Anterior and Medial Thigh and Pelvis

hip bone

• are separate in children, fuse in puberty

• outer surface has the acetabulum

• sciatic notch posterior to acetabulum

• lesser sciatica notch on other side of the spine of ischium\

  • these notches become foramina due to presence sacrotuberuous and sacropinous ligaments

three fused bones in hip

• llium

• ischium

• pubis

illium

Upper flattened part of hip bone

• Iliac crest runs between:

◦ Anterior and posterior superior iliac spines (ASIS & PSIS)

• Inferior to superior iliac spines are:

◦ Anterior and posterior inferior iliac spines (AIIS & PIIS)

• Inner surface of ilium artculates with sacrum

• Iliopectneal lines runs around the inside of the ilium

◦ Divides the false from true pelvis

ischium

Inferior & Posterior part of the lower pelvis

Features:

◦ Ischial spine

◦ Ischial tuberosity

pubis

Anterior part of lower pelvis

Features:

◦ Body

◦ Pubic crest

◦ Pubic tubercle

◦ Superior & inferior pubic rami

• Articulations

  • Pubic tubercles as the symphysis pubis

2 hip bones

• Sacrum

• Coccyx

Articulations:

◦ articulate at pubis symphysis

◦ articulate with sacrum at sacroiliac joints

symphisis pubis

• Articulation between two pubic tubercles

• Cartlaginous joint

• Articular surface covered by hyaline

• Connected with a fibrocartilaginous disc

• Joint surrounded by ligaments

• Almost no movement possible

◦ Hormonal exceptions (pregnancy)

sacroiliac joint

• Very strong joint between the surfaces of the sacrum and iliac bones.

• Sacrum suspended between the iliac bones by the posterior and interosseous sacroiliac ligaments

• Rotary movement prevented by sacrotuberous and sacrospinous ligaments

• Function: transmit weight

• Nerve supply: Sacral spinal nerves

obturator foramen and membrane

Large opening bounded by ischium and pubis

Obturator membrane

◦ Completely closes the foramen with the exception of a small gap

• Obturator canal

◦ Allows for passage of obturator nerve and vessels into thigh

sacrococcygeal joint

• Cartilaginous joint

• Bodies of last sacral vertebra and first coccygeal vertebra

• Joined by ligaments

• Movements of flexion and extension

◦ Labor

◦ Defecation

female pelvic inlet

more rounded

male pelvic inlet

butterfly shaped

female sacrum

shorter, wider and flatter

male sacrum

taller, narrower, and bumpier

common iliac

• Arises from the aorta

• Divides into the external and internal iliac arteries

hip

Acetabulum

• Lateral aspect of the hip bone

• Parts of the ilium, ischium, and pubis form

femur

Bone of the thigh

◦ Longest and heaviest bone in the body

• Articulates with the:

◦ Pelvis/ hip (proximal/ medial)

◦ Tibia (distally)

◦ Patella (anteriorly)

femur head

articulates with the acetabulum

femur neck

• angled at 115-140 degrees

• Changes during the lifespan

• Differs between gender

fovea of heat (fovea capitis)

Attachment of the ligamentum teres

coxa vara

• Decreased angle

• Mild shortening of the lower limb

• Limits hip ABD, may see a limp

coxa valga

• Increased angle

• Hip muscle weakness

• Associated conditions, i.e. cerebral palsy

greater trochanter

Projects superiorly and posteriorly where the femur neck joins the femur body

lesser trochanter

Extends medially below the femur neck and femur body juncton

intertrochanteric line

• Rough ridge that runs from the greater to the lesser trochanters

• Site where the femur neck joins the femur body

shaft/body

Slightly bowed anteriorly

adductor tubercle

An elevaton of the medial epicondyle where the adductor magnus inserts

medial femoral condyle

Articulates with the medial tibial condyle

lateral femoral condyle

Articulates with the lateral tibial condyle

intertrochanteric crest

Joins the trochanters posteriorly

linea aspera

A longitudinal crest in the middle third of the femur

◦ Medial and lateral lip

◦ Inserton point

intercondylar fossa

Separates the condyles

hip joint

• Between head of femur and acetabulum

• Articular surfaces covered by hyaline cartilage

• Synovial- ball and socket join

• Movement sacrifced for strength and stability

• Strength depends on shape of bones, and strength of ligaments.

hip joint nerve supply

femoral, obturator, sciatic and nerve to the quadratus femoris

movement of hip joint

√, /, ABD, ADD, lateral and medial rotation, circumducton

anterior thigh muscles

flexors of the hip and extensors of the knee

• Pectineus,

• Iliopsoas

• Tensor of fascia lata

• Sartorius

• Quadriceps femoris group

pectineus

• Origin: superior ramis of the pubis

• Insertion: pectineal line of the femur

• Innervation: femoral n.

• Action: ADD, √ thigh, medial rotation

ilopsas

• Origin:

  • Illiacus: upper two-thirds of the iliac fossa and the lateral parts of the wing of the sacrum.

  • Psosas Major: The transverse processes and lateral surfaces of the vertebral bodies of L1- L4

  • Psoas Minor: T12 and L1 and lies anteriorly to the psoas major

• Insertion:

  • Iliacus and Psoas Major: join together, pass under the inguinal ligament onto the femoral lesser trochanter

  • Psoas Minor: iliopectineal eminence

• Innervation: L4-L5, Femoral nerve

• Action: chief flexor of the thigh, √ trunk at hip

  
  

tenor fascia lata

Enclosed in the fascia lata

Gluteal muscle that is an anterior thigh muscle

• Origin: iliac spine and crest

• Insertion: iliotbial tract

• Innervation: superior gluteal n.

• Action: ABD, medially rotates, √ thigh

sartorius

“Tailor’s muscle”

Longest muscle in the body

Travels lateral to medial

◦ Origin: iliac spine

◦ Insertion: superior tibia

◦ Innervation: femoral n.

◦ Action: √, ABD, laterally rotates thigh, and √ knee

quadriceps femoris

◦ Rectus femoris

◦ Vastus lateralis

◦ Vastus intermedius

◦ Vastus medialis

• Great extensors of the leg

• All combine to form 1 tendon = quadriceps tendon

rectus femoris

• Origin: iliac spine, ilium

• Insertion: base of patella

• Innervation: femoral n.

• Action: / knee, steadies hip joint, and assists with thigh √

vastus lateralis

• Origin: greater trochanter, lateral lip of linea aspera

• Inserton: base of patella

• Innervaton: femoral n.

• Action: / knee, steadies hip joint, and assists with thigh √

vastus medialis

• Origin: intertrochanteric line, medial lip of linea aspera

• Insertion: base of patella

• Innervation: femoral n.

• Action: / knee, steadies hip joint, and assists with thigh √

vastus intermediuis

◦ Origin: anterior and lateral surfaces of the femur

◦ Inserton: base of patella

◦ Innervaton: femoral n.

◦ Action: / knee, steadies hip joint, and assists with thigh √

medial thigh muscles

◦ Adductor longus

◦ Adductor brevis

◦ Adductor magnus

◦ Gracililis

◦ Obturator externus

adductor longus

◦ Large fan-shaped muscle

◦ Most anterior ADD muscle

◦ Origin: pubis

◦ Insertion: linea aspera

◦ Innervation: obturator n.

◦ Action: ADD thigh

adductor brevis

◦ Deep to the pectineus and adductor longus

◦ Origin: pubis

◦ Insertion: pectineal line and linea aspera

◦ Innervaton: obturator n.

◦ Action: ADD thigh, some thigh √

adductor mag

obturator externus

Small, fan-shaped muscle deep

◦ Origin: obturator foramen

◦ Insertion: trochanteric fossa of femur

◦ Innervation: obturator n.

◦ Action: lateral rotaton of thigh, steadies head of femur in acetabulum

femoral nerve

Originates from the lumbar plexus

◦ Under the inguinal ligament → lateral to femoral vessels → divides

into branches (saphenous nerve)

◦ Supplies anterior thigh muscles and skin, hip and

knee joints

obturator nerves

Originates from the lumbar plexus

◦ Arises from the obturator foramen and divides

◦ Anteriorly descends between the adductor longus and brevis

◦ Posteriorly descends between the adductor brevis and magnus

◦ Supplies anterior and posterior thigh muscles

femoral artery

◦ Chief artery to the lower limb

◦ Continuation of the external iliac artery
◦ Has many branches proximally

◦ Femoral pulse

◦ Inserton point for a catheter for a cardiac angiography

◦ Up to the aorta

◦ Vulnerable to punctures/ injury due to the locaton

femoral artery blood supply

Begins at the inguinal ligament → femoral triangle, lateral to femoral vein → between the

fascia lata, iliopsoas, and pectneus → adductor canal → adductor hiatus changing to the

popliteal artery

femoral vein

◦ Continuaton of the popliteal vein

◦ Travels alongside the femoral artery within the femoral sheath

◦ Ends at the inguinal ligament which changes to the external iliac vein

◦ Great saphenous vein branches off

◦ Site for insertion of catheters into the right side of the heart/ inferior vena cava

great saphenous vein

◦ Ascends anteriorly to the medial malleolus

◦ Passes posteriorly to the medial condyle of the femur

◦ Arises from the saphenous opening in the fascia lata

◦ Empties into the femoral vein

◦ Has 10-12 valves which enables the blood to flow against gravity

ilitobial tract (IT band)

◦ Encloses the large muscles of the thigh

◦ Inserts into the lateral condyle of the tbia.

rider’s strain

◦ Strain of the adductor longus

◦ Usually occurs with horseback riders due to the need to actvely ADD thighs

to stay on the horse.

◦ Tendons will ossify = riders’ bones

pulled groin

◦ Flexor and ADD thigh muscles

◦ Usually occurs in sports that require a quick start

◦ Strain, stretching, and/ or tearing of the muscles

varicose veins

◦ Valvular insufciency

◦ Treatment with compression, elevaton, surgery

gluteal fold

If uneven in children can be a sign of hip dysplasia

gluteal sulcus

The boundary between the buttocks and the thigh

sacrotuberuous

Attaches from the ischial tuberosity to the sacrum and coccyx

sacrospinous

Attaches from the ischial spine to the sacrum and coccyx

• Change the greater and lesser sciatic notches into the greater and lesser sciatic foramen.

• Stabilize the sacrum and prevent rotation at sacroiliac joint by weight of the upper body.

deep gluteal muscles

◦ Piriformis

◦ Obturator internus

◦ Gemelli superior

◦ Gemelli inferior

◦ Quadratus femoris

gluteus maximus

◦ Origin: ilium, sacrum, coccyx, sacrotuberous ligament

◦ Insertion: iliotbial tract, gluteal tuberosity of femur

◦ Innervation: inferior gluteal n.

◦ Action: / thigh, lateral rotaton

◦ Rising from the seated positon

◦ Straightening from a bending positon

◦ Walking upstairs

◦ Running

gluteus medius

◦ Origin: ilium

◦ Insertion: lateral surface of the greater trochanter of the femur

◦ Innervation: superior gluteal n.

◦ Action: ABD, medial rotaton of the thigh

gluteus minimus

◦ Origin: ilium

◦ Insertion: anterior surface of the greater trochanter

◦ Innervation: superior gluteal n.

◦ Action: ABD, medial rotation of the thigh

◦ With the gluteus medius, prevents sagging of the unsupported limb when walking

◦ Helps advance the limbs in walking

pirifiromis

- Origin:

• Anterior aspect of the sacrum at the level of about S2 through S4

• Sacrotuberous ligament

• Periphery of the greater sciatic notch

- Insertion: Superior and medial aspects of the greater trochanter.

- Innervation: S1-S2 Rami

- Action: laterally rotate the extended thigh; ABD the flexed thigh; steadies the femoral head in the acetabulum

obturator internus

Action: laterally rotate the extended thigh; ABD the flexed thigh; steadies the femoral head in

the acetabulum

◦ Together with the gemelli forms a tricipital muscle= triceps coxae

◦ Bursa of the obturator internus

gemellus superior

◦ Origin: ischial spine

◦ Insertion: medial surface of the greater trochanter

◦ Innervation: nerve to the obterator internus

◦ Action: laterally rotate the extended thigh; ABD the flexed thigh; steadies the femoral head in the acetabulum

gemellus inferior

◦ Origin: ischial tuberosity

◦ Insertion: medial surface of the greater trochanter

◦ Innervation: nerve to the quadratus femoris

◦ Action: laterally rotate the extended thigh; ABD the fexed thigh; steadies the femoral head in the acetabulum

quadratus femoris

◦ Origin: lateral border of the ischial tuberosity

◦ Insertion: intertrochanteric crest

◦ Innervation: nerve to the quadratus

◦ Action: laterally rotates the thigh, steadies the femoral head in the acetabulum

posterior femoral cutaneous nerve

Arises from the sacral plexus

◦ Emerges from the inferior border of the glut max

◦ Main part lies deep in the fascia of the buttocks

◦ Sacral plexus →greater sciatic foramen, inferior to the piriformis → branches→ supplies the skin of the buttocks and posterior thigh and calf, and lateral perineum

superior gluteal nerve

Runs with the superior gluteal artery

◦ Ventral rami →greater sciatic foramen, superior to the piriformis → between the glut med and min→ supplies the glut med, glut min, and tensor fasciae latae

inferior gluteal nerve

ventral rami →greater sciatc foramen, inferior to the piriformis → branches→ supplies the glut max

sciatic nerve

largest nerve in the body

◦ Sacral plexus →greater sciatic foramen, inferior to the piriformis→ splits into the tbial

and common fbular nerves about halfway down the thigh

◦ 12% splits occur higher

sciatic nerve supplies to

the skin of the foot, most of the leg, posterior thigh muscles, all leg and foot

muscles, and lower limb joints.

hamstring muscles

◦ Semitendinosus

◦ Semimembranosus

◦ Biceps femoris (long head)

hamstrings

Span from the hip to the knee joints

◦ Originate from the ischial tuberosity

◦ Innervated by the tbial porton of the sciatc n.

◦ Action: / thigh, √ leg

◦ Nerve supply= sciatc nerve

semitendinosus

Attaches to the medial surface of the tibia

semi membranous

Attaches to the medial condyle of the tibia

biceps femoris

Origin: Short head originates on the linea aspera and lateral supracondylar line of the femur

◦ Insertion- Long and short heads join= attaches to the head of fibula

◦ Short head innervated by the fibular n.

femoral fractures

broken hip= fracture neck of the femur or intertrochanteric fracture

◦ Troublesome and problematc

◦ Many time rupture the vessels (medial circumflex femoral a.) = necrosis

◦ Higher incidence in individuals over 60 years old, and women= osteoporosis

osteoarthritis

◦ Hip replacements

◦ Metal prosthesis replaces the head and neck of the femur

◦ Plastic socket replaces the acetabulum

ischial bursitis

◦ Repeated stress over the ischial bursae

◦ Inflammaton or calcificatons

◦ Pain with movement of the glut max

◦ Pressure sores from bearing body weight

sciatic nerve pain

◦ Pain in the buttocks

◦ Athletes with excessive glut muscle use and women

◦ Spasm of the piriformis= nerve compression

◦ Gunshots or stab wounds= incomplete injury= slow recovery

◦ More likely to occur if insult is medial; body provides protection laterally

hamstring strains

◦ People have different lengths of these muscles

◦ Injury caused by excessive stretching movements

◦ Tear proximal attachments at the ischial tuberosity

◦ Most likely due to not stretching enough