Hip joint, gluteal region, posterior thigh

Recognise the major bony features of the hip bone and upper thigh and appreciate how these bones articulate with each other.

Recognise the major muscles surrounding the hip and thigh, and explain their actions.

Identify the major features of the hip joint and understand their importance in the functioning of the lower limb.

Recognise and name the major nerves that enter the lower limb from the trunk and describe the muscle groups each one supplies.

What makes up the lower limb?

thigh, leg, foot and hip, knee ankle joints

What are the basic movements of the lower limb?

• Extension / flexion

• Abduction / adduction

• Medial (internal) / lateral (external) rotations

• Circumduction

• Eversion / inversion + plantarflexion / dorsiflexion

What makes up the pelvic girdle?

sacrum and coccyx, hip bones (ilium + pubis + ischium - fuse at the acetabulum)

What are another names for the hip bone?

os coxae or innominate bone

What are the joints of the pelvis?

sacroiliac joint, pubic symphysis and hip joint

What does the hip joint transition between ?

trunk and lower limb

What does the hip joint join between?

hip bone (acetabulum and labrum) and femur (femoral head)

Why is the hip joint termed multiaxial?

allows flexion, extension, abduction, adduction, external (lateral) rotation, internal (medial) rotation and circumduction

Define the labrum

ring of cartilage that surrounds the brim of the acetabulum. Stabilises and lubricates joint, and absorbs shock

What are the capsular ligaments of the hip joint?

iliofemoral, pubofemoral and ischiofemoral

What distinguishes capsular from intracapsular joints?

thickened intrinsic parts of joint that provide stability // separate structures located in the synovial capsule that guide complex movements

synovial joint meaning

most common, freely movable joint type in the human body, characterized by a fluid-filled cavity (synovial cavity) enclosed by a fibrous capsule eg shoulder, hips, knees, elbows - allow for extensive movement

synovial capsule meaning

two-layered, fibrous envelope surrounding synovial joints that separates them from other tissues, providing structural stability and enclosing the synovial cavity

What are the intracapsular ligaments of the hip joint?

transverse acetabular ligament, ligament of the head of the femur (LHF)

What are other terms for the ligament of the head of the femur?

ligamentum capitis femoris, ligamentum teres

Identify the ligaments of the hip joint

anterior capsular ligaments so iliofemoral and pubofemoral are visible

Identify the capsular ligaments of the hip joint

anterior capsular ligaments so iliofemoral and pubofemoral are visible

Which joint is on this photo ? What gives this away?

ischiofemoral ligament - posterior view

Describe the blood supply to the hip joint?

Common iliac artery → internal iliac artery → superior gluteal artery then internal iliac artery off of which comes the obturator artery + deep femoral artery from external iliac artery

Which arteries anastomose off of the common iliac artery to provide blood to the hip joint?

deep femoral artery, obturator, superior and inferior gluteal arteries

Which two arteries give rise to the arteries that supply the hip bone? Which ones?

• external iliac artery - deep femoral artery

• internal iliac artery - superior gluteal artery and inferior gluteal artery off of which comes the obturator artery

both from common iliac artery (L4)

Which 4 nerves innervate the hip joint?

femoral, obturator, superior gluteal and quadratus femoris nerves

Anterior innervation of the hip joint/anterior compartment thigh

femoral nerve

Inferior innervation of the hip joint/medial compartment thigh

obturator nerve

Superior innervation of the hip joint/gluteus medius and minimus mm

superior gluteal nerve

Posterior innervation of the hip joint/quadratus femoris and inferior gemellus mm

nerve to quadratus femoris nerve

Locate the gluteal region relative to the pelvic girdle, iliac crest and gluteal fold

posterior to pelvic girdle, inferior to iliac crest and superior to gluteal fold

What are the 2 muscular groups of the gluteal region?

gluteal group and lateral rotator group

Describe the size of the muscles of the gluteal group vs lateral rotator group of muscles of the gluteal region

superficial, large muscles vs deep, small muscles

Movement gluteal group

abduct or extend the femur at the hip joint + stabilisation

Movement lateral rotator group

mainly laterally rotate the femur at the hip joint

List the muscles that make up the gluteal group of the gluteal region

Gluteus maximus, gluteus medius, gluteus minimus and tensor fascia latae

List the muscles that make up the lateral rotator group of the gluteal region

Quadratus femoris, piriformis, gemellus superior, gemellus inferior, obturator internus, and obturator externus

blood supply to the gluteal group of muscles of the gluteal region

superior and inferior gluteal arteries

Mvt gluteus maximus

Main extensor of the thigh, assists with lateral rotation if force is needed

Mvt gluteus medius

Abduction and medial rotation of the thigh, stabilises pelvis on locomotion (medi is medial)

Mvt gluteus minimus

Abduction and medial rotation of the thigh, stabilises pelvis on locomotion (mini is medial mvt)

Innervation gluteus maximus

inferior gluteal nerve (extends lower than the other 2 muscles)

Innervation gluteus medius

superior gluteal nerve (inserts higher than glut max)

Innervation gluteus minimus

superior gluteal nerve (inserts higher than glux max)

What is the innervation of both the tensor fascia and latae and the gluteus minimus/medius ?

superior gluteal nerve

What is the role of the tensor fascia latae?

Stabilises hip and knee joints and supports gait cycle and climbing via iliotibial band, assists gluteus medius and minimus (abduction and medial rotation of the thigh)

What is the blood supply to the gluteal group of the gluteal region and the tensor fascia latae?

superior and inferior gluteal arteries

What is the role of the iliotibial band/tract?

fibrous reinforcement of the fascia lata on the lateral thigh. Stabilises primarily the knee, but also hip joint, during locomotion and against gravity on knee flexion

What is the fascia lata ?

deep fascia of the thigh

What is the reinforcement of the fascia lata of the thigh called?

iliotibial band

Which 3 structures share a same function of stabilisation, abduction and medial rotation of the thigh ?

gluteus minimus, medius and tensor fascia latae

Nerve piriformis

nerve to piriformis

Nerve quadratus femoris

nerve to quadratus femoris

What is the movement of the piriformis ?

lateral rotation of the thigh, abduction when hip is flexed

What is the movement of the quadratus femoris ?

lateral rotation of the thigh, weak adduction of the thigh

What is the blood supply to the lateral rotator group of the gluteal region?

superior and inferior gluteal arteries

Locate the muscles of the lateral rotator group of the gluteal region on the following image

Innervation of superior gemellus

nerve to obturator internus (muscle located just above and piggy backs the innervation of obturator internus)

Innervation of obturator internus

nerve to quadratus femoris

Innervation of inferior gemellus

nerve to quadratus femoris (muscle located just above and piggy backs the innervation of quadratus femoris)

Mvt of superior gemellus

Lateral rotation of the thigh, abduction when hip is flexed 

Mvt of obturator internus

Lateral rotation of the thigh, abduction when hip is flexed 

Mvt of inferior gemellus

Lateral rotation of the thigh, abduction when hip is flexed 

What is the longest and widest single nerve in the body?

sciatic nerve

What is the course of the sciatic nerve ?

• from anterior lumbar and sacral nerve fibres from the spinal cord

• nerve roots unite into single nerve anterior to piriformis muscle

• exits pelvis between piriformis and superior gemellus into gluteal region

• travels down into posterior thigh

Below which muscle do the inferior gluteal artery and nerve go below?

piriformis

When administering a shot in the gluteal region, which site is preferred ? What are risks of doing it in a different region?

cross on the gluteus maximus - left upper corner is target region

jab can be very jerksome/can induce damage to the sciatic nerve leading to paralysis of the lower limbs

From which collection of nerves does the sciatic nerve come from? Where does it originate?

lumbosacral plexus - originates from vertebrae L4 to S3

What joints define the upper and lower thigh?

hip and knee joints

Which bone is located in the thigh?

femur

What are the 3 fascial/muscular compartments of the thigh?

anterior, medial and posterior

Which 3 muscles make up the posterior compartment of the thigh?

biceps femoris, semitendinosus and semimembranosus

What is the blood supply to the posterior muscles of the thigh?

inferior gluteal artery (proximal) and deep femoral artery

Innervation of posterior muscles of the thigh

sciatic nerve

What are the posterior muscles of the thigh called as a unit?

hamstrings

Which muscles of the thigh cross the hip vs the knee and therefore what are their movements?

long head of biceps femoris crosses over hip so extends it + semi-tendinosus/mebranosus // all three cross over the anterior knee joint so all flex it

Movements of the posterior compartment muscles

extension of hip and flexion of knee

Describe the structure of the adductor magnus

posterior and anterior portions, the two portions of the muscle don’t lie laterally but at a slight angle

Role of pubofemoral portion of the adductor magnus of the posterior compartment of the thigh

flexion of hip

Role of ischiocondylar portion of the adductor magnus of the posterior compartment of the thigh

extension of the hip

Innervation of adductor magnus

sciatic and obturator nerves

Blood supply to adductor magnus

deep femoral artery

Which portion of the adductor magnus is innervated and has the same movement as the hamstring?

ischiocondylar portion

Label the hamstrings

What is an easy way to distinguish semitendinosus and semimembranosus muscles of the posterior compartment of the thigh?

tendinosus looks like a tendon, membranosus is flat and looks like a membrane

What is the course of the sciatic nerve on the posterior thigh?

• from gluteal region → between adductor magnus and biceps femoris, lateral to semimembranosus/semitendinosus

• divides at apex of popliteal fossa (behind knee)

What are the 2 divisions of the sciatic nerve on the posterior thigh?

tibial and common fibular nerves

What role do gluteus medius and minimus have in walking?

stabilise the pelvis while one leg is up - more pronounced in women bc of the larger pelvis, allow counter balance when walking

Describe the obturator foramen

large paired opening below acetabulum, covered by thin fibrous membrane leaving an obturator canal through which the obturator nerve, artery and vein pass

Which artery gives the deep femoral artery (similar to the arm blood supply)

femoral artery comes off external iliac artery and deep brachial artery comes off and wraps around to posterior compartment of the thigh (like deep brachial artery in arm)

What is an easy way to identify the ischiofemoral ligament of the hip joint?

only posterior one, other 2 are anterior + has horizontal fibres

What is the role of LHF? What differs between this ligament in children vs in adulthood ?

anchors head of femur, making up for the horseshoe shape of the acetabulum and maintaining stability at the joint

in children has its own artery // in adulthood regresses to a ligament

What is the aspect of pubofemoral and iliofemoral ligaments of the hip joint?

both melded in cadavers, only distinction is relative positions, overlap in the middle where they join

congruent meaning

degree to which opposing articular surfaces of a joint fit together

How congruent are the acetabulum and head of femur?

very ! removing makes a popping sound, fit very well together, head of femur is very round and goes deep into socket

At which point could the hip joints open? Under action of what?

during childbirth only - fibres or joint relax and cartilage enlarge - under action of relaxin hormone

At what stage of life do the bones of the pubis fuse forming the socket of the hip bone (acetabulum)?

adolescence

What is the most anterior part of the pelvis?

pubic symphysis cartilage

What is the leg?

between knee and ankle joints

What are the 2 surfaces of the ala ?

pelvic (anterior) and dorsal (posterior)