physical Exam no longer go anywhere. Any chance it could get fixed?

  6. Nice. I don’t see the link to the previous postings, though. As an ER provider, my masochistic tendencies float to the top anyway, so I would like to traumatize myself further by reading them thoroughly. Could you check that link out?

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