Thighs

Question 1

Iliopsoas

Answer 1

Proximal: Iliac fossa, T12-L5 spinous & transverse processes

Distal: Lesser trochanter

Innervation: Iliacus: Femoral nerve (L1-L4), Psoas major: Lumbar plexus (L1-L4)

actions: Bilateral contraction: flexes hip and anteriorly tilts pelvis
Unilateral contraction: hitches hip

Palpation: Palpate slightly proximal to the bottom of the navel, behind iliac crest. Get patient to extend and lift leg to feel the contraction as you gently dig into the muscle attachment site.

Give resistance.

Question 2

Rectus femoris

Answer 2

Proximal: AIIS

Distal: Base of patella, tibial tuberosity

Innervation: Femoral nerve (L2-L4)

actions: hip: flexes
Knee: extends

Palpation: Palpate near AIIS. Get patient to flex hip and extend knee.
Want to show more muscles, turn the leg outwards

Question 3

Vastus lateralis

Answer 3

Proximal: Greater trochanter

Distal: Lateral border of patella and tibial tuberosity via patellar ligament

Innervation: Femoral nerve (L2-L4)

actions: extends knee

Palpation: contract thigh muscles

Question 4

Vastus medialis

Answer 4

Proximal: Medial and posterior aspects of the femur, as high up as the
intertrochanteric line and as far posterior as the linea aspera

Distal: Medial border of patella and tibial tuberosity via patellar ligament

Innervation: Femoral nerve (L2-L4)

actions: extends knee

Stabilize patella

Palpation: contract thigh muscles

Question 5

Sartorius

Answer 5

Proximal: ASIS

Distal: Medial tibia

Innervation: Femoral nerve (L2-L3)

actions:
hip: flexes, abducts and lateral rotates
Knee: flexes and medial rotates

Palpation: palpate ASIS. Cradle patient’s lower leg. Instruct patient to slide heel along the shin

Question 6

Tensor fascia latae

Answer 6

Proximal: Iliac crest, ASIS

Distal: Ilio-Tibial Tract/Ilio-Tibial Band

Innervation: Branch of superior gluteal nerve (L4-L5, S1)

actions: Hip: flexes, abducts and medially rotates
Knee: flexes

Palpation: Instruct patient to do hip flex, knee extension, abduct and medially rotate the hip

Or
Long-sitting position.
Instruct patient to abduct the leg and internal rotate

Question 7

Adductor longus

Answer 7

Proximal: Pubis

Distal: Linea aspera

Innervation: Obturator nerve (L3-L4)

actions: adducts hip

Assists in flexion or extension of hip

Palpation: difficult to isolate

Fingers on the medial side, get patient to adduct inwards

Question 8

Adductor brevis

Answer 8

Proximal: Pubis

Distal: Linea aspera and pectineal line

Innervation: Obturator nerve (L3-L4)

actions: adducts hip

Palpation: difficult to isolate
Fingers on the medial side, get patient to adduct inwards

Question 9

Adductor magnus

Answer 9

Proximal: Pubic & ischial rami, ischial tuberosity

Distal: Linea aspera, adductor tubercle of femur

Innervation: Obturator nerve (L2-L4) and sciatic nerve (L4)

actions: adducts hip

Palpation: difficult to isolate
Fingers on the medial side, get patient to adduct inwards

Question 10

Gracilis

Answer 10

Proximal: Pubis

Distal: Anterior, medial aspect of proximal tibia

Innervation: Obturator nerve (L2-L3)

actions: adducts hip

Palpation: difficult to isolate
Fingers on the medial side, get patient to adduct inwards

Question 11

Bicep femoris (Long Head)

Answer 11

Proximal: ischial tuberosity

Distal: Fibular head and lateral condyle of tibia

Innervation: Sciatic nerve (L4-L5, S1-S2)

actions: hip: extends
Knee: flexes and lateral rotates

Palpation: Prone:

Push in gluteal fold- ischial tuberosity and get patient to flex the knee. Provide some resistance on the leg.

palpate muscle belly and instruct patient to flex knee with tibial lateral rotation ( toes turning out).

Question 12

Bicep Femoris (Short Head

Answer 12

Proximal: Lateral lip linea aspera

Distal: Fibular head and lateral condyle of tibia

Innervation: Sciatic nerve (L4-L5, S1-S2)

actions:
Palpation:

Question 13

Semimembranosus / Semitendinosus

Answer 13

Proximal: Ishcial tuberosity

Distal: Posterior aspect of medial condyle of tibia
(semimembranosus is distal to gracilis in the pes anserinus
attachment)

Innervation: Sciatic nerve (L4-L5, S1-S2)

actions: hip: extends
Knee: flexes and medially rotates

Palpation:

Question 14

Gluteus maximus

Answer 14

Proximal: Posterior iliac crest, sacrum, coccyx, sacrotuberous ligament

Distal: Gluteal tuberosity (distal to greater trochanter); helps form the iliotibial tract

Innervation: inferior gluteal nerve (L5, S1-S2)

actions: extends and lateral rotates hip
Posteriorly tilts pelvis

Palpation: Prone.
Get patient to clench his bottom

Question 15

Gluteus medius / Gluteus minimus

Answer 15

Proximal: Gluteus medius: Iliac crest, anterior gluteal line (which separates gluteus medius attachment from that of the gluteus minimus)

Gluteus minimus: Ilium, between the anterior and inferior gluteal lines

Distal: Gluteus medius: Greater trochanter

Gluteus minimus: Anterior border of greater trochanter

Innervation: Superior gluteal nerve (L4-L5, S1)

actions: anterior portion: abducts, flexes and medially rotates hip

Posterior portion: abducts, extends and laterally rotates hip

Prevent opposite side of pelvis from dropping in standing

Palpation: palpate greater trochanter. Patient does abduction with straight leg to minimize flexion

Give resistance

Question 16

Piriformis

Answer 16

Proximal: Anterior surface of sacrum, sciatic notch, sacrotuberous ligament.

Distal: Medial aspect of the greater trochanter. The fibres run inferiorly and laterally from sacrum towards femur.

Innervation: branch from first and second sacral nerves, (L5, S1-S2)

actions: laterally rotates hip when hip is extended.

Medially rotates hip with increasing hip flexion.

Palpation: maintain the hip in 90 degree. Palpate over greater trochanter, cradle the lower leg. Internal rotation