Download - The pelvis and hip
The Pelvis and Hip The Pelvis and Hip
Nervous SystemNervous System
Highly complexControls, stimulates, and coordinates all
other body systemsCan be divided:
– Central Nervous System (CNS)– Peripheral Nervous System (PNS)– Autonomic Nervous System (ANS)
THE NERVOUS SYSTEMTHE NERVOUS SYSTEM
Peripheral Nervous System Peripheral Nervous System (PNS)(PNS)
Composed of all the nervous tissue outside the vertebral canal
Begins at the anterior horn of the spinal cord
Branches of the Spinal Nerves Branches of the Spinal Nerves
Posterior primary rami innervate the deep muscles of the back and the skin covering these muscles
Spinal nerve continues as the anterior primary ramus
Branches of the Spinal Nerves Branches of the Spinal Nerves (cont(cont’’d)d)
Anterior primary rami innervate all muscles and skin not innervated by the posterior primary rami
Plexus FormationPlexus Formation
Anterior branches of spinal nerves in thoracic region give rise to intercostal nerves (not a plexus)
Spinal nerves in other regions combine to form complex networks called plexuses
Plexus Formation Plexus Formation (cont(cont’’d)d)
1. Cervical Plexus - C1 - C4– Innervates neck muscles
2. Brachial Plexus - C5 - T1– Innervates UE muscles
3. Lumbosacral Plexus- L1 - S5– Innervates LE muscles– Lumbar portion- L1-L4
Supplies mostly the thigh
– Sacral portion - L5-S5 Supplies mostly the leg
and foot
IliopsoasIliopsoas Actually two muscles
– Separate origin– Common insertion
O: Iliacus - iliac fossaPsoas major - anteriorand lateral surfaces T12-L5
I: Lesser trochanterA: Hip flexionN: Iliacus - Femoral Nerve
Psoas Major - L2-3
Rectus FemorisRectus Femoris
Part of the quadriceps Two-joint muscle crosses hip
and knee anteriorly
O: Anterior inferior iliac spine
I: Tibial tuberosity
A: Hip flexion, Knee extension
N: Femoral Nerve, L2-L4
SartoriusSartorius
Longest muscle in the body Straplike muscle “Tailor’s Muscle”
O: Anterior superior iliac spine
I: Proximal medial aspect of tibia
A: Hip flexion, abduction, lateral rotation
N: Femoral Nerve, L2-L3
PectineusPectineus Located
– Medial to the iliopsoas– Lateral to the adductor
longus
O: Superior ramus of pubis
I: Pectineal line of femur
A: Hip flexion and adduction
N: Femoral Nerve, L2-L4
Adductor Longus (A)Adductor Longus (A)
Most superficial– Tendon palpable in anterior-
medial groin
O: PubisI: Middle 1/3 linea
asperaA: Hip adductionN: Obturator Nerve,
L3-L4
Adductor Brevis (B)Adductor Brevis (B) Shorter Deep to adductor longus Superficial to adductor magnus
O: Pubis
I: Pectineal line and proximal linea aspera
A: Hip adduction
N: Obturator Nerve, L3-4
Adductor Magnus Adductor Magnus (C)(C)
Largest, most massive, and deepest
Opening or hiatus in distal attachment between linea aspera and adductor tubercle– Femoral artery and vein pass
through opening– After femoral artery and vein
pass through, their names change to popliteal artery and vein
Adductor MagnusAdductor Magnus (C)(C)
(cont(cont’’d)d)
O: Ischium and pubis
I: Entire linea aspera and adductor tubercle
A: Hip adduction, extension
N: Obturator and sciatic nerve (L3-L4)
GracilisGracilis
Two-joint muscle
O: Pubis
I: Anterior medial surface of proximal end of tibia
A: Hip adduction
N: Obturator Nerve, L2-L3
Gluteus MaximusGluteus Maximus Large, one-joint, quadrilateral-shaped,
thick, superficial muscle Some fibers attach to iliotibial band
O:Posterior sacrum and ilium
I: Posterior femur distal to greater trochanter
A: Hip extension, hyperextension, lateral rotation
N: Inferior gluteal nerve, L5, S1, S2
Deep RotatorDeep RotatorMusclesMuscles
Number = 6, deep, mostly posterior muscles spanning the hip joint in a horizontal direction
Laterally rotate the hip
O: Posterior sacrum, ischium, pubis
I: Greater trochanter area
A: Hip lateral rotation
Deep Rotator MusclesDeep Rotator Muscles
Muscle Proximal Attachment Distal Attachment Innervation
Obturator externus Rami of pubis and ischium Trochanteric fossa Obturator nerve
Obturator internus Rami of pubis and ischium Greater trochanter Nerve to obturatorinternus
Quadratus femoris Ischial tuberosity Intertrochanteric crest Nerve to quadratus
femoris
Piriformis Sacrum Greater trochanter S1, S2 segments
Gemellus superior Ischium Greater trochanter Nerve to obturator
internus
Gemellus inferior Ischial tuberosity Greater trochanter Nerve to quadratus
femoris
Deep Rotator Muscles Deep Rotator Muscles (cont(cont’’d)d)“Piece Goods Often Go On Quilts”
Anatomical order superior to inferior– Piriformis– Gemellus superior– Obturator internus– Gemellus inferior– Obturator externus– Quadratus femoris
HamstringsHamstrings
Posterior thigh muscles Two joint muscles except
short head of biceps femoris Ischial tuberosity - common
origin
A. Semitendinosus
B. Biceps femoris
C. Semimembranosus
SemimembranosusSemimembranosus (C)(C)
O: Ischial tuberosity
I: Posterior surface of medial condyle of
tibia
A: Extend hip, flex knee
N: Sciatic nerve
L5, S1, S2
Semitendinosus Semitendinosus (A)(A)
O: Ischial tuberosity
I: Anteromedial surface of proximal tibia
A: Extend hip, flex knee
N: Sciatic nerve
L5, S1, S2
Biceps Femoris Biceps Femoris (B)(B)
O: Long head: Ischial tuberosityShort head: lateral lip
linea aspera
I: Fibular head
A: Long head: Extend hip, flex knee
Short head: Flex knee
N: Long head: Sciatic nerve, S1-S3
Short head: Common peroneal nerve, L5-
S2
Gluteus MediusGluteus Medius
Triangular shaped
O: Outer ilium
I: Greater trochanter
A: Hip abduction
N: Superior gluteal nerve
L4, L5, S1
Gluteus MinimusGluteus Minimus Deep and inferior to the gluteus
medius
O: Lateral ilium I: Anterior surface of the
greater trochanterA: Hip abduction, internal
rotationN: Superior gluteal nerve
L4, L5, S1
Reversal of Muscle FunctionReversal of Muscle Function
When you stand on one leg:– Distal segment (femur) becomes more stable than the
proximal segment (os coxae)– Origin moves toward insertion
Without contracting - pelvis would drop on opposite side
Weakness “Trendelenberg gait”– If weak right hip abductors, stand on right, left side drops
Reversal of Muscle Reversal of Muscle FunctionFunction (cont(cont’’d)d)
A. In reversal of muscle function, the right hip abductors contract to keep the pelvis steady when the left leg is lifted.
B. When right hip abductors are weak, the left side of the pelvis drops.
Tensor Fascia LataeTensor Fascia Latae
Short muscle Long tendinous attachment
O: Anterior superior iliac spine
I: Lateral condyle of tibia
A: Combined hip flexion and abduction
N: Superior gluteal nerve
L4-L5
Force-Couple for anterior tilt
Compensation for tight hip flexors
Stabilizing role of abdominalsStabilizing role of abdominals
Poor stabilization of abdominals
Bilateral cooperation of adductorsBilateral cooperation of adductors