Download PTA Hip Student Presentation Fall 2015

The Hip (Iliofemoral) Joint
Heather Friedland, Liz Huisman, Josh McCoy
Surface Anatomy
Iliac Crest?
Iliac Crest! (and Inguinal Ligament)
Josh McCoy
Surface Anatomy,
continued
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Gluteal Fold/Sulcus
Intergluteal Cleft
Sacrum
Iliac Crest
Josh McCoy
Surface Anatomy,
continued
• Anterior Superior Iliac Spine
• Iliac Crest
• Tip of Greater Trochanter
Josh McCoy
Surface Anatomy, continued
Posterior Superior Iliac Spine
Josh McCoy
Surface Anatomy, continued
 Supracristal Plane
• Inguinal Ligament
Josh McCoy
The Hip Joint
Liz Huisman
Iliofemoral Ligament (red)
Prevents hyperextension
Pubofemoral Ligament
(green)
 Prevents overabduction.
Liz Huisman
Ishiofemoral ligament
 Slackens during
adduction, tenses
during abduction
Liz Huisman
Ligaments that support walking
posterior
anterior
Inguinal
ligament
Sacrotuberous
ligament
Liz Huisman
Bursae
Trochanteric bursa
Gluteofemoral bursa
Ischial bursa
Liz Huisman
Bones of the Hip Joint
Heather Friedland
Os Coxa
 Pubis
 Inferior ramus
 Acetabulum
 Ischial tuberosity
 Iliac fossa
 Lesser sciatic notch
 Superior pubic ramus
 Pubic (or suprapubic) arch
 Obturator foramen
 Superior ramus
 Obturator foramen
 Ischium
 Iliac crest
 Ischial spine
 Symphysis pubis
 Inferior pubic ramus
 Pubic crest
 Greater sciatic notch
Heather Friedland
Heather Friedland
Iliac Spines
 Anterior superior
 Anterior Inferior
 Posterior superior
 Posterior inferior
Heather Friedland
Femur
 Head
 Neck
 Greater Trochanter
 Lesser Trochanter
 Linea Aspera
 Pectineal line
 Adductor tuberacle
 Condyles (medial and
lateral)
 Epicondyles (medial and
lateral)
Heather Friedland
Bones: Tibia
 Lateral and Medial Condyles
 Intercondylar Eminence
 Tibial Tuberosity
 Crest
Josh McCoy
Muscles of the Hamstrings
Heather Friedland
A&P 106
11/18/2015
Muscles
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Semitendinosus
Semimembranosus
Gracilis
Pectinius
Biceps Femoris
Piriformis
Heather Friedland
Semitendinosus
 Nerve: Tibial Nerve
 Roots: L5, S1 & S2
 Origin: Ischial tuberosity
 Insertion: Proximal medial shaft of the tibia
at Pes Anserinus tendon
Heather Friedland
Semitendinosus
 Synergist:
 Knee Flexion: Biceps femoris, Semimembranosus, gracilis, sartorius,
gastrocnemius, popliteus
 Hip extension: Gluteus Maximus, Biceps femoris, semimembranosus
 Medial rotation: semimembranosus, gracilus, Sartorius, popliteus,
Semimembranosus
 Antagonist:
 Knee extension: Rectus femoris, Vastus (medialis, lateralis, and intermedialis)
 Hip Flexion: Rectus femoris, iliopsoas, pectineus, Sartorius
 Lateral rotation: Biceps femoris
 Action: Flexes knee. Medially rotates knee. Extends the knee
Heather Friedland
Semimembranosus
Heather Friedland
Semimembranosus
 Nerve: Tibial Nerve
 Roots: L5, S1 & S2
 Origin: Ischial tuberosity
 Insertion: Posterior medial condyle of the tibia
 Synergist: Same as Semitendinosis
 Antagonist: Same as Semitendinosis
 Action: Flexes knee. Medially rotates flexed knee
and extends the hip
Heather Friedland
Gracilis
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Nerve: Obturator nerve
Roots: L2 and L3
Origin: Body and inferior ramus of pubis
Insertion: Anterior medial proximal tibia
Heather Friedland
Gracilis
 Synergist:
 Adduction: Adductor(magnus, brevis, and longus), Gracilis, pectineus
 Medial rotation: Gluteus (medius and minimus), adductor (all 3), Pectinius, TFL,
Gracilis
 Knee flexion: Semimembranosus, Semiteninosis, biceps femoris, gracilis,
gastrocnemius, Popliteus, Sartorius
 Antagonist:
 Abduction: Gluteus (maximus, medius, and minimus), TFL, Sartorius
 Lateral Rotation: Gluteus maximus, Sartorius, piriformis, iliopsoas
 Knee extension: Rectus femoris, Vastus (medialis, lateralis, and intermedialis)
 Action: Adducts and medially rotates hip. Flexes the knee
Heather Friedland
Pectineus
Heather Friedland
Pectinius
 Nerve: Femoral Nerve, also fibers from the Obturator nerve
 Roots: L2 - L4
 Origin: Superior ramus of the pubis
 Insertion: Pectineal line inferior to lesser trochanter of femur
Heather Friedland
Pectineus
 Synergist:
 Flexion: Rectus femoris, Iliopsoas, TFL, Sartorius, Adductor (longus & brevis)
 Adduction: Adductor (longus, brevis, and magnus), Gracilis, Pectineus
 Medial rotation: Gluteus(medius & minimus), Adductor (longus and brevis),
Gracilis
 Antagonist:
 Extension: Gluteus maximus, Semimembranosus, Semitendinosis, Biceps femoris,
Adductor magnus
 Abduction: Gluteus(medius and minimus), TFL, Sartorius
 Lateral Rotation: Gluteus maximus, Piriformis, Sartorius
 Action: Flexes, adducts, and assists with medial rotation of the hip
Heather Friedland
Biceps Femoris
Heather Friedland
Biceps Femoris
 Nerve: Tibial nerve (LH) and Fibular nerve (SH)
 Roots: L5, S1 & S2
 Origin: Long head: Ischial tuberosity
Short Head: Linea aspera of femur
 Insertion: Head of fibula and lateral condyle of tibia
Heather Friedland
Biceps Femoris
 Synergist:
 Hip Extension: Gluteus maximus, Semitendinosis, Semimembranosis, Adductor
 Lateral Rotation: Gluteus Maximus, Piriformis, Iliopsoas, Sartorius
 Knee Flexion: Semitendinosis, Semimembranosis, Gastrocnemius, Gracilis, Sartorius
 Antagonist:
 Hip Flexion: Rectus femoris, Iliopsoas, Pectinus, TFL, Sartorius
 Medial Rotation: Gluteus(medius and minimus), TFL, Adductor (magnus, longus, and
brevis), pectineus, Gracilis
 Knee Extension: Vastus (medialis, lateralis, and intermedialis), Rectus femoris
 Action:
 Long head: Extends hip and flexes knee
Short Head: Flexes knee and laterally rotates hip
Laterally rotates flexed knee
Heather Friedland
Piriformis
Heather Friedland
Piriformis
 Nerve: Piriformis Nerve
 Roots: L5, S1 & S2
 Origin: Anterior Surface of lateral process of sacrum and gluteal
surface of ilium at the margin of the greater sciatic notch
 Insertion: Superior border of greater trochanter
Heather Friedland
Piriformis
 Synergist:
 Abduction: Gluteus (medius, minimus), TFL, Sartorius
 Lateral rotation: Gluteus maximus, Iliopsoas, piriformis, Sartorius
 Medial rotation: Glutues (minimus, medius), TFL, Adductor (all 3), Gracilis
 Antagonist:
 Adduction: adductors (all 3), Gracilis, Pectinius, Gluteus maximus
 Medial rotation: Gluteus (Minimus and medius), TFL, Adductor (all 3),
Pectinius, Gracilis
 Action: Laterally rotates and abducts thigh when hip is flexed
Heather Friedland
Adductors Brevis & Longus
Actions:
 Adduction
 Flexion
 Assists in medial hip
rotation
Liz Huisman
Adductors Brevis
Origin:
Nerve:
 Anterior surface of the inferior
ramus of the pubis
 Obturator nerve
Insertion:
 Pectineal line, medial lip of
linea aspera of femur.
Roots:
 L2-L4
Liz Huisman
Adductor Brevis
Synergists
Antagonists
Adduction:
 Adductor (longus & magnus), gracilis,
pectineus
Medial Rotation:
 Gluteus (minimus & medius), adductor
(longus & magnus), pectineus, tensor
fascaie latae, gracilic
Flexion:
 Rectus femoris, Iliopsoas, pectineus,
TFL, sartorius
Abduction:
 Gluteus (all 3), TFL, Sartorius
Lateral Rotation:
 Gluteus maximus, Sartorius,
piriformis, Iliopsoas
Extension:
 Gluteus maximus,
semimembgranosus, semitendinosus,
biceps femoris, adductor magnus
Liz Huisman
Adductor longus
Origin:
Nerve:
 Body of pubis inferior to pubic
crest & lateral pubic symphysis.
 Obturator nerve
Insertion:
 Middle 1/3 of linea aspera of the
femur
Roots:
 L2-L4
Liz Huisman
Adductor Longus
Synergists
Adduction:
 Adductors (brevis & magnus),
gracilis, pectineus
Medial Rotation:
 Gluteus (minimus &medius),
adductor (brevis & magnus),
pectineus, TFL, gracilis
Flexion:
 Rectus femoris, Iliopsoas,
pectineus, TFL, sartorius
Antagonists
Abduction:
 Gluteus (all 3), TFL, Sartorius
Lateral Rotation:
 Gluteus maximus, Sartorius,
piriformis, Iliopsoas
Extension:
 Gluteus maximus,
semimembranosus,
semitendinosus, biceps femoris,
adductor magnus
Liz Huisman
Adductor Magnus
Origin:
Inferior ramus of pubis and ischium to ischial tuberosity.
Insertion:
Linea aspera of femur. Medial supracondylar line and
adductor tubercle.
Nerve:
Obturator and tibial nerve
Roots:
L2-L4
Actions: Adducts thigh, superior horizontal fibers flexes thigh,
posterior portion extends thigh at hip joint
Liz Huisman
Adductor Magnus
Synergists
Antagonists
Adduction:
 Adductor (longus & brevis),
gracilis, pectineus
Abduction:
 Gluteus (all 3), TFL, Sartorius
Hip Flexion:
 Rectus femorus, Iliopsoas,
pectineus, TFL, gluteus (medius
& minimus), adductor (longus &
brevis)
Hip Extension:
 Gluteus maximus,
semimembranosus,
semitendinosus, biceps femoris
Liz Huisman
The Glutes
Actions
Gluteus medius & minimus
 Hip abduction
 Medial rotation of hip
Gluteus maximus
 Extends the hip
Liz Huisman
Gluteus Minimus
Origin:
 Dorsal ilium between inferior
and anterior gluteal lines
Insertion:
 Greater trochanter of femur
Nerve:
 Superior gluteal nerve
Roots:
 L4 & L5, S1
Liz Huisman
Gluteus Minimus
Synergists
Abduction:
 Gluteus medius, tensor fasciae
latae, Sartorius
Medial Rotation:
 Gluteus medius, tensor fasciae
latae, Adductor (all 3)
Antagonists
Adduction:
 Adductors (all3), gracilis,
pectineus, gluteus maximus
Lateral Rotation:
 Gluteus maximus, piriformis,
iliopsoas, sartorius
Liz Huisman
Gluteus Medius
Origin:
 Dorsal ilium inferior to iliac
crest
Insertion:
 Greater trochanter of femur
Nerve:
 Superior Gluteal nerve
Roots:
 L4 & L5, S1
Liz Huisman
Gluteus Medius
Synergists
Antagonists
Abduction:
 Gluteus (maximus & minimus),
tensor fasciae latae, Sartorius
Adduction:
 Adductors (all 3), gracilis,
pectineus
Medial Rotation:
 Gluteus minimus, tensor fasciae
latae, adductors (all 3),
pectineus, gracilis
Lateral Rotation:
 Gluteus maximus, piriformis,
iliopsoas, sartorius
Liz Huisman
Gluteus Maximus
Origin:
 Iliac crest, sacrum, coccyx and
aponeurosis of sacrospinalis
Insertion:
 Lateral part of linea aspera
under greater trochanter
(gluteal tuberosity) of femur
Nerve:
 Inferior gluteal nerve
Roots:
 L5, S1 & S2
Liz Huisman
Gluteus Maximus
Synergists
Antagonists
Extension:
 Semimembranosus,
semitendinosus, biceps femoris,
adductor magnus
Flexion:
 Gluteus (medius & minimus),
rectus femoris, iliopsoas,
pectineus, TFL, Sartorius
Lateral Rotation:
 Piriformis, iliopsoas, sartorius
Medial Rotation:
 Gluteus (medius & minimus),
TFL, adductors (all 3), pectineus,
gracilis
Liz Huisman
Psoas Major (of Iliopsoas)
 Action: Hip/Thigh Flexion
 Origin: Transverse Processes of T12-L5
 Insertion: Lesser Trochanter
 Nerve: Lumbar Nerves (L1-L3)
Josh McCoy
Iliacus (of Iliopsoas)
 Action: Hip/Thigh Flexion
 Origin: Iliac Crest, Fossa,
Anterior Sacroiliac Ligament
 Insertion: Lesser Trochanter
 Synergist (Iliopsoas): Rectus
Femoris, Pectineus
 Antagonist (Iliopsoas): Gluteus
Maximus, Semimembranosus,
Semitendinosus, Biceps Femoris
Josh McCoy
Rectus Femoris
• Action: Extension at Knee, Flexion at Hip
• Origin: Anterior Inferior Iliac Spine
• Insertion: Patella via Quadriceps Tendon
and then Tibial Tuberosity via Patellar
Ligament
• Nerve: Femoral
• Roots: L2-L4
Josh McCoy
Rectus Femoris, continued
 Synergist:
 Hip Flexion: Iliopsoas (Psoas Major and Iliacus), Pectineus
 Knee Extension: Vastus (Medialis, Lateralis, and Intermedialis)
 Antagonist:
 Hip Extension: Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps
Femoris
 Knee Flexion: Semimembranosus, Semitendinosus, Biceps Femoris
Josh McCoy
Sartorius
 Action: Flexes Knee; Flexes, Abducts, and
Laterally Rotates Hip
 Origin: Anterior Iliac Spine
 Insertion: Upper Medial Surface of Body of Tibia
 Nerve: Femoral
 Roots: L2-L3
Josh McCoy
Sartorius, continued
 Synergist:
 Hip Flexion: Rectus Femoris, Iliopsoas, Pectineus
 Knee Flexion: Semimembranosus, Semitendinosus, Biceps Femoris
 Hip Abduction: Gluteus Minimis and Medius
 Antagonist:
 Hip Extension: Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps Femoris
 Knee Extension: Quadriceps Muscles
 Hip Adduction: Adductor (Longus, Brevis, and Magnus), Pectineus, Gracillis
Josh McCoy
Tensor Fascia Latae (TFL)
 Action: Flexes and Abducts Thigh
at Hip Joint; Helps stabilize and
steady the Hip and Knee Joints
by putting tension on the
Iliotibial Band of Fascia
 Origin: Anterior Superior Iliac
Spine and Anterior Iliac Crest
 Insertion: Tibia by way of
Iliotibial Tract
Josh McCoy
Tensor Fascia Latae (TFL), continued
 Nerve: Superior Gluteal Nerve
 Roots: L4, L5, S1
 Synergist:
 Flexion: Rectus Femoris, Iliopsoas, Pectineus
 Abduction: Gluteus Medius and Minimis
 Antagonist:
 Extension: Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps Femoris
 Adduction: Gracillis, Pectineus, Adductors (All Three)
Josh McCoy
Nerves
Obturator and Femoral
Superior and Inferior Gluteal, Sciatic
Josh McCoy
More Nerves (are we
getting on yours yet?)
Common Peroneal
Josh McCoy
What are Pirate’s favorite
vessels? ARRRRteries!
Har har har
• Femoral
• Deep Femoral (Profundus)
• Obturator
• Medial Circumflex Femoral
• Lateral Circumflex Femoral
Josh McCoy
Posterior Arteries
 Superior Gluteal
 Inferior Gluteal
Josh McCoy
You’re so VEIN, you probably think this slide is
about you! Don’t you, don’t you?
 Femoral
 Great Saphenous
 Profunda (Deep) Femoral
Josh McCoy
Clinical Concerns: Total Hip Replacement
Josh McCoy
Clinical Concerns: Total Hip Replacement,
continued
According to www.medicinenet.com, “A total hip replacement is
a surgical procedure whereby the diseased cartilage and bone of
the hip joint is surgically replaced with artificial materials. The
normal hip joint is a ball and socket joint. The socket is a ‘cupshaped’ component of the pelvis called the acetabulum.”
Josh McCoy