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Endgames Anatomy Quiz

Sites of tendon insertion on a pelvic radiograph

BMJ 2013; 346 doi: (Published 15 April 2013) Cite this as: BMJ 2013;346:f2286

Rapid Response:

Re: Sites of tendon insertion on a pelvic radiograph

I fear the answers provided for this anatomy quiz will confuse and mislead;

answer A, sartorius is specific and correct, the arrow indicates the anterior superior iliac spine which is the origin of this muscle.

answer B, is almost half correct - the arrow indicates the lateral margin of the acetabulum, which is the origin of the reflected head of rectus femoris, the AIIS is superomedial to this and is the origin of the straight head of rectus femoris.

Answer C is specific and correct - the lesser trochanter is the point of insertion of the iliopsoas tendon.

Answer D is non specific and incomplete - not all the adductors originate from the pubis (see below), whilst as the arrows also indicate the superior part of the pubis then the rectus abdominis should be included.

Answer E is incorrect - the arrow indicates the medial half of the ischium, which is the origin of adductor magnus. The hamstrings originate from the lateral half and lateral edge of the ischium.

Answer F is so nonspecific as to be incorrect, the medial part of the iliac crest identified on the image is the specific insertion of quadratus lumborum, but also includes parts of some of the other abdominal wall and paraspinal muscles [this point was expanded for clarity by the author on 5.6.13].

It is difficult to produce quiz images of this type. Candidates attempting such a question cannot know whether an answer has to be specific or general, or even correct! I would give a maximum mark of 3 out of a possible 6 for the answers provided.

Competing interests: No competing interests

13 May 2013
Richard W Whitehouse
Manchester Royal infirmary
Oxford Road, Manchester M13 9WL