The Hip (Iliofemoral) Joint Heather Friedland, Liz Huisman, Josh McCoy

The Hip (Iliofemoral) Joint

Heather Friedland, Liz Huisman, Josh McCoy

Surface Anatomy

Iliac Crest? Iliac Crest! (and Inguinal Ligament)

Josh McCoy

Surface Anatomy, continued• Gluteal Fold/Sulcus• Intergluteal Cleft• Sacrum• Iliac Crest

Josh McCoy

Surface Anatomy, continued• Anterior Superior Iliac

Spine• Iliac Crest• Tip of Greater Trochanter

Josh McCoy

Surface Anatomy, continued

Posterior Superior Iliac Spine

Josh McCoy

Surface Anatomy, continued

Supracristal Plane • Inguinal LigamentJosh McCoy

The Hip Joint

Liz Huisman

Iliofemoral Ligament (red)Prevents hyperextension

Pubofemoral Ligament (green)

Prevents overabduction.

Liz Huisman

Ishiofemoral ligament

Slackens during adduction, tenses during abduction

Liz Huisman

Ligaments that support walking

Sacrotuberous ligament

Inguinal ligament

Liz Huisman

posterior anterior

Bursae

Trochanteric bursa

Gluteofemoral bursa

Ischial bursa

Liz Huisman

Bones of the Hip Joint

Heather Friedland

Os Coxa

Pubis Inferior ramus Acetabulum Ischial tuberosity Iliac fossa Lesser sciatic notch Superior pubic ramus Pubic (or suprapubic) arch Obturator foramen

Superior ramus Obturator foramen Ischium Iliac crest Ischial spine Symphysis pubis Inferior pubic ramus Pubic crest Greater sciatic notch

Heather Friedland

Click to add text

Heather Friedland

Iliac Spines

Anterior superior Anterior Inferior Posterior superior Posterior inferior

Heather Friedland

Femur

Head Neck Greater Trochanter Lesser Trochanter Linea Aspera Pectineal line Adductor tuberacle Condyles (medial and

lateral) Epicondyles (medial and

lateral)

Heather Friedland

Bones: Tibia

Lateral and Medial Condyles Intercondylar Eminence Tibial Tuberosity Crest

Josh McCoy

Muscles of the Hamstrings

Heather Friedland A&P 10611/18/2015

Muscles

• Semitendinosus• Semimembranosus• Gracilis• Pectinius• Biceps Femoris• Piriformis

Heather Friedland

Semitendinosus Nerve: Tibial Nerve Roots: L5, S1 & S2 Origin: Ischial tuberosity Insertion: Proximal medial shaft of the tibia

at Pes Anserinus tendon

Heather Friedland

Semitendinosus

Synergist: Knee Flexion: Biceps femoris, Semimembranosus, gracilis, sartorius,

gastrocnemius, popliteus Hip extension: Gluteus Maximus, Biceps femoris, semimembranosus Medial rotation: semimembranosus, gracilus, Sartorius, popliteus,

Semimembranosus Antagonist: Knee extension: Rectus femoris, Vastus (medialis, lateralis, and intermedialis) Hip Flexion: Rectus femoris, iliopsoas, pectineus, Sartorius Lateral rotation: Biceps femoris Action: Flexes knee. Medially rotates knee. Extends the knee

Heather Friedland

Semimembranosus

Heather Friedland

Semimembranosus

Nerve: Tibial Nerve Roots: L5, S1 & S2 Origin: Ischial tuberosity Insertion: Posterior medial condyle of the tibia Synergist: Same as Semitendinosis Antagonist: Same as Semitendinosis Action: Flexes knee. Medially rotates flexed knee and extends the hip

Heather Friedland

Gracilis

Nerve: Obturator nerve Roots: L2 and L3 Origin: Body and inferior ramus of pubis Insertion: Anterior medial proximal tibia

Heather Friedland

Gracilis

Synergist: Adduction: Adductor(magnus, brevis, and longus), Gracilis, pectineus Medial rotation: Gluteus (medius and minimus), adductor (all 3), Pectinius, TFL,

Gracilis Knee flexion: Semimembranosus, Semiteninosis, biceps femoris, gracilis,

gastrocnemius, Popliteus, Sartorius Antagonist:

Abduction: Gluteus (maximus, medius, and minimus), TFL, Sartorius Lateral Rotation: Gluteus maximus, Sartorius, piriformis, iliopsoas Knee extension: Rectus femoris, Vastus (medialis, lateralis, and intermedialis)

Action: Adducts and medially rotates hip. Flexes the knee

Heather Friedland

Pectineus

Heather Friedland

Pectinius

Nerve: Femoral Nerve, also fibers from the Obturator nerve Roots: L2 - L4 Origin: Superior ramus of the pubis Insertion: Pectineal line inferior to lesser trochanter of femur

Heather Friedland

Pectineus

Synergist: Flexion: Rectus femoris, Iliopsoas, TFL, Sartorius, Adductor (longus & brevis)

Adduction: Adductor (longus, brevis, and magnus), Gracilis, Pectineus Medial rotation: Gluteus(medius & minimus), Adductor (longus and brevis),

Gracilis Antagonist: Extension: Gluteus maximus, Semimembranosus, Semitendinosis, Biceps femoris,

Adductor magnus Abduction: Gluteus(medius and minimus), TFL, Sartorius Lateral Rotation: Gluteus maximus, Piriformis, Sartorius

Action: Flexes, adducts, and assists with medial rotation of the hipHeather Friedland

Biceps Femoris

Heather Friedland

Biceps Femoris

Nerve: Tibial nerve (LH) and Fibular nerve (SH) Roots: L5, S1 & S2 Origin: Long head: Ischial tuberosity

Short Head: Linea aspera of femur Insertion: Head of fibula and lateral condyle of tibia

Heather Friedland

Biceps Femoris Synergist: Hip Extension: Gluteus maximus, Semitendinosis, Semimembranosis, Adductor

Lateral Rotation: Gluteus Maximus, Piriformis, Iliopsoas, Sartorius Knee Flexion: Semitendinosis, Semimembranosis, Gastrocnemius, Gracilis, Sartorius

Antagonist: Hip Flexion: Rectus femoris, Iliopsoas, Pectinus, TFL, Sartorius

Medial Rotation: Gluteus(medius and minimus), TFL, Adductor (magnus, longus, and brevis), pectineus, Gracilis

Knee Extension: Vastus (medialis, lateralis, and intermedialis), Rectus femoris Action: Long head: Extends hip and flexes knee

Short Head: Flexes knee and laterally rotates hip Laterally rotates flexed knee Heather Friedland

Piriformis

Heather Friedland

Piriformis

Nerve: Piriformis Nerve Roots: L5, S1 & S2 Origin: Anterior Surface of lateral process of sacrum and gluteal

surface of ilium at the margin of the greater sciatic notch Insertion: Superior border of greater trochanter

Heather Friedland

Piriformis

Synergist: Abduction: Gluteus (medius, minimus), TFL, Sartorius

Lateral rotation: Gluteus maximus, Iliopsoas, piriformis, Sartorius Medial rotation: Glutues (minimus, medius), TFL, Adductor (all 3), Gracilis

Antagonist: Adduction: adductors (all 3), Gracilis, Pectinius, Gluteus maximus

Medial rotation: Gluteus (Minimus and medius), TFL, Adductor (all 3), Pectinius, Gracilis

Action: Laterally rotates and abducts thigh when hip is flexed

Heather Friedland

Adductors Brevis & Longus

Actions:

AdductionFlexionAssists in medial hip rotation

Liz Huisman

Adductors Brevis

Origin:Anterior surface of the inferior ramus of the pubis

Insertion:Pectineal line, medial lip of linea aspera of femur.

Nerve:Obturator nerve

Roots:L2-L4

Liz Huisman

Synergists

Adduction:Adductor (longus & magnus), gracilis, pectineusMedial Rotation:Gluteus (minimus & medius), adductor (longus & magnus), pectineus, tensor fascaie latae, gracilicFlexion:Rectus femoris, Iliopsoas, pectineus, TFL, sartorius

Antagonists

Abduction:Gluteus (all 3), TFL, Sartorius

Lateral Rotation: Gluteus maximus, Sartorius, piriformis, IliopsoasExtension:Gluteus maximus, semimembgranosus, semitendinosus, biceps femoris, adductor magnus

Adductor Brevis

Liz Huisman

Adductor longus

Origin:Body of pubis inferior to pubic crest & lateral pubic symphysis.

Insertion:Middle 1/3 of linea aspera of the femur

Nerve: Obturator nerve

Roots:L2-L4

Liz Huisman

Synergists

Adduction:Adductors (brevis & magnus), gracilis, pectineusMedial Rotation:Gluteus (minimus &medius), adductor (brevis & magnus), pectineus, TFL, gracilisFlexion:Rectus femoris, Iliopsoas, pectineus, TFL, sartorius

Antagonists

Abduction:Gluteus (all 3), TFL, Sartorius

Lateral Rotation:Gluteus maximus, Sartorius, piriformis, IliopsoasExtension:Gluteus maximus, semimembranosus, semitendinosus, biceps femoris, adductor magnus

Adductor Longus

Liz Huisman

Adductor MagnusOrigin:Inferior ramus of pubis and ischium to ischial tuberosity.Insertion:Linea aspera of femur. Medial supracondylar line and adductor tubercle.Nerve:Obturator and tibial nerveRoots:L2-L4

Actions: Adducts thigh, superior horizontal fibers flexes thigh, posterior portion extends thigh at hip joint

Liz Huisman

Synergists

Adduction:Adductor (longus & brevis), gracilis, pectineus

Hip Flexion: Rectus femorus, Iliopsoas, pectineus, TFL, gluteus (medius & minimus), adductor (longus & brevis)

Antagonists

Abduction:Gluteus (all 3), TFL, Sartorius

Hip Extension:Gluteus maximus, semimembranosus, semitendinosus, biceps femoris

Adductor Magnus

Liz Huisman

The Glutes

Actions

Gluteus medius & minimusHip abductionMedial rotation of hip

Gluteus maximusExtends the hip

Liz Huisman

Origin:Dorsal ilium between inferior and anterior gluteal linesInsertion:Greater trochanter of femurNerve:Superior gluteal nerveRoots:L4 & L5, S1

Gluteus Minimus

Liz Huisman

Synergists

Abduction:Gluteus medius, tensor fasciae latae, Sartorius

Medial Rotation:Gluteus medius, tensor fasciae latae, Adductor (all 3)

Antagonists

Adduction:Adductors (all3), gracilis, pectineus, gluteus maximus

Lateral Rotation: Gluteus maximus, piriformis, iliopsoas, sartorius

Gluteus Minimus

Liz Huisman

Origin:Dorsal ilium inferior to iliac crestInsertion:Greater trochanter of femurNerve:Superior Gluteal nerveRoots:L4 & L5, S1

Gluteus Medius

Liz Huisman

Synergists

Abduction:Gluteus (maximus & minimus), tensor fasciae latae, Sartorius

Medial Rotation:Gluteus minimus, tensor fasciae latae, adductors (all 3), pectineus, gracilis

Antagonists

Adduction:Adductors (all 3), gracilis, pectineus

Lateral Rotation:Gluteus maximus, piriformis, iliopsoas, sartorius

Gluteus Medius

Liz Huisman

Origin:Iliac crest, sacrum, coccyx and aponeurosis of sacrospinalisInsertion:Lateral part of linea aspera under greater trochanter (gluteal tuberosity) of femurNerve:Inferior gluteal nerveRoots:L5, S1 & S2

Gluteus Maximus

Liz Huisman

Synergists

Extension:Semimembranosus, semitendinosus, biceps femoris, adductor magnus

Lateral Rotation:Piriformis, iliopsoas, sartorius

Antagonists

Flexion:Gluteus (medius & minimus), rectus femoris, iliopsoas, pectineus, TFL, Sartorius

Medial Rotation:Gluteus (medius & minimus), TFL, adductors (all 3), pectineus, gracilis

Gluteus Maximus

Liz Huisman

Psoas Major (of Iliopsoas)

Action: Hip/Thigh Flexion Origin: Transverse Processes of T12-L5 Insertion: Lesser Trochanter Nerve: Lumbar Nerves (L1-L3)

Josh McCoy

Iliacus (of Iliopsoas)

Action: Hip/Thigh Flexion Origin: Iliac Crest, Fossa,

Anterior Sacroiliac Ligament Insertion: Lesser Trochanter Synergist (Iliopsoas): Rectus

Femoris, Pectineus Antagonist (Iliopsoas): Gluteus

Maximus, Semimembranosus, Semitendinosus, Biceps Femoris

Josh McCoy

Rectus Femoris

• Action: Extension at Knee, Flexion at Hip• Origin: Anterior Inferior Iliac Spine• Insertion: Patella via Quadriceps Tendon

and then Tibial Tuberosity via Patellar Ligament

• Nerve: Femoral• Roots: L2-L4

Josh McCoy

Rectus Femoris, continued

Synergist: Hip Flexion: Iliopsoas (Psoas Major and Iliacus), Pectineus Knee Extension: Vastus (Medialis, Lateralis, and Intermedialis)

Antagonist: Hip Extension: Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps

Femoris Knee Flexion: Semimembranosus, Semitendinosus, Biceps Femoris

Josh McCoy

Sartorius

Action: Flexes Knee; Flexes, Abducts, and Laterally Rotates Hip

Origin: Anterior Iliac Spine Insertion: Upper Medial Surface of Body of Tibia Nerve: Femoral Roots: L2-L3

Josh McCoy

Sartorius, continued

Synergist: Hip Flexion: Rectus Femoris, Iliopsoas, Pectineus Knee Flexion: Semimembranosus, Semitendinosus, Biceps Femoris Hip Abduction: Gluteus Minimis and Medius

Antagonist: Hip Extension: Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps Femoris Knee Extension: Quadriceps Muscles Hip Adduction: Adductor (Longus, Brevis, and Magnus), Pectineus, Gracillis

Josh McCoy

Tensor Fascia Latae (TFL)

Action: Flexes and Abducts Thigh at Hip Joint; Helps stabilize and steady the Hip and Knee Joints by putting tension on the Iliotibial Band of Fascia

Origin: Anterior Superior Iliac Spine and Anterior Iliac Crest

Insertion: Tibia by way of Iliotibial Tract

Josh McCoy

Tensor Fascia Latae (TFL), continued

Nerve: Superior Gluteal Nerve Roots: L4, L5, S1 Synergist: Flexion: Rectus Femoris, Iliopsoas, Pectineus Abduction: Gluteus Medius and Minimis

Antagonist: Extension: Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps Femoris Adduction: Gracillis, Pectineus, Adductors (All Three)

Josh McCoy

Nerves

Superior and Inferior Gluteal, SciaticObturator and FemoralJosh McCoy

More Nerves (are we getting on yours yet?)Common Peroneal

Josh McCoy

What are Pirate’s favorite vessels? ARRRRteries! Har har har• Femoral

• Deep Femoral (Profundus)

• Obturator

• Medial Circumflex Femoral

• Lateral Circumflex Femoral

Josh McCoy

Posterior Arteries

Superior Gluteal Inferior Gluteal

Josh McCoy

You’re so VEIN, you probably think this slide is about you! Don’t you, don’t you?

Femoral Great Saphenous Profunda (Deep) Femoral

Josh McCoy

Clinical Concerns: Total Hip Replacement

Josh McCoy

Clinical Concerns: Total Hip Replacement, continued

According to www.medicinenet.com, “A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. The normal hip joint is a ball and socket joint. The socket is a ‘cup-shaped’ component of the pelvis called the acetabulum.”

Josh McCoy