Hip (Iliofemoral) Joint

PTA Students Curtis, Tonya, Emilee, & Zeke

Bones

Them Bones…..

…Of the iliofemoral joint.And one extra.

Bones

Os Coax: The Pelvic Trifecta

Bones

Medial View

Bones

Lateral View, with a side of landmarks

Bones

Find the Angry Bird

Bones

The Femur: Foreplay for cave men

BonesTibia- Not part of the hip, but it was on the list, so here goes….

Ligaments

Iliofemoral ligament Pubofemoral ligament

Ligaments

Ischiofemoral ligament

Ligaments

Sacrotuberous ligament

Ligaments & Cartilage

Transverse acetabular ligament Acetubular labrum Articular cartilage of head of femur Ligament of head of femur

Articular Capsule

Synovial membrane Fibrous layer

Ligaments

Zona orbicularis

Bursae

Trochanteric bursa Deep Superficial

Bursae

Gluteofemoral bursa Ischial Bursa

MusclesAnterior Compartment Thigh Muscles

Pectineus Innervation:

Femoral Nerve, also fibers from obturator nerve Origin:

Superior Ramus of Pubis Insertion:

Pectineal line inferior to lesser trochanter of femur Action:

Flexes, adducts and assists with medial rotation Synergist:

Flexion = Rectus Femoris and Iliopsoas Adduction = Adductors (all 3) and gracilis Medial Rotation = Gluteus Minimus

Antagonist: Extension = Gluteus Maximus, Semimembranosus,

Semitendinosus, and Biceps Femoris Abduction = Gluteus Medius and Minimus Lateral Rotation = Gluteus Maximus

MusclesAnterior Compartment Thigh Muscles

Sartorius Innervation:

Femoral Nerve Origin:

Anterior superior iliac spine Insertion:

Upper medial surface of body of tibia Action:

Flexes knee Flexes, abducts and laterally rotates hip

Synergist: Knee Flexion = Semimembranosus, Semitendinosus & Biceps

Femoris Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Hip Abduction = Gluteus Medius and Minimus

Antagonist Knee Extension = Quadriceps muscles Hip Extension = Gluteus maximus, Semimembranosus,

Semitendinosus & Biceps Femoris Hip Adduction = Adductors (all 3), Pectineus & Gracilis

MusclesAnterior Compartment Thigh Muscles

IliopsoasPsoas Major & Iliacus

Innervation: Lumbar Nerves Femoral Nerves

Origin: Transverse Process of T12-L5 Iliac Crest, Iliac Fossa, Anterior Sacroiliac Ligament

Insertion: Lesser Trochanter

Action: Hip/Thigh Flexion

Synergist: Hip Flexion = Rectus Femoris & Pectineus

Antagonist: Hip Extension = Gluteus Maximus, Semimembranosus, Semitendinosus

& Biceps Femoris

MusclesAnterior Compartment Thigh Muscles Quadriceps Femoris: Rectus Femoris Innervation:

Femoral Nerve Origin:

Anterior inferior iliac spine Insertion:

Patella via quadriceps tendon and then tibial tuberosity via patellar ligament

Action: Knee Extension and Hip Flexion

Synergist: Knee Extension = Vastus Medialis, Intermedialis & Lateralis Hip Flexion = Iliopsoas & Pectineus

Antagonist: Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris Hip Extension = Gluteus Maximus, Semimembranosus, Semitendinosus

& Biceps Femoris

MusclesAnterior Compartment Thigh Muscles

Quadriceps Femoris: Vastus Medialis Innervation:

Femoral Nerve Origin:

Linea Aspera of the femur Insertion:

Patella via the quadriceps tendon and then tibial tuberosity via the patellar ligament

Action: Knee Extension

Synergist: Knee Extension = Rectus Femoris, Vasus Lateralis and Intermedius

Antagonist: Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris

MusclesAnterior Compartment Thigh Muscles

Quadriceps Femoris: Vastus Lateralis Innervation:

Femoral Nerve Origin:

Intertrochanteric line and linea aspera of the femur Insertion:

Patella via the quadriceps tendon and then tibial tuberosity via the patellar ligament

Action: Knee Extension

Synergist: Knee Extension = Rectus Femoris, Vastus medialis and

intermedialis Antagonist:

Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris

MusclesAnterior Compartment Thigh Muscles

Quadriceps Femoris: Vastus Intermedius Innervation

Femoral Nerve Origin

Anterior 2/3 and lateral shaft of femur Insertion

Patella via quadriceps tendon and then tibial tuberosity via patellar ligament

Action Knee Extension

Synergist Knee Extension = Rectus Femoris, Vastus Lateralis and Medialis

Antagonist Knee Flexion = Semimembranosus, Semitendinosus & Biceps

Femoris

MusclesMedial Thigh Muscles

Adductor Brevis Innervation:

Obturator Nerve Origin

Anterior surface of the inferior ramus of the pubis Insertion

Superior half of linea aspera of femur Action

Adducts, flexes and helps to laterally rotate the hip Syngerist

Hip Adduction = Adductors longus and magnus, Gracilis & Pectineus Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Lateral Rotation = Gluteus Maximus

Antagonist Hip Abduction = Gluteus medius and minimus Hip Extension = Gluteus maximus, Semimembranosus, Semitendinosus

& Biceps Femoris Medial Rotation = Gluteus Minimus

MusclesMedial Thigh Muscles

Adductor Longus Innervation:

Obturator Nerve Origin:

Body of pubis inferior to pubic crest and lateral pubic symphysis Insertion:

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

Adducts, flexes & laterally rotates the hip Synergist:

Hip Adduction = Adductors longus and magnus, Gracilis & Pectineus Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Lateral Rotation = Gluteus Maximus

Antagonist: Hip Abduction = Gluteus medius and minimus Hip Extension = Gluteus maximus, Semimembranosus, Semitendinosus

& Biceps Femoris Medial Rotation = Gluteus Minimus

MusclesMedial Thigh Muscles

Adductor Magnus Innervation:

Obturator and Tibial Nerves Origin:

Inferior ramus of pubis and ischium to ischial tuberosity Insertion:

Linea aspera of the femur and medial supracondylar line Action:

Adducts thigh, superior horizontal fibers flex the thigh and posterior portion extends thigh at hip joint

Syngerist: Hip Adduction = Adductors longus and brevis, Gracilis &

Pectineus Hip Flexion = Rectus femorus, Iliopsoas & Pectineus

Antagonist: Hip Abduction = Gluteus medius and minimus Hip Extension = Gluteus Maximus, Semimembranosus,

Semitendinosus & Biceps Femoris

MusclesMedial Thigh Muscles

Gracilis Innervation:

Obturator Nerve Origin:

Body and inferior ramus of pubis Insertion:

Anterior medial proximal tibis Action:

Adducts and medial rotates hip Knee Flexion

Synergist: Hip Adduction = Adductors Brevis, Longus & Magnus, Pectineus Medial rotation of hip = Gluteus Minimus Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris

Antagonist: Hip Abduction = Gluteus Medius and Minimus Lateral rotation of hip = Gluteus Maximus Knee Extension = Rectus Femoris & Vastus medialis, lateralis &

intermedius

MusclesGluteal Region

Tensor Fasciae Latae Innervation:

Superior Gluteal Nerve Origin:

Anterior superior iliac spine and anterior iliac crest Insertion:

Tibia by way of the iliotibial tract Action:

Flexes and abducts the thigh at the hip joint and helps to stabilize and stead the hip and knee joints by putting tension on the iliotibial band of fascia

Synergist: Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Hip Abduction = Gluteus medius and minimus

Antagonist: Hip Extension = Gluteus Maximus, Semimembranosus, Semitendinosus

& Biceps Femoris Hip Adduction = All 3 Adductors, Gracilis & Pectineus

MusclesGluteal Region

Gluteus Maximus Innervation:

Inferior Gluteal Nerve Origin:

Iliac crest, Sacrum, Coccyx & Aponeurosis of Sacrospinalis Insertion:

Iliotibial tract of fascia lata and lateral part of linea aspera under greater trochanter (gluteal tuberosity) of the femur

Action: Extends the thigh at the hip and laterally rotates thigh – middle fibers

abduct the hip Synergist:

Hip Extension = Semimembranosus, Semitendinosus & Biceps Femoris Hip Abduction = Gluteus medius and minimus

Antagonist: Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Hip Adduction = Adductors longus and brevis, Gracilis & Pectineus Medial Rotation of Hip = Gluteus Minimus

MusclesGluteal Region

Gluteus Medius Innervation:

Superior Gluteal Nerve Origin:

Dorsal ilium inferior to the iliac crest Insertion:

Greater Trochanter of the Femur Action:

Abducts and medially rotates the hip Synergist:

Gluteus Minimus (for both) Antagonist:

Hip Adduction = All 3 Adductors, Gracilis & Pectineus Lateral Rotation of the Hip = Gluteus Maximus

MusclesGluteal Region

Gluteus Minimus Innervation:

Superior Gluteal Nerve Origin:

Dorsal Ilium between inferior and anterior gluteal lines Insertion:

Greater trochanter of the femur Action:

Abducts and medially rotates the hip Synergist:

Gluteus Medius (for both) Antagonist:

Hip Adduction = All 3 Adductors, Gracilis & Pectineus Lateral Rotation of the Hip = Gluteus Maximus

MusclesGluteal Region

Piriformis Innervation:

Piriformis Nerve 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 the greater trochanter

Action: Laterally rotates and abducts the thigh at the hip joint

Synergist: Hip Abduction = Gluteus medius and minimus Lateral Rotation of Hip = Gluteus Maximus

Antagonist: Hip Adduction = All 3 Adductors, Gracilis & Pectineus Medial Rotation of Hip = Gluteus medius and minimus

MusclesPosterior Thigh Muscles

Biceps Femoris Innervation:

Tibial Nerve Origin:

Long Head: Ischial Tuberosity Short Head: Linea aspera of the femur

Insertion: Head of fibula and lateral condyle of the tibia

Action: Long Head: Extends hip and flexes knee Short Head: Flexes knee and laterally rotates hip

Synergist: Hip Extension = Gluteus Maximus Extension of Hip and Flexion of Knee = Semitendinosus and

semimembranosus Lateral Rotation of Hip = Gluteus Maximus

Antagonist: Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Knee Flexion = Vastus (lateralis, medialis & intermedialis) Medial Rotation = Gluteus Minimus

MusclesPosterior Thigh Muscles

Semitendinosus Innervation:

Tibial Nerve Origin:

Ischial Tuberosity Insertion:

Proximal part of medial surface of shaft Action:

Knee Flexion Extends and medially rotates hip

Synergist: Knee Flexion = Biceps Femoris, Semimembranosus Hip Extension = Gluteus Maximus, Biceps Femoris & Semimembranosus Medial Rotation of Hip = Gluteus Minimus

Antagonist: Knee Extension = Rectus Femoris, Vastus (medialis, lateralis &

intermdialis) Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Lateral Rotation of Hip = Gluteus Maximus

MusclesPosterior Thigh Muscles

Semimembranosus Innervation:

Tibial Nerve Origin:

Ischial Tuberosity Insertion:

Posterior medial condyle of tibia Action:

Knee Flexion Extends and medially rotates the hip

Synergist: Knee Flexion = Biceps femoris & Semitendinosus Medial Rotation = Gluteus minimus

Antagonist: Knee Extension = Rectus Femoris & Vastus (medialis, lateralis &

intermedialis) Lateral Rotation of Hip = Gluteus maximus

Nerves

Femoral Nerve Obturator Nerve

Nerves

Sciatic Nerve

Superior Gluteal nerve

Inferior gluteal nerve

Common peroneal nerve

Arteries

Femoral artery

Lateral circumflex artery Obturator artery

Deep femoral (Profunda) artery

Arteries

Superior Gluteal Artery

Inferior Gluteal Artery

Veins

Femoral Vein

Profunda (Deep Femoral) Vein

Great Saphenous Vein

Surface Anatomy

-Gluteal fold/Gluteal Sulcus

-Sacrum

-Posterior superior iliac spine

-Tip of Greater trochanter -Intergluteal cleft

-Iliac crest

Surface Anatomy

-Supracristal plane

-Anterior superior iliac spine

-Inguinal ligament

Clinical Concern – Piriformis Syndrome

Piriformis Syndrome-is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the Piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg.