Anatomy: Hip Part 2 Flashcards
(43 cards)
Medial Compartment
- Separated from the anterior compartment by the medial IMS
- Separated from the poster compartment of the thigh by the fascial plane between the Adductor Magnus and the Hamstrings (no IMS intervenes)
- Muscular contents
Gateways into the lower limb: Obturator Canal
- Connects abdominopelvic region with medial thigh
- Obturator nerve and vessels
Gateways into the lower limb: Greater Sciatic Foramen
- Route for passage b/t pelvis and gluteal region
- Piriformis m.
- Superior gluteal n. and vessels above.
- Sciatic n., inf gluteal n. and vessels, pudendal, etc. below.
Gateways into the Lower Limb: Lesser Sciatic Foramen
-Connects gluteal region w/ perineum
Gateways into the Lower Limb: Gap between the Inguinal Ligament and the Pelvic Bone
- Route b/t abdomen and ant. thigh
- Psoas maj., Iliacus, Pectineus m.
- Femoral artery, vein, nerve
- Lymphatics
Femoral Triangle
- Superior=Inguinal Ligament
- Medial= Adductor Longus
- Lateral= Sartorius
Contents (lateral to medial):
-Femoral Nerve-Artery-Vein
Femoral Pulse
Palpation of Femoral Pulse
- Place patient supine in some hip flexion and external rotation. Palpate distal to inguinal ligament, in-between Adductor Longus and Sartorius
- Superficial Inguinal Lymph nodes here.
Adductor Canal
- Subsartorial Canal/Hunter’s Canal
- A músculo-fascial canal which descends medially down the thigh and posteriorly through the adductor hiatus to pass posterior into the knee region.
- Borders
- Posterior Wall
- Superiorly formed by the adductor Longus
- Inferiorly formed by the adductor magnus
- Lateral wall is Vastus Medialis
- Roof is formed by the sartorius
- Contents: Femoral Artery, vein and saphenous nerve.
- Posterior Wall
Adductor Hiatus
- An opening in the tendon of insertion of the adductor magnus muscle.
- Boundaries
- Medial-portion of the tendon of adductor magnus that attaches to the adductor tubercle.
- Later- Insertion of the adductor magnus into the linea aspera
- Inferior- Femur
- Contents: femoral artery and vein, which then turns in to popliteal artery and vein.
Muscular Patterns
- Muscles of the hip/thigh can be grouped based on innervation
- Peripheral nerve patterns
- Root level patterns
- Muscles of the hip/thigh can be grouped based on function
- Action on the hip
- Action on the knee
- Muscles of the hip/thigh can be grouped on location
- Compartment
- Location with respect to the joints.
Muscles of Hip Flexion
- Psoas Major
- Iliacus
- Rectus Femoris
- Sartorius
- TFL
- Psoas Minor-secondary
- Adductor Longus
- Pectineus- secondary
Iliacus and psoas become the iliopsoas
Psoas Major
- PA: TPs, Vertebral Bodies and Adjoining discs of T12-L5
- DA: Lesser Trochanter
- Innervation: Ventral Rami L1-L3(4)
- Actions: hip flexion, Hip ER, Trunk Ipsilateral SB, Spinal Flexion during Sit-ups, Spinal Stabilzation
Iliacus
- PA: superior 2/3 of iliac fossa; Anterior SI Ligaments
- DA: Lesser Trochanter of Femur
- Innervation: Femoral nerve L2-L3
- Actions: Flexes Hip, externally rotates the flexed hip
Rectus Femoris
- PA: Straight Head-AIIS; Reflected Head- groove on ilium superior to acetabulum, fibrous capsule of hip joint
- DA: Patella by quadriceps tendon, tibial tuberosity by patellar tendon (ligament)
- Action: extends the knee and flexes the hip
- Innervation: Femoral Nerve L2,3,4
-Unique Feature: two joint muscle
Sartorius (Tailor’s Muscles)
- PA: ASIS
- DA: Proximal medial surface of tibia at pes anserine
- Innervation: Femoral Nerve L2-3
- Actions: Flex, ER and Abduct the hip; Flex and IR knee (more so of the Tibia)
- Muscles that meet at the Pes Anserine:
- Sartorius
- Gracilis
- Semitendinosus
Tensor Fascia Latae
- PA: Anterior Iliac Crest, Lateral Surface of ASIS, and a portion of the border of the notch below it.
- DA: Iliotibial Band (ITB) and hence to the lateral tibial condyle at Gerdy’s Tubercle of tibia
- Actions: Extends and Laterally rotates the knee; flexes, abducts and internally rotates the hip
- Innervation: Superior Gluteal Nerve L4,5, S1
Unique Features: considered part of gluteal region, ITB is a very thick tissue
Muscles of Hip Extension
- Gluteus Maximus
- Hamstrings
- Semitendinosus
- Semimembranosus
- Biceps Femoris
- Adductor Magnus
Gluteus Maximus
- PA: Posterior gluteal line of ilium, posterior sacrum, sacrotuberous ligament
- DA: Gluteal tuberosity of femur and ITB
- Innervation: Inferior Gluteal Nerve (L5,S1,S2)
- Actions: Hip Extension, ABD, and ER; assists in stabilization of knee through action of ITB
Biceps Femoris
- PA: Long Head-Upper Ischial Tuberosity; Short Head-Lateral lip of linea aspera inferior to gluteus maximus attachment, proximal 1/2 of lateral supracondylar line
- DA: Fibular Head, LCL of knee, Lateral Tibial Condyle
- Actions: Flexes knee, extends hip, secondarily laterally rotates hip and knee
- Innervation: Long Head-Tibial division of sciatic L5, S1-2; Short Head- Common peroneal division of sciatic L5, S1-2
Unique Features: 2 heads, shares proximal tendon with semitendinosus
Semitendinosus
- PA: Inferomedial aspect of Ischial Tuberosity
- DA: Medial aspect of proximal tibia at pes anserine
- Actions: Flexes knee, extends hip, secondarily medially rotates hip and knee
- Innervation: Tibial division of sciatic nerve L5, S1-2
Unique Features: Named in reference to its long tendon, shares proximal tendon with biceps femoris, forms posterior most portion of pes anserine.
Semimembranosus
- PA: Superolateral aspect of ischial tuberosity
- DA: Posterior Aspect of medial tibial condyle
- Actions: Flexes knee, extends hip, secondarily IR hip and knee
- InnervationL Tibial division of sciatic nerve L5, S1-S2
Unique Features: Name in reference to its membranous PA
Adductor Magnus
- PA: Inferior ramus of pubis, inferior ramus of ischium, and ischial tuberosity
- DA: linea Aspera, medial suprcondylar line and adductor tubercle
- InnervationL Obturator and tibial division of sciatic, L2-L4
- Actions: Hip adduction and extension
- Largest and deepest of the adductor muscles
- Palpate while patient is laying prone
Muscles of Hip Adduction
- Adductor Magnus
- Adductor Longus
- Adductor Brevis
- Pectineus
- Gracilis
Adductor Longus
- PA: Anterior Pubic Body
- DA: middle 1/3 of medial lip of line aspera
- Innervation: Obturator nerve, L2-L4
- Actions: hip adduction and flexion
- Medial Compartment