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Test: Palpation - Sartorius
Video Link
Background/Purpose
The sartorius is the longest muscle in the human body. It arises from the anterior superior iliac spine (ASIS), crosses the anterior thigh obliquely from lateral to medial, and inserts on the proximal medial tibia as part of the pes anserinus, along with the gracilis and semitendinosus (Standring, 2020). It is innervated by the femoral nerve (L2–L3) and crosses two joints. At the hip it contributes to flexion, abduction, and external rotation. At the knee it contributes to flexion and internal rotation of the tibia, which makes it one of the dynamic restraints of tibial rotation (Standring, 2020; Magee & Manske, 2021). The "tailor's position" (sitting cross-legged) uses all of these actions together, which is where the muscle's name comes from. Palpating the sartorius helps localize pain at several clinically important sites: ASIS origin. Tenderness here may reflect strain or, in adolescent athletes, avulsion of the ASIS apophysis. The ASIS is a recognized avulsion site in sprinting and kicking sports (Rossi & Dragoni, 2001). Pes anserine insertion. Tenderness and swelling on the proximal medial tibia, about 2–5 cm below the joint line, is the hallmark finding of pes anserine bursitis or tendinopathy, which often accompanies knee osteoarthritis (Helfenstein & Kuromoto, 2010). Femoral triangle. The sartorius forms the lateral border of the femoral triangle. Lateral femoral cutaneous nerve. The nerve passes near the ASIS close to the sartorius origin. Reproducing anterolateral thigh paresthesia during palpation in this area may suggest meralgia paresthetica (Cheatham et al., 2013). Adductor canal. The muscle covers the adductor (Hunter's) canal, where the saphenous nerve can become entrapped. Palpation is a localization tool rather than a stand-alone diagnostic test. Interpret findings alongside history, resisted testing, and special tests. References: Biel A. Trail Guide to the Body. 6th ed. Books of Discovery; 2019. Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther. 2013;8(6):883–893. Helfenstein M Jr, Kuromoto J. Anserine syndrome. Rev Bras Reumatol. 2010;50(3):313–327. Magee DJ, Manske RC. Orthopedic Physical Assessment. 7th ed. Elsevier; 2021. Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skeletal Radiol. 2001;30(3):127–131. Standring S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. Elsevier; 2020.
Procedure
The patient lies supine. To make the muscle prominent, the patient places the heel of the tested leg on or near the opposite shin or knee. This flexes, abducts, and externally rotates the hip and flexes the knee (Biel, 2019). The clinician stands on the tested side.
Locate the ASIS and palpate just distal and slightly medial to it to find the proximal tendon. The sartorius and tensor fasciae latae form an inverted "V" just below the ASIS, with the sartorius as the medial limb (Biel, 2019).
Have the patient gently resist further hip flexion and external rotation so the muscle contracts and stands out.
Follow the muscle belly obliquely down the anterior thigh toward the medial knee, using flat fingers and moderate pressure.
Palpate the pes anserine insertion on the proximal medial tibia, below the medial joint line and medial to the tibial tuberosity.
Compare with the uninvolved side.
The patient can also be examined seated with the heel resting on the opposite knee. Record any tenderness and its location (origin, belly, or insertion), swelling, increased tone or trigger points, palpable defects, and any reproduction of paresthesia.
Performed: Unilaterally
Dialog
"Bring your heel up toward your other knee and hold it. I'll press along the front of your thigh. Tell me if anything is tender."Criteria
- No trigger points
- No tenderness or swelling at the pes anserine insertion on the proximal medial tibia.
- Adequate muscle tone
- No reproduction of numbness or tingling in the anterolateral thigh
Measurement
0.00LOINC Code
0Scale/Grading
selection range; grade - LOINC IDTest Stats
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Side Pass Fail Left 0 0 Right 0 0 Avg. Measure. Left 0.0 0.0 Avg. Measure. - Right 0.0 0.0