FDN Level 2: Advanced Hip & Pelvis

Muscle Chart

Posterior Hip Landmarks

1. PSIS (oblong)

2. Inferior lip of PSIS = level of S2

3. lumbosacral junction

4. Iliac crest

5. Sacral hiatus = inferior edge of the sacrum

6. S4 = at the level of the “scoopy landmark”

7. Lateral edge sacrum towards PSIS

8. Greater trochanter (just superior to it = attachments)

9. Ischial tuberosity

10. Sciatic nerve = lateral edge of the ischial tuberosity to medial edge of piriformis

Femoral Triangle Landmarks

1. Sartorius: ASIS. Run leg up and down shin in figure 4 to activate

2. Adductor longus: Pull knee inward to isolate, cord-like and round

3. Inguinal ligament

4. Femoraly artery (pulse) is midway between pubic ramus and ASIS

5. Femoral nerve = lateral to artery (NAV)

6. Femoral vein = medial to artery (NAV)

Piriformis

O: sacrum (near S4)

I: greater trochanter

N: L5-S2 nerve to piriformis

A: ER extended femur, abd flexed femur

T: Prone, centre of ILA and PSIS, Pull tissue towards sacrum and needle to bone, pull up and then pull laterally and needle just anterior to the sacrum

Superior Gemellus

O: External ischial spine

I: medial side of the greater trochanter

N: L5-S1 nerve to obturator interns

A: ER extended femur, abd flexed femur

Inferior Gemellus

O: upper aspect of ischial tuberosity

I: medial side of greater trochanter

N: L5-S1 nerve to Quadratus femoris

A: ER extended femur, abd flexed femur

Obturator Internus

O: anterolateral wall of true pelvis

I: medial greater trochanter

N: L5-S1 nerve to obturator interns

A: ER extended femur, abd flexed femur

Quadratus Femoris

O: lateral ischium just anterior to ischial tuberosity

I: Quadrate tubercle on intertrochanteric crest of prox femur (lower portion of the greater trochanter)

N: L5-S1 nerve to Quadratus

A: ER

C: Sciatic nerve lives just lateral to the ischial tuberosity

Iliacus

O: posterior abdominal wall, iliac fossa

I: lesser trochanter

N: L2-3 femoral nerve

A: hip flex

T: Landmark ilium near the ASIS, get bony contact, slide off and ride needle along the inside of the ilium

Psoas Major/Iliopsoas

O: Posterior abdominal wall (L/S TP)

I: lesser trochanter

N: L1-3

A: flex hip

T: landmark the femoral artery, bracket and compress, needle AP, good to stim d/t difficulty to tx

Pectineus

O: Pectineal line

I: base of the lesser trochanter

N: L2-3 femoral nerve

A: adduct anf flex hip

C: you are within the femoral triangle, palpate femoral artery

T: just medial to the femoral artery