Movement Anatomy Chapter 18

these two gluteal muscles have another very important function: (gluteus medius and gluteus minimus)

contract to keep the pelvis fairly level and to prevent the opposite side of the pelvis from dropping too much (lateral tilt) when you stand on one leg

ischiofemoral ligament where it is attaches where what it does

covers the capsule posteriorly. attaches on the ischial portion of the acetabulum, crosses the joint in a lateral and superior direction, and attaches on the femoral neck. its fibers limit hypertension and medial rotation

retroversion in angle of torsion

decrease in the angle of torsion forces the hip joint into a more laterally rotated position, causing the person to walk more "toed- out"

common hip pathologies* coxa vara

deformity in which the neck-shaft angle is less than the normal 125 degrees because It is more "bent" it tends to make the involved limb shorter, dropping the pelvis on that side during weight bearing

common hip pathologies* Osteoarthritis

degeneration of the articular cartilage of the joint. may result from trauma or wear and tear and is typically seen later in life commonly treated with a total joint replacement

Bony landmarks of the femur* lateral condyle

distal lateral end

Bony landmarks of the femur* medial condyle

distal medial end

Bony landmarks of the ischium* ischial ramus

extends medially from the body to connect with the inferior ramus of the pubis. the adductor magnus, obturator externus, and obturator internus muscles attach here

Bony landmarks of the pubis* pubic body

externally forms about 1/5th of the acetabulum and internally provides attachment for the obturator internus muscle

the ilium is ____ shaped and

fan shaped and makes up the superior portion of the innominate bone

end feel for all hip motions except flexion is

firm because of tension in the capsule, ligaments and muscles

the end feel for all hip joint motions, except flexion is

firm because of the tension in the joint capsule, ligaments, and muscle

motions of the hip joint in the sagittal plane and degrees of freedom

flexion, extension, and hyperextension flexion has 120 degrees hyperextension has 15 degrees of freedom

adductor hiatus is the

gap or opening in the distal attachment of the adductor magnus between the linea aspera and the adductor tubercle. it is significant because the femoral artery and vein pass through this opening to reach the posterior surface of the knee, where their name changes to *popliteal artery and vein

what hyperextends the hip

gluteus maximus

what lateral rotates the hip

gluteus maximus, deep rotators

what extends the hip

gluteus maximus, semitendinosus, semimembranosus, biceps femoris (long head)

what abducts the hip

gluteus medius, gluteus minimus

what medial rotates the hip

gluteus minimus

Bony landmarks of the femur* neck

narrower portion located between the head and the trochanters

six muscles of the deep rotator muscles

obturator externus, obturator internus, quadratus femoris, piriformis, gemellus superior, gemellus inferior small, deep, mostly posterior- span the hip joint in a horizontal direction, all laterally rotate the hip

Bony landmarks of the femur* lateral epicondyle

projection proximal to the lateral condyle

Bony landmarks of the femur* medial epicondyle

projection proximal to the medial condyle

Bony landmarks of the pubis* pubic tubercle

projects anteriorly on the superior ramus near the symphysis pubis and provides attachment for the inguinal ligament

Bony landmarks of the femur* linea aspera

prominent longitudinal ridge or crest running down the middle third of the posterior shaft of the femur to which many muscles attach

what flexes the hip

rectus femoris, iliopsoas, pectineus

iliofemoral ligament what it does attaches where resembles what AKA

reinforces the joint capsule anteriorly by attaching proximally to the AIIS and crossing the joint anteriorly. splits into two parts distally to attach to the intertrochanteric line of the femur. Resembles an inverted Y, often referred to as the Y ligament. AKA as the ligament of bigelow. main function is to limit hypertension

common hip pathologies* trochanteric bursitis

result of either acute trauma or overuse can be seen in runners, bicyclists, or in someone with a leg length discrepancy, or can be caused by other factors that put repeated stress on the greater trochanter

Bony landmarks of the ischium* ischial tuberosity

rough, blunt projection on the inferior part of the body, which is weight bearing when you are sitting. it provides attachment for the hamstring and adductor magnus muscles

Bony landmarks of the femur* head

rounded portion covered with articular cartilage articulating with the acetabulum

Bony landmarks of the femur* pectineal line

runs from below the lesser trochanter diagonally toward the linea aspera. it provides attachment for the adductor brevis

what muscle moves hip in combo of flexion, abduction and lateral rotation

sartorius

Muscles of the hip* deep rotator muscles Origin insertion action nerve

Origin: anterior sacrum, ischium, pubis insertion: greater trochanter area action: hip lateral rotation nerve: numerous

Muscles of the hip* rectus femoris muscle Origin insertion action nerve

*anterior side Kicking muscle part of quadriceps muscle and only one to cross the hip joint Origin: AIIS insertion: Tibial tuberosity action: Hip flexion, knee extension nerve: Femoral nerve (L2, L3, L4)

muscles of the hip* iliopsoas muscle Origin insertion action nerve

*anterior side Hip Flexor two muscles with separate proximal attachments and a common distal attachment. made up of the psoas major and the iliacus Iliacus origin: iliac fossa Psoas major origin: anterior and lateral surfaces of T12 through L5 Insertion: lesser trochanter Action: hip flexion Nerve: iliacus portion: femoral nerve (L2, L3) Psoas major portion: L2 and L3

Muscles of the hip* Sartorius muscle Origin insertion action nerve

*anterior side longest muscle in the body straplike muscle, not considered a prime mover in any motion but a helper of movement most efficient when doing all four motions at the same time Ex: cross your legs by putting one foot on the opposite knee Origin: ASIS insertion: Proximal medial aspect of tibia action: combo of hip flexion, abduction, lateral rotation, and knee flexion nerve: femoral nerve (L2, L3)

Muscles of the hip* Biceps femoris muscle Origin insertion action nerve

*hamstring muscle* has two heads and runs down the thigh laterally on the posterior side Origin: long head- ischial tuberosity short head- lateral lip of linea aspera insertion: fibular head action: long head- hip extension and knee flexion short head- knee flexion nerve: long head- sciatic nerve- tibial division (L5, S1, S2) short head- common fibular (peroneal) nerve (L5, S1, S2)

Muscles of the hip* semitendinosus muscle Origin insertion action nerve

*hamstring muscle* much longer and narrower distal tendon that spans the knee joint posteriorly and then moves anteriorly to attach to the anteromedial surface of the tibia with the gracilis and sartorius muscles Origin: ischial tuberosity insertion: anteromedial surface of proximal tibia action: hip extension and knee flexion nerve: sciatic nerve (L5, S1, S2)

Muscles of the hip* semimembranosus muscle Origin insertion action nerve

*hamstring muscle* runs down the medial side of the thigh, deep to the semitendinosus muscle Origin: ischial tuberosity insertion: posterior surface of medial condyle of tibia action: hip extension and knee flexion nerve: sciatic nerve- tibial division (L5, S1, S2)

Muscles of the hip* adductor Magnus muscle Origin insertion action nerve

*medial side largest and deepest of the adductors makes up the most of the bulk on the medial thigh there is an interruption called the adductor hiatus, in the distal attachment between the linea aspera and adductor tubercle. the femoral artery and vein pass through this opening. after their structures have passed through this opening, their names become the popliteal artery and vein. Origin: ischium and pubis insertion: entire linea aspera and adductor tubercle action: hip adduction nerve: obturator and sciatic nerve (L2, L3, L4)

Muscles of the hip* adductor longus Origin insertion action nerve

*medial side one of the three one-joint hip adductors, most superficial of them all can be easily felt in the anteromedial groin prime mover in hip adduction Origin: pubis insertion: middle third of the linea aspera action: hip adduction nerve: obturator nerve (L2, L3, L4)

Muscles of the hip* pectineus muscle Origin insertion action nerve

*medial side Origin: superior ramus of pubis insertion: pectineal line of femur action: hip flexion and adduction nerve: femoral nerve (L2, L3)

Muscles of the hip* gracilis muscle Origin insertion action nerve

*medial side only hip adductor that is a two-joint muscle Origin: pubis insertion: anteromedial surface of proximal end of tibia action: hip adduction nerve: obturator nerve ( L2, L3)

Muscles of the hip* adductor brevis muscle Origin insertion action nerve

*medial side shorter than the other adductor muscles lies deep to the adductor longs muscle but superficial to the adductor magnus muscle Origin: pubis insertion: pectineal line and proximal linea aspera action: hip adduction nerve: obturator nerve (L2, L3)

Muscles of the hip* gluteus maximus Origin insertion action nerve

*posterior large, thick, one- joint, quadrilateral muscle located superficially on the posterior buttock helps in everything except flexion Origin: posterior sacrum and ilium insertion: posterior femur distal to greater trochanter and to iliotibial band action: hip extension, hyperextension, lateral rotation nerve: inferior gluteal nerve (L5, S1, S2)

1.) all three of the hip joint ligaments attach along the 2.) the combined effect of this spiral attachment is to 3.) in other words, these ligaments are ________ in flexion, and become _______ as the hip joint moves into hypertension

1.) rim of the acetabulum and crosses the hip joint in a spiral fashion to attach on the femoral neck 2.) limit motion in one direction (hypertension) while allowing full motion (flexion) in the other direction. 3.) slack in flexion, become taut as the hip joint moves into hypertension

iliotibial band or tract

IT band! very long, tendinous portion of the tensor fascia lata muscle. attaches to the anterior portion of the iliac crest and runs superficially down the lateral side of the thigh to attach to the tibia. both the gluteus Maximus and tensor fascia lata muscles have fibers attaching to the iliotibial band.

Bony landmarks of the pubis* symphysis pubis

a cartilaginous joint connecting the bodies of the two pubic bones at the anterior midline

acetabulum

a deep, cup-shaped cavity that articulates with the femur. it is made up of nearly equal portions of the ilium, ischium, and pubis

motions of the hip joint in the frontal plane and degrees of freedom

abduction and adduction abduction has 45 degrees of freedom adduction has an additional 25 degrees of motion possible beyond the anatomical position

the depth of the acetabulum is increased by the fibrocartilaginous _________________, located around

acetabular labrum, the rim the free end of the labrum surrounds the femoral head and helps to hold the head in the acetabulum

common hip pathologies* legg- calvé- Perthes disease

aka coxa plana condition in which the femoral head undergoes necrosis (the death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply). usually seen in children between the ages of 5 and 10 years old. during the course of the disease, it may take about 2-4 years for the head to die, revascularize, and then remodel

common hip pathologies* congenital hip dislocation

aka dysplasia, occurs when an unusually shallow acetabulum causes the femoral head to slide upward. the joint capsule remains intact, though stretched

common hip pathologies* hamstring strain

aka pulled hamstring most common muscle problem in the body often recurrent result from the overload of the muscle or trying to move the muscle too fast common injury among sprinters and in sports that require bursts of speed or rapid acceleration (soccer, track and field, football, baseball, rugby) can occur at one of the attachment sites or at any point along the length of the muscle

anteversion in angle of torsion

an increase in the angle of torison forces the hip joint into a more medially rotated position . causes a person to walk more "toed- in"

angle of inclination

angle between the shaft and the neck of the femur in the *frontal plane normally 125 degrees at birth the angle may be as great as 170 degrees, but by adulthood it decreases significantly factors such as congenital deformity, trauma, or disease may affect the angle

the hip joint is a

ball and socket joint

Bony landmarks of the ilium* iliac crest

bony part that your hands rest on when you put your hands on your hips. its borders are the anterior superior iliac spine and the posterior superior iliac spine

the hip joint, like all synovial joints, has a fibrous ___________, covers the hip joint in a ____________ fashion.

capsule, cylindrical

common hip pathologies* coxa valga

characterized by a neck-shaft angle greater than 125 degrees because this angle is "straighter" it tends to make the limb longer, thus placing the hip in an adducted position during weight bearing

tightness of the piriformis can

compress the sciatic nerve resulting in radiating pain down the back of the leg

inguinal ligament

has no function at the hip joint but it has a presence. runs from the ASIS to the pubic tubercle and is the landmark that separates the anterior abdominal wall from the thigh. *when the external iliac artery and vein pass under the inguinal ligament, their names change to the femoral artery and vein.

ligaments that reinforce the joint capsule:

iliofemoral ligament* most important pubofemoral ligament ischiofemoral ligament

Bony landmarks of the ilium* posterior superior iliac spine (PSIS)

is the posterior projection on the iliac crest

greater sciatic notch

large notch just below the PIIS that is actually made into a foramen by the sacrospinous and sacrotuberous ligaments. the sciatic nerve, piriformis muscle, and other structures pass through this opening.

obturator foramen

large opening surrounded by the bodies and rami of the ischium and pubis and through which pass blood vessels and nerves

Bony landmarks of the tibia* tibial tuberosity

large projection at the proximal end, in the midline. provides attachment for the patellar tendon

Bony landmarks of the femur* greater trochanter

large projection located laterally between the neck and the body of the femur, providing attachment for the gluteus medius and minimus and for most deep rotator muscles

Bony landmarks of the ilium* iliac fossa

large, smooth, concave area on the internal surface to which the iliac portion of the iliopsoas muscle attaches

femur is the

largest, strongest, and heaviest bone in the body. a persons height can roughly be estimated to be four times the length of the femur.

when the femur moves _______ in hip abduction, the femoral head glides

laterally, medially

Bony landmarks of the pubis* inferior ramus

lies posterior, inferior, and lateral to the body. provides attachment for the adductor magnus and braves and gracilis muscles

Bony landmarks of the pubis* superior ramus

lies superiorly between the acetabulum and the body and provides attachment for the pectineus muscle

Bony landmarks of the femur* patellar surface

located between the medial and lateral condyle anteriorly. it articulates with the posterior surface of the patella

Bony landmarks of the ilium* posterior inferior iliac spine (PIIS)

located just below the PSIS

Bony landmarks of the ischium* ischial spine

located on the posterior portion of the body between the greater and lesser sciatic notches. it provides attachment for the sacrospinous ligament

Bony landmarks of the femur* body

long, cylindrical portion between the bone ends; also called the shaft. it is bowed slightly anteriorly

Bony landmarks of the ischium* ischial body

makes up about 2/5's of the acetabulum

open packed position is where _________ joint surface movement is possible

maximal

motions of the hip joint in the transverse plane and degrees of freedom

medial and lateral rotation 45 degrees of freedom in each direction

Bony landmarks of the femur* trochanteric fossa

medial surface of the greater trochanter

during hip adduction, the femur moves _______while the femoral head glides _______

medially, laterally

common hip pathologies* hip pointer

misnomer because it occurs at the pelvis, not the hip joint. severe bruise caused by direct trauma to the iliac crest of the pelvis commonly associated with football but can be seen in almost any contact sport

the hip is in the ________ __________ position when it is in 30 degrees of flexion, 30 degrees of abduction, and a small degree of lateral rotation

open packed

common hip pathologies* iliotibial band syndrome

overuse injury causing lateral knee pain. commonly seen in runners and bicyclists syndrome is believed to result from repeated friction of the band that slides over the lateral femoral epicondyle during knee motion caused by factors such as muscle tightness, worn down shoes, and running on uneven surfaces. *** because many muscles insert at the greater trochanter, there are many bursae providing a friction- reducing cushion between the muscles and bone.

what adducts the hip

pectineus, adductor longus, adductor brevis, adductor Magnus, gracilis

the lower extremity includes the

pelvis thigh leg and foot

the ischium is the

posterior inferior portion of the innominate bone

common hip pathologies* slipped capital femoral epiphysis

seen in children during the growth-spurt years. the proximal epiphysis slips from its normal position on the femoral head.

Bony landmarks of the femur* adductor tubercle

small projection proximal to the medial epicondyle to which a portion of the adductor magnus muscle attaches

Bony landmarks of the femur* lesser trochanter

smaller projection located medially and posteriorly just distal to the greater trochanter, providing attachment for the iliopsoas muscle

Muscles of the hip* gluteus minimus muscle Origin insertion action nerve

smallest of the gluteus muscles, lies deep and inferior to the gluteus medius muscle on the lateral ilium diagonal line of pull Origin: lateral surface of the ilium insertion: anterior surface of the greater trochanter action: hip abduction, medial rotation nerve: superior gluteal nerve (L4, L5, S1)

Bony landmarks of the femur* intertrochanteric crest

smooth ridge between greater and lesser trochanters. serves as attachment for quadratus femoris

end feel for hip flexion

soft because of contact between the anterior thigh and the abdomen

end feel for hip joint flexion is

soft because of contact between the anterior thigh and the abdomen

pubofemoral ligament where it is what it does

spans the hip joint medially and inferiorly. attaches from the medial part of the acetabular rim and superior ramus of the pubis and runs down and back to attach on the neck of the femur. limits hypertension , also limits abduction

common hip pathologies* hip fractures

tend to be one of two types: intertrochanteric and femoral neck very common among elderly people. usually resulting from falls high impact trauma such as motor vehicle accidents may cause hip fractures in younger individuals

what muscle is a combo of flexion and abduction movement

tensor fascia lata muscle

angle of torsion

the angle between the shaft and the neck of the femur in the *transverse plane normally has the head and neck rotated outward from the shaft approx. 15-25 degrees

the pubis forms

the anterior inferior portion of the innominate bone. can be divided into three parts- the body and its two rami

the hip joint capsule attaches proximally around

the lip of the acetabulum and distally to the neck of the femur. forms a cylindrical sleeve that encloses the joint and most of the femoral neck

Bony landmarks of the ilium* anterior superior iliac spine (ASIS)

the projection on the anterior end of the iliac crest. the tensor fascia lata and sartorius muscles and the inguinal ligament attach here

Bony landmarks of the ilium* anterior inferior iliac spine (AIIS)

the projection to which the rectus femoris attaches is on the AIIS

the hamstring is composed of ______ muscles

three; semimembranosus, semitendinosus, and biceps femoris all originate on the ischial tuberosity

the result or weakness or loss of the gluteus medius and gluteus minimus is

trendelenburg gait

Muscles of the hip* gluteus medius muscle Origin insertion action nerve

triangular, like the deltoid muscle Origin: outer surface of the ilium insertion: lateral surface of the greater trochanter action: hip abduction nerve: superior gluteal nerve (L4, L5, S1)

the hip joint is a ___axial joint and has motion in __________ planes

triaxial, all three planes

Muscles of the hip* tensor fascia lata muscle Origin insertion action nerve

very short muscle with a very long tendinous attachment arises from the ASIS, crosses hip joint laterally and slightly anteriorly, and then attaches to the long fascial band called the iliotibial band, which proceeds down the thigh and attaches to the lateral condyle of the tibia Strongest when performing a combo of flexion and abduction aka most efficient when abducting in a slightly anterior direction Origin: ASIS insertion: lateral condyle of tibia action: combined hip flexion and abduction nerve: superior gluteal nerve (L4, L5, S1)