Hip And Pelvis (7A) Flashcards
Bones and pertinent bony landmarks of the pelvis
- ilium
- pubis
- ischium
- anterior superior iliac spine (ASIS)
- posterior superior iliac spine (PSIS)
- obturator foramen (where the obturator nerve passes through)
- ischial tuberosity
- iliac crest
- acetabulum
Bones and pertinent landmarks of femur
- head
- neck
- greater trochanter
- lesser trochanter
- trochanteric fossa
- shaft
- lateral epicondyle
- medial epicondyle
- lateral condyle
- medial condyle
Hip joint
- an articulating joint between the acetabulum of the pelvis and the femur
- called as the coxal joint in the textbook
- when we put our hands on the hip, really we are touching the iliac crest (not the actual hip joint)
- femur = thigh
- leg = distal to the knee (tibia and fibula)
Ilipsoas
- flex hip = strongest action
- iliacus and psoas major
- very powerful muscle, rarely weak in health people
Attachments of iliopsoas
- proximal = transverse processes of lumbar vertebrae and iliac fossa
- distal = lesser trochanter of femur
Innervation of iliopsoas
- L1-L3
- femoral nerve
is part of the core, so it is super strong
Actions of iliopsoas
Open chain movements:
- flex the hip
- externally rotate the hip
Closed chain movements:
- flex the trunk toward the thigh
- tilt pelvis anteriorly
Unilaterally:
- laterally flex lumbar spine (assist)
Gluteus Maximus
- large strong muscle for extending the hip
- extend hip = strongest action
- muscle fibers run in different directions
is the most powerful when the hip is flexed meaning when you squat and you need to get up, you’re using that muscle
Attachments of gluteus maximus
- proximal = sacrum, coccyx, and posterior iliac crest
- distal = iliotibial tract (IT tract AKA IT band: a tendonous sheath) and posterior femur
Innervation of gluteus maximus
- inferior gluteal nerve
Actions of gluteus maximus
All fibers:
- extend the hip
- externally rotate the hip
- abduct the hip
Lower fibers:
- adduct the hip
Tensor fasciae latae (TFL)
- abduct hip = strongest action
- small muscle belly on anterior ilium that becomes the IT tract (IT band)
Attachments of tensor fascia latae
- proximal = iliac crest outer lip (outside flare) and ASIS
- distal = lateral condyle of tibia (the textbook says IT band which attaches there)
Innervation of tensor fascia latae (TFL)
- superior gluteal nerve
Actions of tensor fascia latae
- flex the hip
- internally rotate the hip
- abduct the hip
Gluteus medius
- abduct hip = strongest action
- deep to gluteus maximus
Attachments of gluteus medius
- proximal = posterior ilium
- distal = greater trochanter of femur
Innervation of gluteus medius
- superior gluteal nerve
Actions of gluteus medius
- kind of similar to the deltoid of how it’s shaped
All fibers: - abduct the hip
Anterior fibers: - flex the hip
- internally rotate the hip
Posterior fibers: - extend the hip
- externally rotate the hip
Gluteus minimus
- smallest of the three gluteus muscles
- the deepest of the three
- abduct hip = strongest action
Attachments of gluteus minimus
- proximal = posterior ilium
- distal = anterior greater trochanter (unlike the medius which spans the entire trochanter, hence less actions)
Innervation of gluteus minimus
- superior gluteal nerve
Actions of gluteus minimus
- abduct the hip
- internally rotate the hip
- flex the hip
Pectineus
- most proximal distal attachment (AKA shortest) of the adductors
- adduct hip = strongest action
Attachments of pectineus
- proximal = pubic bone
- distal = proximal aspect of medial femur
Innervation of pectineus
- femoral nerve
- obturator nerve
Adductor longus
- not the strongest adductor of the muscles that adduct the hip
- adduct hip = strongest action
Attachments of adductor longus
- proximal = pubic bone
- distal = mid shaft aspect of medial femur
Innervation of adductor longus
- obturator nerve
Adductor brevis
- deep to adductor longus and pectineus
- adduct hip = strongest action
Attachments of adductor brevis
- proximal = pubic bone
- distal = medial femur, between pectineus and longus (and deep to it)
Innervation of adductor brevis
- obturator nerve
Actions of pectineus, adductor longus, and adductor brevis
- adduct the hip
- internally rotate the hip
- flex the hip (assist)
- internally rotate the flexed knee
Adductor Magnus
- largest hip adductor
- adduct hip = strongest action
Attachments of adductor magnus
- proximal = pubic bone and ischium (these bones are oriented anterior/posterior, so the muscle makes a 90 degree turn to attach to its distal attachment)
- distal = medial shaft of femur
Innervation of adductor Magnus
- obturator nerve
- sciatic nerve
Actions of adductor magnus
- adduct the hip
- internally rotate the hip
- flex the hip (assist)
- internally rotate the flexed knee
Posterior fibers: - extend the hip
Gracilis
- longest (most fusiform) of all adductors
- fusiform = most ROM generated
- adduct hip = strongest action
- crosses the knee (moves it weakly though)
Attachments of gracilis
- proximal = pubic bone
- distal = proximal/medial tibia
Innervation of gracilis
- obturator nerve
Actions of gracilis
- adduct the hip
- internally rotate the hip
- flex the knee
- internally rotate the flexed knee
Piriformis
- most superior of hip ER muscles
- externally rotate hip = strongest action
- implicated in sciatica = old person disease (muscles get tight and the nerve gets pinched)
Attachments of piriformis
- proximal = sacrum
- distal = greater trochanter, superior aspect
Innervation of piriformis
- sacral plexus
Actions of piriformis
- externally rotate the hip
- abduct the hip when the hip is flexed
Obturator externus
- most anterior of hip external rotators
- externally rotate hip = strongest action
Attachments of obturator externus
- proximal = ischium and anterior pubic bone
- distal = trochanteric fossa of femur (the dip between the head and the greater trochanter)
**this muscle moves anterior to posterior which is why it externally rotates, not adducts nor internally rotates
Innervation of obturator externus
- obturator nerve
Actions of obturator externus
- externally rotate the hip
Obturator internus
- externally rotate hip = strongest action
Attachments of obturator internus
- proximal = inferior surface of obturator foramen
- distal = medial surface of greater trochanter of femur
Innervation of obturator internus
- sacral plexus
Actions of obturator internus
- externally rotate the hip
Gemelli
- consists of gemellus superior and gemellus inferior
- deep to obturator internus (obturator internus does attach to ischium too, just more medially)
- externally rotate hip = strongest action
Attachments of gemelli
- proximal = ischium
- distal = medial surface of greater trochanter
Innervation of gemelli
- sacral plexus
Actions of gemelli
- externally rotate the hip
Quadratus femoris
- like the other “quadratus”, it is broad and flat (like pronation quadratus and quadratus lumborum)
- is most inferior of ER muscles
Attachments of quadratus femorus
- proximal = pubic bone and ischium
- distal = trochanteric fossa of femur
Innervation of quadratus femorus
- sacral plexus
Actions of quadratus femorus
- externally rotate the hip
Open chain movement of iliopsoas
- flexing the knee like marching
Closed chain movement of iliopsoas
- flexing the trunk towards the thigh (squatting down)
- tilts pelvis anteriorly
Open chain movement in sagittal plane of gluteus maximus
- extend the hip
Closed chain movement in sagittal plane of gluteus maximus
- coming up from a squat
Open chain movement in frontal plane of gluteus medius and minimus and TFL to an extent
- abducts hip
Closed chain movement in frontal plane of gluteus medius and minimus and TFL to an extent
- elevates the opposite hip
- when standing on one leg, then dropping your opposite hip, that is gluteus medius not contracting and while still standing on that same leg, the gluteus medius contracts to elevate the hip to make pelvis level
Open chain in frontal plane in hip adductors
- adducts the hip
Closed chain movement in frontal plane of hip adductors
- elevates the same hip
Closed chain movement of hip internal rotation
- rotating the pelvis away from the body
Closed chain movement of hip external rotation
- rotating the pelvis towards the body