Anatomy of the Hip and Gluteal Region

Western University

• Western University is a university located in Canada.

Hip and Gluteal Region

• This is a topic in an anatomy lesson.
• The lesson will cover the bones, ligaments, movements and muscles of the hip and gluteal region.
• Learning outcomes include:
  • Identifying and describing the bones and ligaments related to the hip joint and those that stabilize it.
  • Explaining the basic movements occurring at the hip
  • Identifying intrinsic muscles of the hip and gluteal region, describing their functions and innervations
  • Predicting the implications of nervous and musculoskeletal injuries to the hip and gluteal region.

Regions of the Lower Limb

• The lower limb is divided into regions for study.
• Regions include:
  • Hip
  • Thigh
  • Knee
  • Leg
  • Foot

Bones of the Lower Limb

• The coxal (hip) bone is composed of three separate bones: ilium, ischium, and pubis.
• The left and right coxal bones articulate at the pubic symphysis and sacroiliac joints to form the pelvic girdle.
• The coxal bone articulates with the femur to form the hip joint.
• The femur articulates with the patella and tibia to form the knee joint.
• The fibula also articulates with the tibia.
• The tibia and fibula articulate with the tarsal bones at the ankle joint.

Bones, Joints, and Ligaments

• A general title for the subject matter of these study notes.

Bones of the Hip and Pelvis

• The left and right coxal bones articulate with the sacrum posteriorly (at the sacroiliac joints) and with each other anteriorly (at the pubic symphysis).
• This forms the pelvic girdle
• The coccyx articulates with the inferior aspect of the sacrum.
• The femur articulates with the coxal bone to form the hip joint.

Coxal Bone: Ilium

• The coxal bones (or hip bones) are also known as the innominate bones.
• The innominate bones are formed from the fusion of three smaller bones: the ilium, the ischium, and the pubis.
• The ilium has significant bony features, such as the iliac crest, anterior superior iliac spine, and anterior inferior iliac spine.
• Landmarks on the ilium serve as important reference points for muscle attachments and assessments.

Coxal Bone: Ischium

• The ischium has two main bony landmarks: the ischial spine and the ischial tuberosity.
• These landmarks are important for muscle attatchments and as reference points.
• The greater and lesser sciatic notches are important sites for neurovascular structures passing through them.

Coxal Bone: Pubis

• The pubis, along with the ilium and ischium, forms the coxal bone.
• Landmarks on the pubis, such as the superior and inferior pubic rami, are important for muscle attachments.
• The pubic tubercle and the superior/inferior pubic rami are important reference points
• The obturator foramen is a significant opening important for the passage of nerves and vessels.

Pelvic Joints and Ligaments

• The pelvic girdle is supported by ligaments that provide both stability and mobility to the joints.
• Lumbosacral joints are supported by anterior longitudinal and iliolumbar ligaments.
• Sacroiliac joints are supported by sacroiliac ligaments.
• The pelvic joints are generally stable but can be vulnerable to injury in certain situations, such as difficult childbirth or car accidents.
• Ligament tears and separations are possible consequences.

Pelvic Ligaments

• Ligaments act as both landmarks for muscle attachments and stabilizers of pelvic joints.
• Ligaments include Inguinal, sacrospinous, and sacrotuberous ligaments.

Hip Joint and Proximal Femur

• The head of the femur articulates with the acetabulum of the coxal bone, forming the hip joint.
• Major landmarks on the proximal femur are important for muscle attachments.
• Landmarks include the greater and lesser trochanters and the gluteal tuberosity.

Surface Anatomy

• Several landmarks on the coxal bone and femur are palpable.
• These landmarks are used for clinical assessments and interventions.

The 'Femur Gun'

• A helpful technique for identifying the left and right femurs.

Hip Joint

• Like the shoulder joint, the hip joint is a ball-and-socket joint.
• The hip joint is deeper and more stable than the shoulder joint, but with less mobility.

Movements at the Hip

• The hip, being a ball-and-socket joint, allows for a range of movements.
• Movements include flexion, extension, abduction, adduction, rotation, and circumduction.

Hip Joint and Femur: Sex Differences

• Anatomical differences based on sex (male and female) exist in the hip and femur.
• Differences are considered for diagnosis and treatment planning of hip injuries based on observed variations in the anatomy of the hip.

Hip Joint and Ligaments

• The hip joint has ligaments.
• Important stabilizing ligaments are: iliofemoral, pubofemoral, and ischiofemoral ligaments.
• The spiral appearance of these ligaments is a result of embryolical development.

Hip Joint Injury

• Common hip injuries include dislocation and femoral neck fracture.
• Hip injuries can result in pain, disability, and need for surgical intervention.

Gluteal Region Muscles

• Note: Specific muscle actions and attachments are detailed but should not be memorized in entirety.

Fascia

• The iliotibial band is a thickening of the fascia lata.
• The band surrounds the thigh muscles and separates them into compartments.
• Gluteal and crural fasciae are relevant structures for the gluteal region and leg, respectively.

Superficial Gluteal Muscles

• The Gluteus medius, Gluteus minimus, and Tensor fasciae latae are superficial gluteal muscles.
• Their location, actions, innervations are mentioned but the full memorization of actions is not required.

Deep Gluteal Muscles

• Deep gluteal muscles include Gluteus minimus and Medius, which have similar function but are deeper to the superficial muscle counterparts. 

Lateral Hip Rotator Muscles

• Several muscles work to produce lateral hip rotation.
• These include: piriformis, obturator internus, quadratus femoris, gemellus superior, gemellus inferior, and obturator externus muscles.
• Each of these has a specific origin, insertion and innervation.

Neurovasculature

• A general title used for the neurovascular components of the lower limb.

Arteries of the Lower Limb

• Detailed descriptions of major arteries of the lower limb are provided.
• The femoral artery crosses behind the knee, dividing into the popliteal artery and subsequently multiple branches for the leg and foot

Gluteal Region Arteries

• The superior and inferior gluteal arteries supply the gluteal region.
• Detailed origins and distribution paths of branches from relevant arteries are presented

Veins of the Lower Limb

• Deep and superficial leg and foot veins mirror artery pathways.
• The great and small saphenous veins are important superficial veins.

Lumbosacral Plexus

• The lumbar and sacral plexuses work to innervate the lower limb.
• Individual nerves provide innervation to various muscle groups and parts of the lower limb

Gluteal Region Nerves

• The superior and inferior gluteal nerves emerge through the greater sciatic foramen..
• Relevant nerves include superior gluteal and inferior gluteal nerves, sciatic and tibial nerves.

Dermatomes vs Nerve Maps

• Dermatomes and nerve maps overlap but not perfectly.

Simplified Muscle Chart

• Summary of major hip muscles, including origin, insertion, main actions, and innervation.

Upper vs Lower Limb

• Diagram comparing the upper and lower limbs for bones, joints, mobility, and stability.
• Functional differences are emphasized.

Learning Outcomes

• Summary reinforcement of learning expectations for the anatomy lesson.

Explore the anatomy of the hip and gluteal region in this quiz. You'll learn about the bones, ligaments, muscles, and movements associated with the hip joint. Additionally, the implications of injuries to this area will be discussed, enhancing your understanding of human anatomy.