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Hip Muscular Anatomy Flexors Psoas Major Origin Insertion Adjacent margins of the bodies of the vertebra and discs and anterior medial transverse processes from the body of T12 to the body of L5. Tip and posterior aspect of lesser trochanter of the femur Flexion of the hip and lumbar spine Action Anterior rami of L1-L3/4 Nerve Supply Palpation Model supine with hip and knee flexion, feet resting on table. Therapist places fingers 2 inches Lateral to umbilicus on Lateral edge of rectus abdominis. Pressure is applied towards to spinal column. Model can perform hip flexion to confirm palpation. Iliopsoas tendon palpated Lateral to femoral artery inferior to inguinal ligament Iliacus Origin Insertion Action Upper and posterior two thirds of the iliac fossa, ala of the sacrum and anterior sacroiliac ligament. Lesser trochanter of the femur. A few fibres attach to the hip joint capsule Hip Flexion. When the origin and insertion are reversed so the lower point is fixed iliacus is a lumbar flexor and anteriorly tilts the pelvis. Femoral nerve Nerve Supply Palpation Anterior aspect of ilium just medial to the ASIS Psoas Minor Origin Sides of the bodies of T12 and L1 and intervertebral disc. Iliopubic eminence and iliac fascia Insertion Weak flexor of the lumbar spine Action Anterior primary ramus of L1 Nerve Supply N/A Palpation Rectus Femoris Origin Straight Head: Anterior inferior iliac spine Reflected Head: Superior to the acetabulum Insertion Upper border of the patella and merges around patella to form parts of the ligamentum patellae Action Hip flexion, Knee Extension Nerve Supply Femoral Nerve Palpation Model: Straight leg raise Sartorius Origin Anterior superior iliac spine and area just below Insertion Vertical line of the upper medial surface of the tibia shaft. Some fibres merge with the MCL Action Hip flexion, Lateral rotation and abduction. Knee flexion and tibial medial rotation. Nerve Supply Femoral Nerve Palpation Model actively holds leg in hip flexion, abduction and slight Lateral rotation. Belly palpated close to ASIS Extensors Gluteus Medius Origin Insertion Action Outer surface of the ilium from the iliac crest and posterior gluteal line Superolateral surface of the greater trochanter Abduction of the hip. Anterior fibres assist with femoral medial rotation. Posterior fibres assist with Lateral rotation. Stabilise the pelvis on the femur during single leg stance. Superior Gluteal Nerve L4-L5, S1 Nerve Supply Palpation Model side lying. Place hand between the iliac crest and greater trochanter of the femur. Ask model to abduct the femur. Semitendinosus Origin Lower medial facet of the lateral section of the ischial tuberosity Insertion Vertical line of the anterior medial superior aspect of the medial condyle of the tibia Action Hip Extension, Knee Flexion and Tibial medial Rotation Nerve Supply Tibial Division of Sciatic Nerve Palpation Semimembranosus Origin Upper lateral facet of the ischial tuberosity Insertion Posteromedial surface of the medial tibial condyle and oblique popliteal ligament Action Hip Extension, Knee Flexion and Tibial medial Rotation Nerve Supply Tibial Division of Sciatic Nerve Palpation Upper lateral facet of the ischial tuberosity Biceps Femoris Origin Long Head: Lower medial facet of the ischial tuberosity and sacrotuberous ligament Short Head: Lower half of the lateral lip of the linea aspera and the lateral supracondylar line of the femur Insertion Head of the fibula Action Hip Extension, Knee flexion and Tibial Lateral Rotation Nerve Supply Long Head: Tibial Division of Sciatic Nerve Short Head: Common Peroneal Division Palpation Long Head: Lower medial facet of the ischial tuberosity and sacrotuberous ligament Short Head: Lower half of the Lateral lip of the linea aspera and the lateral supracondylar line of the femur Adductors Gracilis Origin Front body and inferior ramus of the pubis and the ramus of the ischium Insertion Vertical line of the upper medial surface of the tibia shaft Action Hip adduction. Knee Flexion and Tibial medial Rotation Nerve Supply Anterior division of the obturator nerve Palpation Distal Tendon: Resist knee flexion and tibial IR. Tendon is medial to the tendon of semitendinosis Proximal belly: Place thigh into hip flexion, abduction, ER. Place flat palm along adductors. Immediate muscle mass is adductor longus. Straighten knee. Mass then found posteriorly is gracilis. Adductor Brevis Origin Insertion Lateral surface of the body of the pubis and inferior pubic ramus Posterior surface of the proximal femur and upper one third of linea aspera Hip adduction Action Obturator Nerve Nerve Supply Palpation Adductor Magnus Origin Insertion Action Nerve Supply Palpation Adductor Part – Ischiopubic ramus Hamstring Part – Ischial tuberosity Adductor Part – posterior surface of proximal femur, linea aspera, medial supracondylar line Hamstring Part – adductor tubercle and supracondylar line Adductor Part – Adduction of the hip. Flexion of the hip Hamstring Part – Extension of the hip Adductor Part - Obturator Nerve Hamstring Part – Sciatic Nerve Adductor Longus Lateral surface of the body of pubis Origin Insertion Linea aspera on middle one third of the shaft of femur Hip Flexion, adduction, medial rotation Action Obturator Nerve Nerve Supply Palpation Pectineus Pectineal line and adjacent bone of pelvis Origin Insertion Oblique line extending from base of lesser trochanter to linea aspera on posterior surface of proximal femur Hip adduction and flexion Action Femoral Nerve Nerve Supply Palpation Abductors Gluteus Maximus Origin Insertion Action Posterior gluteal line of the ilium, tendon of sacrospinalis, dorsal surface of the sacrum, coccyx and sacrotuberous ligament Gluteal tuberosity of the femur and iliotibial tract of fascia lata Extension of the femur, Lateral stabilisation of the hip. Inferior fibres can assist with adduction and Lateral rotation of the femur. Superior fibres can assist with abduction and medial rotation of the femur. Inferior Gluteal Nerve (L5-S2) Nerve Supply Palpation Prone lying with one knee joint flexed to 90. Apply max resistance to posterior surface of thigh and ask for hip extension. Gluteus Minimus Origin Insertion Lateral surface of ilium between inferior and anterior gluteal lines Linear facet on the anterolateral aspect of the greater trochanter and the hip capsule Superior gluteal nerve Action Superior gluteal nerve Nerve Supply Palpation Tensor Fascia Latae Origin Lateral aspect of crest of ilium between anterior superior iliac spine and tubercle of the crest Iliotibial tract of fascia lata Insertion Abduction and Medial Rotation of the hip Action Superior Gluteal Nerve Nerve Supply Palpation Lateral Rotators Piriformis Origin Insertion Action Anterior surface of the sacrum between and Lateral to anterior sacral foramen, capsule of sacroiliac articulation, margin of the greater sciatic foramen and sacrotuberous ligament Superior border of the greater trochanter of the femur. Extension and Lateral rotation of the hip in hip extension or neutral. medial rotation and abduction in 90° of hip flexion. Sacral plexus, L5, S1, S2 Nerve Supply Palpation Model in side lying on uninvolved side with hip flexed to 90°. Palpate in a line from the greater trochanter to the palpable border of the sacrum. Model in prone. Knee flexed to 90°. Palpate in a line from greater trochanter to palpable border of the sacrum. medial and Lateral rotation of the hip can be used to confirm palpation. Gemellus Superior External surface of ischial spine Origin Insertion Action Along length of superior surface of the obturator internus tendon and into the medial side of the greater trochanter of the femus with the obturator internus tendon Laterally rotates the extended hip joint Aducts the flexed hip joint Nerve to Obturator Internus Nerve Supply Palpation Obturator Internus Origin Insertion Medial surface of the obturator membrane, the ischium near the membrane and the rim of the pelvis Medial side of the greater trochanter of the femur and the hip joint Laterally rotates the extended hip joint Action Aducts the flexed hip joint Nerve to obturator internus Nerve Supply Palpation Gemellus Inferior Upper aspect of ischial tuberosity Origin Insertion Action Along length of inferior surface of the obturator internus tendon and into the medial side of the greater trochanter of the femus with the obturator internus tendon Laterally rotates the extended hip joint Aducts the flexed hip joint Neve to quadratus femoris Nerve Supply Palpation Quadratus Femoris Origin Insertion Lateral aspect of the ischium just anterior to the ischial tuberosity Quadrate tubercle on the intertrochanteric crest of the proximal femur Laterally rotates the hip Action Nerve to quadratus femoris Nerve Supply Palpation Obturator Externus Origin Lateral surface of obturator membrane and adjacent bone Trochanteric fossa Insertion Adduction, and Lateral rotation of the hip Action Obturator Nerve Nerve Supply Palpation Flexors Psoas Major Iliacus Psoas Minor Rectus Femoris Sartorius Pectineus Gracilis Tensor Fascia Latae Adductor Longus Adductor Brevis Gluteus Maximus Semimembranosus Extensors Semitendinosus Biceps Femoris Adductor Magnus Abductors Gluteus Medius Gluteus Minimus Tensor Fascia Latae Sartorious Piriformis Obturator Internus Gemellus Superior Gemellus Inferior Gluteus Maximus (Superior Fibres) Pectineus Adductor Longus Adductor Brevis Adductors Adductor Magnus Gracilis Obturator Externus Gluteus Maximus (Inferior Fibres) Gluteus Medius Gluteus Minimus Tensor Fascia Latae Medial Rotation Semimembranosus Semitendinosus Adductor Magnus Adductor Longus Gluteus Maximus (Superior Fibres) Lateral Rotation Piriformis Obturator Internus Obturator Externus Gemellus Superior Gemellus Inferior Quadratus Femoris Sartorius Gluteus Maximus (Inferior Fibres) Gluteus Medius (Posterior Fibres)
