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The Gluteal Region And
Thigh
Dr. Fadel Naim
Orthopedic Surgeon
Faculty of Medicine
IUG
Gluteal Region
The bulky region of hip (the buttocks)
Dr. Vohra
2
Fascia Of The Buttock


The superficial fascia is
thick and impregnated with
large quantities of fat.
 It contributes to the
prominence of the buttock.
It is continuous below with
the deep fascia of the thigh
(fascia lata).
It is attached to the iliac crest.
The deep fascia forms sheaths,
which enclose




The tensor fasciae latae
The gluteus maximus
Gluteal Muscles

The gluteal muscles share a common
compartment but are organized into two layers,
superficial and deep:

The superficial layer consists of:
1.
2.
The three large glutei (maximus, medius, and
minimus)
The tensor of the fascia lata.
Gluteal Muscles
 The

deep layer consists of:
Smaller muscles covered by the inferior
half of the gluteus maximus
1. Piriformis
2. Obturator internus
3. Gemelli
4. Quadratus femoris



All have distal attachments on or adjacent to
the intertrochanteric crest of the femur.
Lateral rotators of the thigh
Stabilize the hip joint
Gluteus Maximus



The largest muscle in the body.
Superficial in the gluteal region
largely responsible for the
prominence of the buttock.

Origin:




Insertion:




the outer surface of the ilium
the posterior surface of the sacrum and coccyx
the sacrotuberous ligament
The fibers pass downward and laterally
Most are inserted into the iliotibial tract
Some of the deeper fibers are inserted into the
gluteal tuberosity of the femur.
Nerve supply:

Inferior gluteal nerve.
Gluteus Maximus

• Action:



It extends and laterally rotates the hip joint
Through the iliotibial tract it helps maintain the knee joint
in extension.
It is most commonly used as an extensor of the trunk on
the thigh

( raising the trunk from the sitting or stooping
positions)
Gluteus Medius


The gluteus medius is a thick, fan-shaped muscle
Its posterior part is covered by the gluteus maximus

origin:


Insertion:



The fibers pass downward and laterally
Attached to the lateral surface of the greater trochanter.
Nerve supply:


From the outer surface of the ilium.
Superior gluteal nerve.
Action:




Acting with the gluteus minimus
Powerfully abducts the thigh at the hip joint.
Most important action takes place in walking or running
The anterior fibers also medially rotate thigh.
Gluteus Minimus

The gluteus minimus is fan shaped and lies
deep to the gluteus medius.

Insertion:



Nerve supply:


The fibers pass downward and laterally
Attached to the lateral surface of the greater trochanter.
Superior gluteal nerve.
Action:



Acting with the gluteus medius
Powerfully abducts the thigh at the hip joint.
The anterior fibers also medially rotate thigh.

Action of abductors of thigh when walking


The three muscles contract and steady the pelvis on the
lower limb
While walking the pelvis is held in position and does not tilt
downward on the unsupported
Tensor Fasciae Latae

Origin:


Insertion:



The fibers run downward and backward
inserted into the iliotibial tract.
Nerve supply:


From the outer edge of the iliac crest between
the anterior superior iliac spine and the iliac
tubercle
Superior gluteal nerve.
Action:



It exerts traction on the iliotibial tract
assists the gluteus maximus muscle in
maintaining the knee in the extended
position.
As long as the iliotibial tract remains in front of
the axis of flexion of the knee, it assists in
keeping the knee extended.
The Iliotibial Tract
•On the lateral surface of the
thigh, thickened to form a strong,
wide band
•From the tubercle of the iliac
crest and below to the lateral
condyle of the tibia
•Forms a sheath for the tensor
fasciae latae muscle
•Receives the greater part of the
insertion of the gluteus
maximus
Tensor Fasciae Latae

In standing upright, the
upward pull of the iliotibial
tract is the most important
factor in keeping the knee
extended
 The quadriceps muscles
may be relaxed.
Piriformis

Origin:


Insertion:



The fibers pass downward and
laterally through the greater
sciatic foramen
Attached to the upper border of
the greater trochanter.
Nerve supply:


From the anterior surface of the
2nd, 3rd, and 4th sacral vertebrae
within the pelvis.
Anterior rami of the first and 2nd
sacral nerves.
Action:

Lateral rotator of the thigh at the
hip joint.
Quadratus Femoris


The quadratus femoris is a quadrilateral-shaped
muscle.
Origin:


Insertion:


The fibers pass laterally to be inserted into the quadrate
tubercle on the intertrochanteric crest of the femur.
Nerve supply:


From the lateral border of the ischial tuberosity.
A branch from the sacral plexus.
Action:

Lateral rotator of the thigh at the hip joint.
Triceps coxae
1.
2.
3.


Obturator Internus
Gemelli Superior
Gemelli inferior
These small muscles form a tricipital muscle
(triceps coxae) located between the piriformis and
quadratus femoris.
The common tendon of the triceps runs horizontally
to the greater trochanter of the femur.
Obturator Internus



A fan-shaped muscle that lies partly
within the pelvis at its origin.
It emerges through the lesser sciatic
foramen to enter the gluteal region.
Origin:


Insertion:



The tendon passes out of the pelvis through the lesser sciatic foramen
and is joined by the superior and inferior gemelli.
The common tendon is inserted into the upper border of the greater
trochanter.
Nerve supply:


From the pelvic surface of the
obturator membrane and the
surrounding bones
Nerve to the obturator internus from the sacral plexus.
Action:

Lateral rotator of the thigh at the hip joint.
Gemellus Superior


The gemellus superior is a small muscle.
Origin:


Insertion:


With the tendon of the obturator internus
Nerve supply:


Spine of the ischium.
Nerve to the obturator internus from the sacral plexus.
Action:

Lateral rotator of the thigh at the hip joint.
Gemellus Inferior


The gemellus inferior is a small muscle.
Origin:


Insertion:


With the tendon of obturator internus
Nerve supply:


Upper margin of the ischial tuberosity.
Nerve to the quadratus femoris from the
sacral plexus.
Action:

Lateral rotator of the thigh at the hip joint.
SIX LATERAL ROTATORS





Piriformis.
Obturator internus.
Gemelli (superior and
inferior ).
Obturator externus.
Quadratus femoris.
DEEP FASCIA OF THE THIGH
(FASCIA LATA)




The deep fascia encloses the thigh like a
trouser leg
At its upper end is attached to the pelvis and
the inguinal ligament
On its lateral aspect, it is thickened to form the
iliotibial tract
The iliotibial tract receives the insertion of


Tensor fasciae latae
Greater part of the gluteus maximus muscle
DR FADEL NAIM
IUG
FASCIAL COMPARTMENTS OF THE THIGH



Three fascial septa pass
from the inner aspect of
the deep fascial sheath of
the thigh to the linea
aspera of the femur
the thigh is divided into
three compartments, each
having muscles, nerves, and
arteries.
The compartments are
Anterior
 Medial
DR FADEL NAIM
 posterior
IUG

CONTENTS OF THE ANTERIOR FASCIAL
COMPARTMENT OF THE THIGH

Muscles:




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Blood supply:


Sartorius
Iliacus
Psoas
Pectineus
quadriceps
femoris.
Femoral artery.
Nerve supply:

Femoral nerve.
DR FADEL NAIM
IUG
Sartorius


A narrow, strap-shaped muscle that covers the
femoral artery in the middle one third of the
thigh.
Origin:


Insertion:



The muscle fibers run downward and medially
Attached to the upper part of the medial surface
of the shaft of the tibia.
Nerve supply:


From the anterior superior iliac spine.
Femoral nerve.
Action:

At the hip joint




Flexes
Abducts
Laterally rotates the thigh
At the knee joint


Flexes
Medially rotates the leg.
DR FADEL NAIM
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Iliacus

Origin:


Insertion:


The fibers converge and join the tendon of the psoas
to form the iliopsoas muscle
Nerve supply:


This fan-shaped muscle arises from the iliac fossa
within the abdomen
A branch of the femoral nerve within the abdomen.
Action:



Flexes the thigh on the trunk at the hip joint
If the thigh is fixed, it flexes the trunk on the thigh
Medially rotates the thigh.
DR FADEL NAIM
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Psoas


A long fusiform muscle that arises within the abdomen and
descends into the thigh.
Origin:

From the 12th thoracic to the 5th lumbar vertebrae




Insertion:

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
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The fibers run downward and laterally
Leave the abdomen to enter the thigh by passing behind the
inguinal ligament.
The iliopsoas tendon is attached to the lesser trochanter of the
femur.
A bursa intervenes between the tendon and the hip joint
May communicate with the joint.
Nerve supply:


From the roots of the transverse processes,
The sides of the vertebral bodies
The intervertebral discs,
Branches from the lumbar plexus.
Action:


The iliopsoas flexes the thigh on the trunk at the hip joint
If the thigh is fixed, it flexes the trunk on the thigh.
DR FADEL NAIM
IUG
DR FADEL NAIM
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Pectineus

Origin:


Insertion:



The muscle fibers pass downward,
backward,and laterally
Attached to the upper end of the linea aspera
just below the lesser trochanter.
Nerve supply:



From the superior ramus of the pubis
Femoral nerve
Occasionally, it receives a branch from the
obturator nerve
Action:

Flexes and adducts the thigh at the hip joint
DR FADEL NAIM
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Quadriceps Femoris

The quadriceps femoris muscle consists of
four parts:





Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
A common tendon of insertion into the upper,
lateral, and medial borders of the patella

Via the ligamentum patellae, into the tubercle of
the tibia.
DR FADEL NAIM
IUG
Rectus Femoris

Origin:



Insertion:



A straight head from the anterior
inferior iliac spine
A reflected head from the ilium above
the acetabulum
The two heads unite in front of the hip
joint,
The bipennate muscle is inserted into
the quadriceps tendon and so into the
patella.
Nerve supply:

Femoral nerve
DR FADEL NAIM
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Vastus lateralis

Origin:




Insertion:



From the intertrochanteric line
The base of the great trochanter
The linea aspera of the femur
The fibers pass downward and forward to
be inserted into the quadriceps tendon
and so into the patella.
Some of the tendinous fibers join the
capsule of the knee joint and
strengthen it.
Nerve supply:

Femoral nerve
DR FADEL NAIM
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Vastus Medialis

Origin:



From the intertrochanteric line
the linea aspera of the femur
Insertion:




The fibers pass downward and forward
inserted into the quadriceps tendon and so
into the patella.
Some of the tendinous fibers join the
capsule of the knee joint and
strengthen it.
The lowest muscle fibers are almost
horizontal in direction and prevent the
patella from being pulled laterally during
contraction of the quadriceps muscle.
 DRNerve
FADEL NAIM
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
supply:
Femoral nerve
Vastus Intermedius

Origin:


Insertion:



The fibers pass downward
join the deep aspect of the quadriceps tendon.
Nerve supply:


From the anterior and lateral surfaces of the
shaft of the femur
Femoral nerve
The articularis genus



a small part of the vastus intermedius
inserted into the upper part of the synovial
membrane of the knee joint.
It serves to retract the synovial membrane
superiorly during extension of the knee joint.
DR FADEL NAIM
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Action of Quadriceps Femoris Muscle (Quadriceps
Mechanism)





a powerful extensor of the knee joint.
Some of the tendinous fibers of the
vastus lateralis and vastus medialis form
bands, or retinacula, that join the
capsule of the knee joint and strengthen
it.
The lowest muscle fibers of the vastus
medialis are almost horizontal and
prevent the patella from being pulled
laterally during contraction of the
quadriceps muscle.
The tone of the quadriceps muscle
greatly strengthens the knee joint.
The rectus femoris muscle also flexes
the hip joint.
DR FADEL NAIM
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DR FADEL NAIM
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QUADRICEPS FEMORIS AS A KNEE JOINT STABILIZER



The quadriceps femoris is a most important extensor muscle
for the knee joint.
Its tone greatly strengthens the joint
Carefully examined

Both thighs should be examined






Size
Consistency
Strength
Reduction in size caused by muscle atrophy can be tested by
measuring the circumference of each thigh a fixed distance
above the superior border of the patella.
The vastus medialis muscle extends farther distally than the
vastus lateralis.
The vastus medialis is the first part of the quadriceps muscle
to atrophy in knee joint disease and the last to recover.
DR FADEL NAIM
IUG
CONTENTS OF THE MEDIAL FASCIAL
COMPARTMENT OF THE THIGH

Muscles:






• Blood supply:



Gracilis
Adductor longus
Adductor brevis
Adductor magnus
Obturator externus
Profunda femoris artery
Obturator artery
• Nerve supply:

Obturator nerve
Gracilis



Long and strap like
Lies on the medial side of the thigh and the knee
Origin:



Insertion:




The fibers pass downward along the medial side of the
thigh
Attached to the upper part of the medial surface of
the shaft of the tibia
Close to that of the sartorius and the
semitendinosus muscles.
Nerve supply:


The outer surface of the inferior ramus of the pubis
The ramus of the ischium
Obturator nerve.
• Action:


Adducts the thigh at the hip joint
Flexes the leg at the knee joint
Adductor Longus



Triangular
The most anterior of the three adductor
muscles
Origin:


Insertion:



The muscle fibers diverge as they pass downward
and laterally
Attached to the linea aspera
Nerve supply:


From the front of the body of the pubis below
and medial to the pubic tubercle
Obturator nerve.
• Action:


Adducts the thigh at the hip joint
Assists in lateral rotation
Adductor Brevis


lies posterior to the pectineus and
the adductor longus.
Origin:


Insertion:



The muscle fibers diverge as they pass
downward and laterally
attached to the linea aspera
Nerve supply:


From the outer surface of the inferior
ramus of the pubis
Obturator nerve.
Action:


Adducts the thigh at the hip joint
Assists in lateral rotation
Adductor Magnus



A large, triangular muscle
Consisting of adductor and hamstring portions
Origin:




Insertion:
In the adductor portion:







The fibers that arise from the ischial tuberosity are inserted below on
the adductor tubercle on the medial condyle of the femur.
Nerve supply:
The adductor portion: the obturator nerve
The hamstring portion: the sciatic nerve.
Action:
The adductor portion



The muscle fibers diverge as they pass downward and laterally
Attached to the posterior surface of the shaft of the femur.
In the hamstring portion


From the outer surface of the inferior ramus of the pubis
From the ramus of the ischium and the ischial tuberosity.
Adducts the thigh at the hip joint
Assists in lateral rotation.
The hamstring portion

Extends the thigh at the hip joint.
Adductor Hiatus


A gap is in the attachment of this muscle to
the femur
Permits the femoral vessels to pass from the
adductor canal downward into the popliteal
space
Obturator Externus


A deeply placed, triangular muscle.
Origin:



• Insertion:



The muscle fibers converge as they pass laterally at first below
and then behind the hip joint
Inserted onto the medial surface of the greater trochanter.
• Nerve supply:


From the outer surface of the obturator membrane
The pubic and ischial rami.
Obturator nerve.
• Action:

Laterally rotates the thigh at the hip joint.
CONTENTS OF THE POSTERIOR FASCIAL
COMPARTMENT OF THE THIGH

Muscles:





Blood supply:


Biceps femoris
Semitendinosus
Semimembranosus
a small part of the
adductor magnus
(hamstring muscles).
Branches of the
profunda femoris artery.
Nerve supply:

Sciatic nerve.
Biceps Femoris

Origin:

The long head


The short head




The two heads unite just above the knee joint
The common tendon is inserted into the head of
the fibula.
Nerve supply:



The linea aspera
The lateral supracondylar ridge of the shaft of the
femur.
Insertion:


The ischial tuberosity
The long head is supplied by the tibial part of the
sciatic
The short head is supplied by the common
peroneal part of the sciatic.
Action:


Flexes and laterally rotates the leg at the knee joint
The long head also extends the thigh at the hip
joint.
Semitendinosus

Origin:


Insertion:


By a long tendon into the upper part of
the medial surface of the shaft of the
tibia.
Nerve supply:


From the ischial tuberosity
The tibial portion of the sciatic.
Action:


Flexes and medially rotates the leg at the
knee joint
Extends the thigh at the hip joint.
Semimembranosus

Origin:


From the ischial tuberosity
Insertion:


Into the posteromedial surface of the medial condyle of the tibia.
The oblique popliteal ligament:


Nerve supply:


A fibrous expansion upward and laterally, which reinforces the
capsule on the back of the knee joint
The tibial portion of the sciatic.
Action:


Flexes and medially rotates the leg at the knee joint
It also extends the thigh at the hip joint.
Adductor Magnus (Hamstring
Portion)

Origin:




Insertion:
In the hamstring portion


the fibers that arise from the ischial tuberosity
are inserted below on the adductor tubercle on
the medial condyle of the femur
Nerve supply:


From the outer surface of the inferior ramus of
the pubis
from the ramus of the ischium and the ischial
tuberosity.
The tibial portion of the sciatic
Action:

Extends the thigh at the hip joint.
Hip Joint






The articulation between the hemispherical head of the femur and the cupshaped acetabulum of the hip bone
The articular surface of the acetabulum is horseshoe shaped and is deficient
inferiorly at the acetabular notch.
The cavity of the acetabulum is deepened by the presence of a fibrocartilaginous
rim called the acetabular labrum.
The labrum bridges across the acetabular notch and is here called the transverse
acetabular ligament
The articular surfaces are covered with hyaline cartilage.
The hip joint is a synovial ball-and-socket joint.
CAPSULE



The capsule encloses the joint
Attached to the acetabular labrum medially
Laterally
 To the intertrochanteric line of the femur in front
 some of its fibers, accompanied by blood vessels,
are reflected upward along the neck as bands called
retinacula.


These blood vessels supply the head and neck of the femur.
Halfway along the posterior aspect of the neck of the bone
behind.
LIGAMENTS OF THE HIP JOINT

The iliofemoral ligament:

Prevents overextension
during standing.
LIGAMENTS OF THE HIP JOINT

The pubofemoral ligament

This ligament limits extension and abduction.
LIGAMENTS OF THE HIP JOINT

The ischiofemoral ligament

This ligament limits extension.
LIGAMENTS OF THE HIP JOINT

The transverse acetabular ligament



formed by the acetabular labrum as it bridges the acetabular
notch
converts the notch into a tunnel through which the blood vessels
and nerves enter the joint.
The ligament of the head of the femur



It is attached by its apex to the pit on the head of the femur
(fovea capitis)
its base to the transverse ligament and the margins of the
acetabular notch.
It lies within the joint and is ensheathed by synovial membrane
NERVE SUPPLY




Femoral nerve
Obturator nerve
Sciatic nerve
The nerve to quadratus femoris
Movements Of The Hip Joint



A wide range of movement, but less so the shoulder joint
Some of the movement has been scarified to provide
strength and stability.
The strength of the joint depends largely on:



The shape of the bones taking part in the articulation
The strong ligaments.
When the knee is flexed

Flexion is limited by


the anterior surface of the thigh coming into contact with the anterior abdominal
wall.
When the knee is extended

Flexion is limited by

the tension of the hamstring group of muscles.
Movements Of The Hip Joint









Flexion
Extension
Abduction
Adduction
Lateral rotation.
Medial rotation.
Circumduction is a combination of the previous movements.
The extensor group of muscles is more powerful than the flexor
group
The lateral rotators are more powerful than the medial rotators.

Extension is limited by the tension of




Abduction is limited by the tension of



Contact with the opposite limb
The tension in the ligament of the head of the femur
Lateral rotation is limited by



The pubofemoral ligament
Adduction is limited by


The iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
The tension in the iliofemoral ligament
Pubofemoral ligament
Medial rotation is limited by

The ischiofemoral ligament