Download Bones of the Hip

Bones of the Hip
Ilium
• Iliac fossa
• Iliac ala
• Arcuate line
– True pelvis
– False pelvis
• Acetabulum
Male and female pelvis
Differences
• Angle of pubic arch – female wider
• Pelvic inlet – female larger
• Sacrum – female less curved
• Obturator foramen – female oval, male round
• Iliac ala – female wider and shallower
figure
Iliac crest
• Thicker posteriorly
• Highest point palpated posteriorly is at
level of L4
• Lips of iliac crest
– Internal lip
– Intermediate lip
– External lip
L4 is colored
Attachments to lips
• Internal lip
– Anterior lip - Transversus abdominis muscle
– Middle lip - Quadratus lumborum muscle
– Posterior lip - Sacrospinalis muscle (erector
spinae muscles of back)
• Intermediate lip
– Anterior lip – internal abdominal oblique
muscle
• External lip
– Anterior lip – external abdominal oblique
muscle
– Anterior lip – origin of tensor fascia latae
muscle
– Posterior lip – origin of latissimus dorsi
muscle
– Whole lip – fascia lata (deep fascia of the
thigh)
Other Structures on Iliac Crest
• Anterior Superior Iliac
Spine (ASIS)
– Sartorius muscle
– Tensor fascia latae
• Posterior Superior
Iliac Spine (PSIS)
– Skin dimples on back
– Level of S2 vertebrae
Other Structures on the Ilium
• Anterior Inferior Iliac Spine
– Origin of part of rectus femoris muscle
– Attachment for iliofemoral ligament
• Posterior Inferior Iliac Spine
– Posterior part of the surface that articulates
with the sacrum
• Greater Sciatic Notch
– Posterior part of ilium
– Just inferior to the PIIS
– Next slide – structures that pass through the
greater sciatic notch
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Superior gluteal nerve and vessels
Piriformis muscle
Inferior gluteal nerve and vessels
Sciatic nerve
Nerve to superior gemellus and obturator
internus muscles
• Nerve to inferior gemellus and quadratus
femoris muscles
• Pudendal nerve and vessels
• Posterior femoral cutaneous nerve
• Note structures which are above and
below the piriformis muscle
Post hip fig
Post hip2
Structures on the external
surface of the ilium
• Three gluteal lines
– Posterior Gluteal line
– Anterior Gluteal line
– Inferior Gluteal line
– Rough area above acetabulum
• Origin of reflected head of the rectus femoris
muscle
Gluteal lines on ADAM
• Origins of:
– Gluteus maximus
– Gluteus medius
– Gluteus minimus
The ISCHIUM
• Body of the ischium
– External surface is the articular and nonarticular surface of the acetabulum
• Acetabulum
– Articular surface – lunate surface which
articulates with the head of the femur
– Non-articular surface – acetabular fossa
• Internal surface of ischium
– Forms part of the wall of the true pelvis
Structures on posterior border
of ischium
• Ischial spine
– Separates the greater and the lesser sciatic
notches
– Origin of superior gemellus muscle
– Attachment site for the sacrospinous ligament
• Ligament helps convert the greater sciatic notch
into the greater sciatic foramen
• Part of sacroischial joint
Post hip lig
• Lesser Sciatic notch
– Passageway for:
• Obturator internus muscle
• Nerve to obturator internus muscle
• Pudendal nerve and vessles
– Note these also travel through the greater sciatic notch
• Ischial tuberosity
– Attachment of hamstring muscles
• Long head of the biceps femoris muscle
• Semitendinosus muscle
• Semimembranosus muscle
– Origin of Inferior Gemellus muscle
– Attachment of sacrotuberous ligament
• Part of sacroischial joint
• Helps convert both the greater and lesser sciatic
notches into foramen
• Superior ischial ramus
– External or lateral wall
• Origin of quadratus femoris muscle
– On ridge between the superior ischial ramus and the
ischial tuberosity
– Lower part is part of the origin of the obturator
externus muscle
The PUBIS
• Body of the pubis
– External surface - acetabulum
• Articular surface
• Non-articular surface – acetabular fossa
– Internal surface
• Forms part of wall of true pelvis
Superior Ramus of the Pubis
• External surface
– Origin of adductor longus muscle
• Just below pubic crest
• Internal surface – part of wall of true pelvis
• Superior border of superior ramus (medial
part)
– Pubic crest – RA and pyramidalis
– Pubic tubercle – inguinal ligament
– Medial border – articular surface for
attachment of fibrocartilage of pubic
symphysis
– Lateral part – part of edge of obturator
foramen
• Superior border of superior ramus (lateral
part)
– Pectineal line – origin of pectineus muscle
– Iliopubic eminence
• Junction of iliac and pubic bones
• Insertion of psoas minor muscle
• Inferior surface of superior pubic ramus
– Obturator crest – part of margin of obturator
foramen
– Obturator “groove” – passageway for
obturator nerve and vessels as they pass
through the obturator foramen
– Posterior surface – part of origin of obturator
internus muscle
Inferior pubic ramus
• External surface
– Origin of adductor brevis muscle
– Origin of gracilis muscle
– Origin of adductor magnus muscle (lateral)
– Origin of obturator externus muscle (bone
near foramen)
Structures common to more than
one part of the innominate bone
• Acetabulum
• Obturator foramen
Acetabulum
• Lateral innominate bone
• Surfaces
– Lunate surface – articulating with head of
femur
– Non-articulating surface – acetabular fossa
• Contains a fat pad
• Acetabular notch – gap in wall of
acetabulum
– Attachment of ligamentum teres (ligament of
the head of the femur)
– Transverse ligament attaches to the edges of
the notch and completes the articular surface
Obturator foramen
• Covered by obturator membrane
• Origin of obturator internus – from inner
(posterior) surface of the membrane and
the surrounding bone
• Origin of obturator externus – from the
external (anterior) surface of the
membrane and the surrounding bone
• Passageway through the membrane for
obturator nerve and vessels to the medial
thigh
Passages
• Structures that enter the lower extremity
must travel through the pelvis
• There are several different ways that
structures (nerves, blood vessels, lymph
vessels, muscles and tendons) can travel
through or around the pelvis
• Greater Sciatic Notch
– Many structures
– Sciatic nerve
– Superior and inferior gluteal nerves and
vessels
– Piriformis muscle
• Lesser Sciatic Notch
– Pudendal nerve and vessels travels back
through
– Obturator internus muscle and its nerve
Obturator foramen
• Obturator nerve and vessels through an
opening in the obturator membrane at the
obturator groove
Structures which pass over the
pelvic brim to lower extremity
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Tendon of the iliacus muscle
Tendon of the psoas major muscle
Femoral Nerve, Artery and Vein
Lateral femoral cutaneous nerve
Lymph vessels
Femoral triangle fig
Post hip lig
Post hip2
Quiz on bony landmarks
• http://www.mhhe.com/biosci/ap/saladin2e/
graphics/saladin02ap/ch09/others/chap09l
abeling09.html
• http://www.mhhe.com/biosci/ap/saladin2e/
graphics/saladin02ap/ch09/others/chap09l
abeling08.html