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Hip ( Iliofemoral ) Joint

PTA Students Curtis, Tonya, Emilee, & Zeke. Hip ( Iliofemoral ) Joint. 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.

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Hip ( Iliofemoral ) Joint

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  1. PTA Students Curtis, Tonya, Emilee, & Zeke Hip (Iliofemoral) Joint

  2. Bones Them Bones….. …Of the iliofemoral joint. And one extra.

  3. Bones Os Coax: The Pelvic Trifecta

  4. Bones Medial View

  5. Bones Lateral View, with a side of landmarks

  6. Bones Find the Angry Bird

  7. Bones The Femur: Foreplay for cave men

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

  9. Ligaments • Iliofemoral ligament • Pubofemoral ligament

  10. Ligaments • Ischiofemoral ligament

  11. Ligaments • Sacrotuberous ligament

  12. Ligaments & Cartilage • Transverse acetabular ligament • Acetubular labrum • Articular cartilage of head of femur • Ligament of head of femur

  13. Articular Capsule • Synovial membrane • Fibrous layer

  14. Ligaments • Zona orbicularis

  15. Bursae • Trochanteric bursa • Deep • Superficial

  16. Bursae Gluteofemoral bursa IschialBursa

  17. 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

  18. 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

  19. MusclesAnterior Compartment Thigh Muscles Iliopsoas Psoas 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

  20. 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 = VastusMedialis, Intermedialis& Lateralis • Hip Flexion = Iliopsoas & Pectineus • Antagonist: • Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris • Hip Extension = Gluteus Maximus, Semimembranosus, Semitendinosus & Biceps Femoris

  21. MusclesAnterior Compartment Thigh Muscles Quadriceps Femoris: VastusMedialis • 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, VasusLateralis and Intermedius • Antagonist: • Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris

  22. MusclesAnterior Compartment Thigh Muscles Quadriceps Femoris: VastusLateralis • Innervation: • Femoral Nerve • Origin: • Intertrochanteric line and lineaaspera 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, Vastusmedialis and intermedialis • Antagonist: • Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris

  23. MusclesAnterior Compartment Thigh Muscles Quadriceps Femoris: VastusIntermedius • 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, VastusLateralis and Medialis • Antagonist • Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris

  24. MusclesMedial Thigh Muscles Adductor Brevis • Innervation: • Obturator Nerve • Origin • Anterior surface of the inferior ramus of the pubis • Insertion • Superior half of lineaaspera 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

  25. 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 lineaaspera 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

  26. 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

  27. 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 & Vastusmedialis, lateralis & intermedius

  28. 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

  29. 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 lineaaspera 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. 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

  36. Nerves • Femoral Nerve • Obturator Nerve

  37. Nerves • Sciatic Nerve • Superior Gluteal nerve • Inferior gluteal nerve • Common peroneal nerve

  38. Arteries • Femoral artery • Lateral circumflex artery • Obturator artery • Deep femoral (Profunda) artery

  39. Arteries • Superior Gluteal Artery • Inferior Gluteal Artery

  40. Veins • Femoral Vein • Profunda (Deep Femoral) Vein • Great Saphenous Vein

  41. Surface Anatomy -Gluteal fold/Gluteal Sulcus -Sacrum -Posterior superior iliac spine -Tip of Greater trochanter -Interglutealcleft -Iliac crest

  42. Surface Anatomy -Supracristal plane -Anterior superior iliac spine -Inguinal ligament

  43. 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.

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