The hip, buttock and thigh part 2 Flashcards
What are the four compartments of this region
Gluteal compartment
Anterior compartment of the thigh
Medial compartment of the thigh
Posterior compartment of the thigh
What movements are the muscles of the gluteal region responsible for
Extension, abduction and external rotation of the
What are the gluteal muscles
Gluteus maximus
Gluteus medius
Gluteus minimus
(tensor fasciae latae – this is neurologically a gluteal muscle (innervated by superior gluteal nerve) but functionally it is more of an anterior compartment muscle)
What are the short external rotators of the hip (found in the gluteal region)
Piriformis
Obturator internus
Quadratus femoris
Gemelli (superior and inferior)
Describe the proximal and distal attachments of the gluteus maximus muscle
Proximal: Fascia covering gluteus medius, external surface of ilium behind posterior gluteal line, fascia of erector spinae, dorsal surface of lower sacrum, lateral margin of coccyx, external surface of sacrotuberous ligament
Distal: 75% iliotibial tract of fascia lata (posterior aspect) ; 25% gluteal tuberosity of proximal femur
Describe the function and innervation of the gluteus maximus muscle
Innervation: Inferior gluteal nerve (L5-S2)
Function: Powerful extensor of flexed femur at hip joint; lateral stabilizer of hip joint and knee joint; laterally rotates and abducts thigh
Describe the attachments of the gluteus medius muscle
Proximal: External ilium between anterior/posterior gluteal lines
Distal: Elongate facet on lateral greater trochanter
Crosses laterally over femur
Describe the innervation and function of the gluteus medius muscle
Innervation: Superior gluteal nerve (L4-S1)
Function: Abducts femur at hip joint; holds pelvis secure over stance leg and prevents pelvic drop on the opposite swing side during walking; medially rotates thigh
Describe the attachments of the gluteus minimus muscle
Proximal: External ilium between anterior/inferior gluteal lines
Distal: Linear facet on anterolateral greater trochanter
Crosses laterally over femur
Describe the innervation and function of the gluteus minimus muscle
Same as gluteus medius
Describe the attachments of the tensor fascia latae
Proximal: Lateral aspect of crest of ilium between anterior superior iliac spine and tubercle of the crest
Distal: Iliotibial tract of fascia lata
Describe the innervation and function of the tensor fascia latae
Innervation: Superior gluteal nerve (L4-S1)
Function: Stabilises the knee in extension.
Describe the attachments of the piriformis
Proximal: Anterior surface of sacrum between anterior sacral foramina
Distal: of sacrum between anterior sacral foramina
Medial side of superior border of greater trochanter of femur
Describe the innervation and functions of the piriformis
Innervation: Branches from S1 and S2
Function: Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
Describe the attachments of the obturator internus
Proximal: Anterolateral wall of true pelvis; deep surface of obturator membrane and surrounding bone (essentially the rim of the obturator foramen)
Distal: Medial side of greater trochanter of femur
Describe the innervation and function of the obturator internus
Innervation: Nerve to obturator internus (L5-S1)
Function: Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
Describe the attachments of the gemelli superior
Proximal: External surface of ischial spine
Distal: Along length of superior surface of the obturator internus tendon and into the medial side of greater trochanter of femur with obturator internus tendon
Describe the innervation and function of the gemelli superior
Same as obturator internus
Describe the attachments of the gemelli inferior
proximal: upper aspect of ischial tuberosity
distal: Along length of inferior surface of the obturator internus tendon and into the medial side of greater trochanter of femur with obturator internus tendon
Describe the innervation and function of the gemelli inferior
Innervation: Nerve to quadratus femoris (L5-S1)
Function: Laterally rotates the extended femur at hip joint; abducts flexed femur at hip joint
Describe the attachments of the quadratus femoris
Proximal: Lateral aspect of the ischium just anterior to the ischial tuberosity
Distal: Quadrate tubercle on intertrochanteric crest of the proximal femur
Describe the innervation and function of the quadratus femoris
Innervation: same as gemelli inferior
Function: Laterally rotates femur at hip joint
Why is the piriformis an important landmark
In addition to its action on the hip joint, the piriformis is an important landmark because it divides the greater sciatic foramen into two regions, one above and one below the piriformis. Vessels and nerves pass between the pelvis and gluteal region by passing through the greater sciatic foramen either above or below the piriformis.
What is a key function of the short external rotators of the hip
Deep muscles of gluteal compartment
Hold head of femur into acetabulum to stabilise the hip joint
Similar to the rotator cuff muscles.
Which compartment is the tensor fascia latae in
Neurologically it is more like a gluteal compartment muscle because it is innervated by the superior gluteal nerve
In terms of action, it is a flexor of the hip so it functions more like an anterior compartment muscle
Which muscles are in the anterior compartment of the thigh
Tensor fasciae latae Pectineus Ilio-psoas Sartorius Quadriceps (rectus femoris, vastus medialis, vastus intermedius, vastus lateralis)
What movements are the anterior muscles of the thigh responsible for
Hip Flexors and Knee Extensors
Describe the attachments of the psoas major muscle
Proximal: Posterior abdominal wall (lumbar transverse processes, intervertebral discs, and adjacent bodies from TXII to LV and tendinous arches between these points)
Distal: Lesser trochanter of femur
Describe the innervation and function of the psoas major muscle
Innervation: Anterior rami (L1-L3)
Function: Flexes the thigh at the hip joint
Describe the attachments of the iliacus
Proximal: Posterior abdominal wall (iliac fossa)
Distal: Lesser trochanter of femur
Describe the innervation and function of the iliacus
Innervation: Femoral nerve (L2-4)
Function; Flexor of the thigh at the hip joint
Describe the attachments of the vastus medialis
Proximal: Femur—medial part of intertrochanteric line, pectineal line, medial lip of the linea aspera, medial supracondylar line
Distal: Quadriceps femoris tendon and medial border of patella
Describe the attachments of the vastus intermedius
proximal: Femur—upper two-thirds of anterior and lateral surfaces
Distal: Quadriceps femoris tendon, lateral margin of patella, and lateral condyle of tibia
Describe the attachments of the vastus lateralis
proximal: Femur—lateral part of intertrochanteric line, margin of greater trochanter, lateral margin of gluteal tuberosity, lateral lip of the linea aspera
distal: Quadriceps femoris tendon and lateral margin of patella
Describe the attachments of the rectus femoris
proximal: Straight head: AIIS
Reflected head: ilium (superior to acetabulum)
distal: quadriceps femoris tendon
What are all the quadricep muscles innervated by
the femoral nerve (L2-L4)
What is the function for all the quadricep muscles except for the rectus femoris
To extend the leg at the knee joint
The rectus femoris also does this but also flexes the thigh at the hip joint.
Also stabilise the position of the patella during knee movement
Describe the attachments of the sartorius
Proximal: ASIS
Distal: Medial tibia just inferomedial to tibial tuberosity
Describe the innervation and function of the sartorius
Innervation: Femoral nerve (L2,L3)
Function: Flexes the thigh at the hip joint and flexes the leg at the knee joint
Also abducts the thigh and rotates it laterally, as when resting the foot on the opposite knee when sitting
What is the most powerful flexor of the hip and describe how this muscle is formed
Ilio-psoas
Psoas major attaches to the lateral parts of the lumbar vertebrae and T12 and Iliacus attaches to the iliac fossa and crest
The two muscles then come together to form a common tendon that attaches to the lesser trochanter
Pass under inguinal ligament along their course
Describe the arrangement of the quadriceps muscles
The two heads of the rectus femoris unite to form an elongate muscle belly, which lies anterior to the vastus intermedius muscle and between the vastus lateralis and vastus medialis muscles, to which it is attached on either side. At the distal end, the rectus femoris muscle converges on the quadriceps femoris tendon and inserts on the base of the patella
What is the patellar ligament
The patellar ligament is functionally the continuation of the quadriceps femoris tendon below the patella and is attached above to the apex and margins of the patella and below to the tibial tuberosity (Fig. 6.58). The more superficial fibers of the quadriceps femoris tendon and the patellar ligament are continuous over the anterior surface of the patella, and lateral and medial fibers are continuous with the ligament beside the margins of the patella.
What is the pes anserinus
The sartorius, gracilis, and semitendinosus muscles attach to the tibia in a three-pronged pattern on the tibia, so their combined tendons of insertion are often termed the pes anserinus (Latin for “goose foot”).
What does a tap on the patellar ligament with a tendon hammer test
Spinal reflex of L3 and L4 (femoral nerve)
Describe the articularis genus
A tiny muscle (articularis genus) originates from the femur just inferior to the origin of the vastus intermedius and inserts into the suprapatellar bursa associated with the knee joint (Fig. 6.58). This articular muscle, which is often part of the vastus intermedius muscle, pulls the bursa away from the knee joint during extension
Which is the only part of the quadriceps femoris that crosses the hip joint
The rectus femoris
What movement are the muscles in the medial compartment of the thigh responsible for
Adduction of the hip
What are the muscles of the medial compartment of the thigh
Obturator externus Gracilis Adductor brevis Adductor longus Adductor magnus
Describe the attachments of the gracilis
Proximal: A line on the external surfaces of the body of the pubis, the inferior pubic ramus, and the ramus of the ischium
Distal: Medial surface of proximal shaft of tibia
Describe the innervation and function of the gracilis
Innervation: Obturator nerve (L2,L3)
Function: Adducts thigh at hip joint and flexes leg at knee joint.
Describe the attachments of the obturator externus
Proximal: External surface of obturator membrane and adjacent bone
Distal: Trochanteric fossa
Describe the innervation and function of the obturator externus
Innervation: Obturator nerve (L3-4)- posterior division
Function: Laterally rotates thigh at hip joint
Describe the attachments of the adductor longus muscle and its innervation
Proximal; External surface of body of pubis (triangular depression inferior to pubic crest and lateral to pubic symphysis)
Distal: Linea aspera on middle one-third of shaft of femur
Innervation: Obturator nerve (L2-4)- anterior division
Describe the attachments of the adductor brevis muscle and its innervation
Proximal; External surface of body of pubis and inferior pubic ramus
Distal: Posterior surface of proximal femur and upper one-third of linea aspera
Innervation; Obturator nerve (L2,L3)
Describe the attachments of the adductor magnus
Proximal: Adductor part: ischiopubic ramus
Hamstring part: ischial tuberosity
Distal: Adductor part: Posterior surface of proximal femur, linea aspera, medial supracondylar line
Hamstring part: Adductor tubercle and supracondylar line
Innervation; Adductor part: Obturator nerve L2-L4)
Hamstring part: Sciatic nerve (tibial division) (L2, L3, L4)
What are the functions of the adductor brevis, longus and magnus muscles
Adduct the hip and medially rotate the thigh at the hip.
Describe the attachments of the pectineus (anterior compartment)
Proximal: Pectineal line (pecten pubis) and adjacent bone of pelvis
Distal: Oblique line extending from base of lesser trochanter to linea aspera on posterior surface of proximal femur
Describe the innervation and function of the pectineus
innervation: femoral nerve (L2,L3)
Function; Adducts and flexes thigh at hip joint.
What is the gracilis sandwiched between
The tendon of the sartorius in front
Tendon of semitendinosus behind
What does the pectineus pass under along its course
The inguinal ligament
What happens to the fibres of the adductor longus muscle as it descends posterolaterally
They expand
What is important to remember about the adductor brevis
It is a triangular muscle attached at its apex to the body of the pubis and inferior pubic ramus just superior to the origin of the gracilis muscle (Fig. 6.60). The muscle is attached by its expanded base via an aponeurosis to a vertical line extending from lateral to the insertion of the pectineus into the upper aspect of the linea aspera lateral to the attachment of the adductor longus.
Describe the adductor hiatus
A large circular gap inferiorly between the hamstring and adductor parts of the muscle is the adductor hiatus (Fig. 6.61), which allows the femoral artery and associated veins to pass between the adductor canal on the anteromedial aspect of the thigh and the popliteal fossa posterior to the knee.
What movements are the muscles in the posterior compartment of the thigh responsible for
Knee Flexors and Hip Extensors
“The Hamstrings”
Which muscles make up the posterior compartment of the thigh
Semitendinosus
Semimembranosus
Biceps femoris
Describe the attachments of the biceps femoris
Proximal: Long head—inferomedial part of the upper area of the ischial tuberosity; short head—lateral lip of linea aspera
Distal: Head of fibula
What is the function of the biceps femoris
Flexes leg at knee joint; extends and laterally rotates thigh at hip joint and laterally rotates leg at knee joint
Describe the attachments of the semitendinosus
proximal; inferomedial part of the upper area of the ischial tuberosity
distal; Medial surface of proximal tibia
Describe the attachments of the semimembranosus
Proximal: Superolateral impression on ischial tuberosity
Distal: Groove and adjacent bone on medial and posterior surface of medial tibial condyle
What are the functions of the semitendinosus and semimembranosus
Flexes leg at knee joint and extends thigh at hip joint; medially rotates thigh at hip joint and leg at knee joint
What are the posterior compartment muscles of the thigh all innervated by
Sciatic nerve (L5-S2)
What does the tendon of the biceps femoris blend with
Extensions from the tendon blend with the fibular collateral ligament and with ligaments associated with the lateral side of the knee joint.
When can the biceps femoris laterally rotate the leg at the knee joint
When the knee is partly flexed
What do expansions from the semimembranosus tendon contribute to
Expansions from the tendon also insert into and contribute to the formation of ligaments and fascia around the knee joint.
What is the distal attachment of the ilio-tibial tract
Gerdy tubercle (lateral side of proximal tibia)
