In situations where exposure of the joint remains inadequate, the incision may be extended proximally from inferior to superior and medial to lateral across the tendonous
portion of the rectus femoris, the so called "quadriceps snip," dramatically releasing tension on the extensor mechanism.
Current theories include (1) irritation of the pharyngeal mucosa from postsurgical (i.e., tonsillectomy) scarring or direct compression; (2) compression of the adjacent cranial nerves; (3) degenerative or inflammatory changes within the tendonous
stylohyoid insertion; (4) pressure on the internal carotid artery, producing irritation of the arterial sheath nerves; or (5) traumatic fracture of the styloid process with subsequent granulation tissue formation.
Important considerations when placing electrodes over any muscle include avoiding the tendonous
regions and locating the electrodes over the midline of the muscle.
There it splits into anatomically distinct superior and inferior branches, both of which pass through the tendonous
ring to proceed to their target structures.
It helps to know just what is occurring when you damage muscle versus tendonous
tissue, in order to understand that the recovery process should never be short-changed, in particular when tendons are involved.
Exposure is improved by widening the incision and dividing the tendonous
insertions of the rectus abdominus muscles.