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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
