UNIT 2 - LE SECOND ORDER

Superficial Gluteal Muscles

1. Gluteus maximus

2. Gluteus medius

3. Gluteus minimus

4. Tensor fasciae latae

Gluteus maximus - O

1. Ilium posterior to posterior gluteal line

2. Dorsal sacrum and coccyx

3. Sacrotuberous ligament

Gluteus maximus - I

1. Lateral condyle of tibia (most fibers end in iliotibial tract)

2. Gluteal tuberosity (some)

Gluteus maximus - A

1. Extends hip joint (flexed position)

2. Assist in lateral rotation

3. Stabilizes hip joint

4. Assist from rising from sitting

Gluteus maximus - N

1. Inferior gluteal N

Gluteus maximus - B

1. Superior gluteal A

2. Inferior gluteal A

Gluteus medius - O

1. External ilium between anterior and posterior gluteal lines

Gluteus medius - I

1. Lateral greater trochanter of femur

Gluteus medius - A

1. ABD hip joint

2. Medially rotate hip joint

3. Helps maintain pelvic level during single-leg stance

   • Ipsi limb is weight bearing

   • Advance opposite (unsupported) side during swing phase

Gluteus medius - N

1. Superior gluteal N

Gluteus medius clinical significance

1. Trendelenburg gait = pelvic drop on contralateral side during walk

Gluteus minimus - O

1. External ilium between anterior and inferior gluteal lines

Gluteus minimus - I

1. Anterior greater trochanter of femur

Gluteus minimus - A

1. ABD hip joint

2. Medially rotate hip joint

3. Maintain pelvic alignment during gait (same as medius)

Gluteus minimus - N

1. Superior gluteal N

Gluteus minimus - B

1. Superior gluteal A

Gluteus minimus clinical significance

1. Shares function with gluteus medius in stabilizing the pelvis

2. Strengthening regimens for hip osteoarthritis or gait dysfunction

Tensor fasciae latae - O

1. Anterior superior iliac spine

2. Anterior iliac crest

Tensor fasciae latae - I

1. Iliotibial tract (attaching to lateral condyle of tibia)

   • Gerdy’s tubercle

Tensor fasciae latae - A

1. ABD hip joint

2. Medially rotate hip joint

3. Maintain pelvic alignment during gait & pelvic level during single-leg stance

   • When ipsi limb is weight-bearing

4. Assist hip flexion

Tensor fasciae latae - N

1. Superior gluteal N (L4-S1)

Tensor fasciae latae - B

1. Lateral circumflex femoral A

2. Superior gluteal A

Tensor fasciae latae clinical significance

1. Tightness = iliotibial syndrome

   • Common overuse injury in runners presenting as lateral knee pain

Deep Gluteal Muscles

1. Piriformis

2. Obturator internus

3. Superior and inferior gemelli

4. Quadratus femoris

Piriformis - O

1. Anterior sacrum

2. Sacrotuberous ligament

Piriformis - I

1. Superior greater trochanter of femur

Piriformis - A

1. Laterally rotate extended hip joint

2. ABD flexed hip joint

3. Stabilize hip joint

Piriformis - N

1. Branches of anterior rami S1 and S2

Piriformis - B

1. Superior gluteal A

2. Inferior gluteal A

Piriformis clinical significance

1. Piriformis syndrome = neuromuscular condition

   • Sciatic N compressed or irritated by muscle

   • Sciatica-like symptoms

Obturator internus - O

1. Pelvic obturator membrane

2. Surrounding bones

Obturator internus - I

1. Medial greater trochanter (trochanteric fossa)

Obturator internus - A

1. Laterally rotate extended hip joint

2. ABD hip joint when flexed

3. Stabilize hip joint

Obturator internus - N

1. Nerve to obturator internus

Obturator internus - B

1. Internal pudendal

2. Obturator As

Superior and inferior gemellus - O

1. Superior: ischial spine of os coxae

2. Inferior: ischial tuberosity of os coxae

Superior and inferior gemellus - I

1. Medial greater trochanter (trochanteric fossa)

Superior and inferior gemellus - A

1. Laterally rotate extended hip joint

2. ABD hip joint when flexed

3. Stabilize hip joint

Superior and inferior gemellus - N

1. Superior: Nerve to obturator internus

2. Inferior: Nerve to quadratus femoris

Superior and inferior gemellus - B

1. Superior: Internal pudenal A

2. Both: Inferior gluteal A

Quadratus femoris - O

1. Lateral ischial tuberosity

Quadratus femoris - I

1. Quadrate tubercle on intertrochanteric crest of femur

2. Area inferior to it

Quadratus femoris - A

1. Laterally rotates hip joint

2. Stabilizes hip joint

Quadratus femoris - N

1. Nerve to quadratus femoris

Quadratus femoris - B

1. Medial circumflex femoral A

Anterior Thigh Muscles Acting on Hip Joint

1. Pectineus

2. Psoas major

3. Psoas minor

4. Iliacus

5. Sartorius

Pectineus - O

1. Superior ramus of pubis

Pectineus - I

1. Pectineal line of femur (inferior to lesser trochanter)

Pectineus - A

1. ADD hip

2. Slightly flexes hip

3. Assists with lateral rotation

Pectineus - N

1. Femoral N

2. May receive a branch of obturator N

Pectineus - B

1. Primarily by medial femoral circumflex A

Pectineus clinical significance

1. Strain injuries in sports involving rapid changes in direction

Psoas major - O

1. Sides of T12-L5 vertebrae and discs in between

2. TP of L1-L5

Psoas major - I

1. Lesser trochanter of femur

Psoas major - A

1. Act conjointly in flexion

2. Lateral rotation of hip joint

3. Stabilizing joint when standing (lumbar spine during hip flexion)

Psoas major - N

1. Anterior rami of lumbar N (L1, L2, L3)

Psoas major - B

1. Lumbar arteries

2. Branches of iliolumbar A

Psoas major clinical significance

1. Chronic hip flexor tightness = increased lumbar lordosis

2. Contribute to low back pain in athletes and sedentary individuals alike

Psoas minor - O

1. Sides of T12-L1 vertebrae

2. Intervertebral discs

Psoas minor - I

1. Pectineal line

2. Iliopubic eminence

Psoas minor - A

1. Act conjointly in flexion

2. Lateral rotation of hip joint

3. Stabilizing joint when standing

Psoas minor - N

1. Anterior rami of lumbar N (L1, L2)

Iliacus - O

1. Iliac crest

2. Iliac fossa

3. Ala of sacrum

4. Anterior sacro-iliac ligaments

Iliacus - I

1. Tendon of psoas major

2. Lesser trochanter

3. Femur distal to it

Iliacus - A

1. Act conjointly in flexion with psoas major

   • Lateral rotation of hip joint

2. Stabilizing hip joint when standing

Iliacus - N

1. Femoral N (L2-L4)

Iliacus - B

1. Iliac branches of iliolumbar A

Iliacus clinical significance

1. Less commonly isolated

2. Deep tenderness and tightness = mimic intra-articular hip pathology

   • Labral tears or bursitis

Sartorius - O

1. Anterior superior iliac spine

2. Superior notch inferior to it

Sartorius - I

1. Superior part of medial tibia (part of pes anserinus)

Sartorius - A

1. Flex hip

2. ABD hip

3. Laterally rotate hip

4. Flex knee joint

   • Medially rotate leg when knee joint is flexed

Sartorius - N

1. Femoral N

Sartorius - B

1. Femoral A and branches

   • Including:

     • Superficial circumflex iliac

     • Descending genicular arteries

Sartorius clinical significance

1. Pes anserine bursitis = valgus knee alignment or overuse from repetitive motions

   • Stair climbing or running

Anterior Thigh Muscles Acting on Knee Joint

1. Rectus femoris

2. Vastus lateralis

3. Vastus medialis

4. Vastus intermedialis

Rectus femoris - O

1. Anterior inferior iliac spine

2. Ilium superior to acetabulum

Rectus femoris - I

1. Via common tendinous (quadriceps tendon) and independent attachments to base of patella

2. Indirectly via patellar ligament to tibial tuberosity

Rectus femoris - A

1. Extends knee joint

2. Steadies hip joint

3. Helps iliopsoas flex hip joint

Rectus femoris - N

1. Femoral N

Rectus femoris - B

1. Lateral cirumflex femoral A

Rectus femoris clinical significance

1. Prone to avulsion injuries in adolescent athletes during sprinting or jumping due to strong eccentric loading

Vastus lateralis - O

1. Greater trochanter

2. Lateral lip of linea aspera of femur

Vastus lateralis - I

1. Common tendinous (quadriceps tendon) and independent attachments to base of patella

2. Indirectly via patellar ligament to tibial tuberosity

3. Medial and lateral vasti also attach to tibia and patella via aponeuroses (medial and lateral patellar retinacula)

Vastus lateralis - A

1. Extend knee

   • Steadies hip joint

   • Helps iliopsoas flex hip

Vastus lateralis - N

1. Femoral N

Vastus lateralis - B

1. Lateral circumflex femoral A

2. Perforating branches of deep femoral A

Vastus lateralis clinical significance

1. Excessive lateral pull (from dominant) contributes to patellar tracking dysfunction

   • Common feature in patellofemoral pain syndrome

Vastus medialis - O

1. Intertrochanteric line

2. Medial lip of linea aspera of femur

Vastus medialis - I

1. Common tendinous (quadriceps tendon) and independent attachments to base of patella

2. Indirectly via patellar ligament to tibial tuberosity

3. Medial and lateral vasti also attach to tibia and patella via aponeuroses (medial and lateral patellar retinacula)

Vastus medialis - A

1. Extend knee joint

   • Steadies hip joint

   • Helps iliopsoas flex hip joint

Vastus medialis - N

1. Femoral N

Vastus medialis - B

1. Femoral A

2. Deep femoral A

Vastus medialis clinical significance

1. Weakness/delay = Vastus Medialis Obliquus (VMO) activation → anterior knee pain and improper patellar alignment

Vastus intermedius - O

1. Anterior lateral shaft of femur

Vasus intermedius - I

1. Common tendinous (quadriceps tendon) and independent attachments to base of patella

2. Indirectly via patellar ligament to tibial tuberosity

3. Medial and lateral vasti also attach to tibia and patella via aponeuroses (medial and lateral patellar retinacula)

Vastus intermedius - A

1. Extends knee joint

   • Steadies hip joint

   • Helps iliopsoas flex hip joint

Vastus intermedius - N

1. Femoral N

Vastus intermedius - B

1. Lateral circumflex femoral A

Medial Thigh Muscles

1. Adductor longus

2. Adductor brevis

3. Adductor magnus

4. Gracilis

5. Obturator externus

Adductor longus - O

1. Body of pubis inferior to pubic crest