kin 3346 lower extremity

hip joint

coxafemoral joint (CFJ) - head of femur connecting with acetabulum of pelvic girdle

pelvic girdle

right and left pelvic bone joined together posteriorly by sacrum

pelvic bones

ilium, ischium and pubis

femur

longest and strongest bone in the body

dorsal/posterior femoral landmark

lesser trochantor

medial femoral landmark

femoral head

sacrum

extension of spinal column with 5 fused vertebrae

coccyx

inferior extension of sacrum

posterior landmark of sacrum (goes with bum)

ischial tubersoity

lateral landmark of sacrum

acetabulum

pelvic bone

os coxa - upper 2/5’s ilium, posterior and lower 2/5’s ischium, anterior and lower 1/5 pubis

origin for hip flexors

anterior pelvis

origin for hip abductors

lateral pelvis

origin for hip adductors

medial pelvis

origin for hip extensors

posterior pelvis

origin for hip extensors

posteroinferior pelvis

insertion for short muscles of the hip

proximal thigh

origin for 3 knee extensors

proximal thigh

insertion for all 4 quadriceps muscles

patella

pes anserene

sartorius, gracilis, semitendinosus

gerdys tubercle

iliotibial tract insertion point

iliofemoral (Y) ligament

anteriorly located ligament that prevents hyperextension (lax in flexion - taught in extension)

pubofemoral ligament

anteromedial/inferiorly located ligament that limits excssive extension and abduction

teres ligament

ligament attached deep in acetabulum to a depression in femoral head that slightly limits adduction

acetabular labrum

provides some shock absorption - lax in abduction and taught in adduction

ischiofemoral ligament

ligament located posteriorly, extending from ischium to trochanteric fossa of femur that limits internal rotation (lax ER, taught IR)

anterior hip and pelvic muscles - primarily hip flexion

iliopsoas, pectineus, rectus femoris, sartorius

medial hip and pelvic muscles - primarily hip adduction

adductor brevis, adductor longus, adductor magnus, gracilis

posterior hip and pelvic muscles - primarily hip extension

gluteus maximus, biceps femoris, semitendinosus, semimembranosus, external rotators

lateral hip and pelvic muscles - primarily hip abductors

gluteus medius, gluteus minimus, external rotators, TFL

anterior compartment of thigh - primarily knee extensors

rectus femoris, vastus medialis, vastus intermedius, vastus lateralis, sartorius

posterior compartment of thigh - hamstring group

biceps femoris, semitendinosus, semimembranosus

medial compartment of thigh - primarily adductors

adductor brevis, adductor longus, adductor magnus, pectineus, gracilis

lumbar plexus

innervates ventral side

sacral plexus

innervates dorsal 1/2

femoral nerve

innervates anterior muscles (hip flexion and knee extension)

obturator nerve

innervates adductors (not including pectineus)

superior gluteal nerve

innervates gluteus medius, minimus and TFL

inferior gluteal nerve

innervates gluteus maximus

tibial division of sciatic nerve

semitendonosis, semimembranosus, long head of biceps femoris, adductor magnus - sensation to posterolateral lower leg and plantar aspect of foot

common peroneal (fibular) division of sciatic nerve

provides sensation to anterolateral lower leg and dorsum of foot

iliopsoas muscle movements

flexion of hip, external rotation of hip, anterior pelvic tilt

iliopsoas origin

lower borders and sides of the transverse processes of lumbar vertebrae 1-5 (and T12) & inner surface of the ilium

iliopsoas insertion

lesser trochanter of femur and shaft & pectineal line and iliopectineal eminence

rectus femoris motions

flexion of hip, extension of knee, anterior pelvic tilt

rectus femoris origin

anterior inferior iliac spine (AIIS)

rectus femoris insertion

superior aspect of the patella and patellar tendon to the tibial tuberosity

sartorius muscle motions

flexion of hip, flexion of knee, external rotation of thigh as it flexes hip and knee, abduction of hip, anterior pelvic tilt, weak internal rotation of knee

sartorius origin

anterior superior iliac spine (ASIS)

sartorius insertion

anterior medial surface of the tibia just below the condyle

sartorius

largest muscle in the body

pectineus muscle motions

flexion of hip, adduction of hip, external rotation of hip, anterior pelvic tilt

pectineus origin

space one inch wide on front of pubis above crest (pectineal line)

pectineus insertion

rough line leading from lesser trochanter down to linea aspera (pectineal line of femur)

adductor brevis muscle motions

adduction of hip, external rotation as it adducts hip, assists in flexion of hip, assists in anterior pelvic rotation

adductor brevis origin

front of inferior pubic ramus just below origin of adductor longus

adductor brevis insertion

lower 2/3’s of pectineal line of femur and upper ½ of medial lip of linea aspera

adductor longus motion

adduction of hip, assists in flexion of hip, assists in anterior pelvic tilt

adductor longus origin

anterior pubis just below crest

adductor longus insertion

middle third of linea aspera

adductor magnus motion

adduction of hip, external rotation as hip adducts, extension of hip

adductor magnus origin

edge of entire ramus of the pubis and the ischium and ischial tuberosity

adductor magnus insertion

whole length of linea aspera, inner condyloid rosge and adductor tubercle

gracilis muscle motion

adduction of hip, weak knee flexion, hip IR, assists with flexion of hip, weak IR of knee

semitendinosus muscle motions

flexion of knee, extension of hip, hip IR, IR of flexed knee, posterior pelvic tilt

gracilis origin

anterior medial edge of decending ramus pf pubis

gracilis insertion

anterior medial surface of tibia just below condyle

semitendinosus origin

ischial tuberosity

semitendinosus insertion

anterior medal surface of tiba just below condyle

semimembranous muscle motions

flexion of knee, extension of hip, IR of hip, IR of flexed knee, posterior pelvic tilt

semimembranosus origin

ischial tuberosity

semimembranosus insertion

posteromedial surface of the medial tibial condyle

biceps femoris motions

flexion of knee, extension of hip, ER of hip, ER of flexed knee, posterior pelvic tilt

biceps femoris origin

ischial tuberosity & lower ½ of linea aspera and lateral condyloid ridge

biceps femoris insertion

lateral condyle of tibia, head of fibula

gluteus maximus motions

extension of hip, ER of hip, upper fibers - abduction, lower fibers - adduction, posterior pelvic tilt

gluteus maximus origin

posterior ¼ of the crest of the ilium, posterior surface of the scarum and coccyx near the ilium and fascia of the lumbar area

gluteus maximus insertion

oblique ridge (gluteal tuberosity) on lateral surface of the greater trochanter and iliotibial band of fascia latae

gluteus medius motions

abduction of hip, anterior pelvic tilt, posterior pelvic tilt

gluteus medius origin

lateral surface of ilium just below crest

gluteus medius insertion

posterior and middle surfaces of greater trochanter of femur

trendelenburg test

weak gluteus medius

gluteus minimus motions

abduction of hip, IR of femur, hip flexion, anterior pelvic tilt

gluteus minimus origin

lateral surface of ilium just below origin of gluteus medius

gluteus minimus insertion

anterior surface of greater trochanter of femur

TFL motions

abduction of hip, flexion of hip, IR og hip tendancy, anterior pelvic tilt

TFL origin

anterior iliac crest and surface of ilium just below crest

TFL insertion

¼ of the way down the thigh into the iliotibial tract which in turn inserts into gerdys tubercle of the anterolateral tibial condyle

6 deep lateral rotator muscles

piriformis, gemellus superior, gemellus inferior, obturator externus, obturator internus, quadratus femoris

6 deep lateral rotator muscles motions

ER of hip

6 deep lateral rotator muscles origin

anterior sacrum posterior portions of ischium and obturator foramen

6 deep lateral rotator muscles insertion

superior and posterior aspect of greater trochanter

knee joint

largest joint in the body by surface area (6)

tibia

medial - bears most weight

fibula

lateral - bears about 7% of weight during midstance and serves as attachment for knee joint structures (and biceps femoris)

patella

used to measure joint width to monitor swelling

patella

largest sesamoid bone imbedded in quadriceps and patellar tendon

tibiofemoral joint

ginglymus joint

patellofemoral joint

arthrodial due to gliding nature moving structure inferior with flexion

menisci

form cushions between bones, attached to tibia/deepen fossa and stability (absorb about 85% of body weight in squat)