Lower Extremity: Hip Muscles PDF

Lower Extremity: Hip Muscles Jason Dring, PT, DPT Heavy Contributions By: E. Costello, PT, PhD, Joe Signorino, PT, DPT  Gluteus Maximus From: posterior ilium to the posterior gluteal line, dorsal surface of sacrum & coccyx, & sacrotuberous ligame...

Lower Extremity: Hip Muscles Jason Dring, PT, DPT Heavy Contributions By: E. Costello, PT, PhD, Joe Signorino, PT, DPT  Gluteus Maximus From: posterior ilium to the posterior gluteal line, dorsal surface of sacrum & coccyx, & sacrotuberous ligament To: iliotibial tract that inserts on lateral tibia condyle; some fibers to gluteal tuberosity of femur Action: extends thigh; extension of trunk when LEs are fixed; assists in lateral rotation of thigh Innervation: Inferior gluteal nerve (L5,S1,S2)  Anterior Posterior Me d Mi M PSI n Inferior x a S PIIS Pubic tubercle  Gluteal Gluteus Lines maximu s https://www.memrise.com/course/548150/skeletal-anatomy/6/  x Gluteus Maximus From: the posterior ilium to the posterior gluteal line, dorsal surface x of sacrum & coccyx, & sacrotuberous ligament To: some fibers to gluteal tuberosity of femur; iliotibial tract that inserts on lateral tibia condyle x From: the posterior ilium to posterior gluteal line, dorsal surface of sacrum & coccyx, & sacrotuberous ligament To: iliotibial tract that inserts on lateral tibia condyle; some fibers to gluteal tuberosity of femur x https://anatomyclass01.us/wp-content/uploads/2017/12/posterior-femoral-cutaneous-nerve-name.jpg  Gluteus Medius From: external surface of ilium between anterior & posterior gluteal lines To: lateral surface of greater trochanter of femur x x Action: – Abducts & rotates thigh Anterior Fibers: internal rotators, abduction Posterior Fibers: external rotators, abduction – Abduction of pelvis (Closed chain) – Levels pelvis when opposite leg is raised Strength deficits leads to a pelvic drop gait (Trendelenburg Sign/Gait) Innervation: Superior gluteal n. (L5, S1)  x Gluteus Medius x From: external surface of ilium between anterior & posterior gluteal lines To: lateral surface of greater trochanter of femur x Gluteus x medius Gluteus medius  Trendelenburg www.mikereinold.com/wp-content/uploads/blogger/32-weak%20gluteus %20medius[5 http://www.thestudentphysicaltherapist.com/uploads/ 1/3/2/6/13261333/1347722932.png Trendelenburg  Trendelenburg Gait Which side is involved? Is she using the cane in the correct UE?  Gluteus Minimus From: external surface of ilium between anterior & inferior gluteal lines To: anterior surface of greater trochanter of femur AXN: abducts & medially rotates thigh; abduction of pelvis (close chain) Innervation: Superior gluteal nerve (L5, S1)  Anterior Posterior Me d Mi M PSI n Inferior x a S PIIS Pubic tubercle  p a x i Gluteus Minimus From: external surface of ilium between anterior & inferior gluteal lines To: anterior surface of greater trochanter of femur (next slide) From: x external surface of ilium between anterior & inferior gluteal lines To: anterior surface of greater trochanter of femur minimus Minimus  Piriformis Muscle From: anterior surface of sacrum and sacrotuberous ligament (exits greater Greater sciatic foramen) Sciatic Foramen To: superior border of greater trochanter of femur Piriformi s AXN: – lateral rotation of the extended/neutral thigh – Abducts (and internally rotates from Interventions) when the thigh is flexed – steadies the femoral head in acetabulum Innervation: N. to piriformis (S1, S2) Piriformis used as a key landmark: – superior gluteal n.a.v. exits above piriformis  x Piriformis Muscle x From: anterior surface of Quadratus femoris sacrum and sacrotuberous ligament To: superior border of greater trochanter of femur Piriformis x  Obturator Internus Muscle From: pelvic surface of the obturator membrane & surrounding pelvis bones To: medial surface of greater trochanter of the femur, blending with the gemelli ms. insertion at trochanteric fossa AXN: – lateral rotation of the extended thigh – abducts the flexed thigh – steadies the femoral head Innervation: N. to obturator internus & superior gemellus (L5, S1) Obturator Internus Muscle From: pelvic surface of the obturator membrane & surrounding pelvis bones To: medial surface of greater trochanter of the femur, blending with the gemelli ms. insertion (at trochanteric fossa)  Obturator Internus Muscle From: pelvic surface of the obturator membrane & Quadratus femoris surrounding bones Note: the yellow circle is To: medial surface the obturator of greater foramen; trochanter of the obturator femur, blending internus is with the gemelli found on the ms. insertion at posterior side trochanteric fossa Posterior view – intertrochanter ic crest and fossa Obturator Internus x  Medial to Lateral: Pudendal nerve Never to the obturator internus and Obturator Internus superior x x Superior gemellus gemellus Posterior femoral cutaneous nerve Inferior gluteal nerve Sciatic nerve  Gemelli Muscles Superior Gemelli: from ischial spine to the medial surface of greater trochanter with inferior gemelli & Trochanteri c fossa obturator internus at the trochanteric (posterior fossa view) Inferior Gemelli: from the ischial https://c1.staticflickr.com/3/2276/2335090659_1f3b773b3a_b.jpg tuberosity to the medial surface of the greater trochanter with inferior gemelli & obturator internus at the trochanteric fossa Action: – lateral rotation of the extended thigh – abducts the flexed thigh – steadies the femur Innervations: – Sup gemelli - N. to obturator internus & superior gemellus (L5,S1) Superior Gemellus – Obturator Internus – Inferior Gemellus “Sandwich” Superior Gemellus Obturator Internus Inferior Gemellus https://www.fotoab.com/wp-content/uploads/2015/07/21-Wegmans- Ham-Sandwhich-.jpg https://static1.squarespace.com/static/57d483ff414fb51a88b0053e/ t/5980c43a914e6bdd45feb79d/1501611074695/  x Superior Gemelli: from ischial spine to the medial surface of greater trochanter with inferior gemelli and Ol at the trochanteric fossa Quadratus femoris Inferior Gemelli: from the ischial tuberosity to the medial surface of the greater trochanter with superior gemelli and OI at the trochanteric fossa Superior gemellus Obturator Internus Inferior gemellus  Quadratus Femoris Muscle Intertrochanteric crest Posteri From: lateral border of or View the ischial tuberosity To: quadrate tubercle on intertrochanteric crest of femur and just inferior to it Action: lateral rotation of thigh; steadies the femoral head Innervation: N. to quadratus femoris & Inferior gemellus (L5, S1) https://classconnection.s3.amazonaws.com/591/flashcards/4380591/jpg/2- 142D99DEE6C63203B69-thumb400.jpg Posterio r view, right femur Quadrat e tubercle  Quadratus Femoris Muscle From: lateral x x border of the ischial tuberosity To: quadrate tubercle on intertrochanteri c crest of the femur and just inferior to it From: lateral border of the x ischial tuberosity To: quadrate tubercle on intertrochanteri c crest of the femur and just inferior to it  Obturator Externus Muscle From: margins of obturator foramen & obturator membrane To: trochanteric fossa of the femur Action: – lateral rotation of the thigh – steadies the head of the femur – secondary adduction Innervation: Obturator N. (post division)- L3, L4 From: margins of x obturator foramen & Quadratus femoris obturator membrane To: trochanter ic fossa of the femur (posterior, next slide) From: x margins of obturator foramen & obturator membrane To: trochanter ic fossa of the femur Posterio r view, right femur Trochant eric fossa (green)  Summary Slide: There are 6 DEEP lateral rotators of the thigh Piriformis Superior gemelli Obturator internus Inferior gemelli http://www.scranton.edu/faculty/kosmahl/courses/gonio/lower/images/hiper.jpg Quadratus femoris Obturator externus https://www.bodbot.com/Images/exercises/hi-res/realname/hip-external-rotation--- bands.jpg