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)