gluteal.pdf

GLUTEAL REGION and HIP JOINT Gluteus Maximus  Orijin: Ileum posterior to posterior gluteal line ,dorsal surface of sacrum and coccyx, and sacrotuberous ligament  Insertion : Most fibers end in iliotibial tract that inserts onto lateral condyle of tibia ; some fibers insert on gluteal tuberosity of...

GLUTEAL REGION and HIP JOINT Gluteus Maximus  Orijin: Ileum posterior to posterior gluteal line ,dorsal surface of sacrum and coccyx, and sacrotuberous ligament  Insertion : Most fibers end in iliotibial tract that inserts onto lateral condyle of tibia ; some fibers insert on gluteal tuberosity of femur  Innervation : Inferior gluteal nerve (L5,S1,S2)  Action :extends thigh and assists in its lateral rotation, steadies thigh and assists in rising from sitting possition Gluteus Medius  Origo: External surface of ileum between anterior and posterior gluteal lines  Insertion : Lateral surface of greater trochanter of femur  Innervation : Superior gluteal nerve (L5,S1)  Action : Abduct and medially rotate thigh ;keeps pelvis level when opposite leg is raised Gluteus Minimus  Origo: External surface of ileum between anterior and posterior gluteal lines  Insertion : Anterior surface of greater trochanter of femur  Innervation : Superior gluteal nerve (L5,S1)  Action : Abduct and medially rotate thigh ;keeps pelvis level when opposite leg is raised Piriformis  Origo: Anterior surface of sacrum and sacrotuberous ligament  Insertion : superior border of greater trochanter of femur  Innervation : Branches of anterior rami of S1,S2  Action : Laterally rotate extended thigh and abduct flexed thigh; steady femoral head in acetabulum Obturator internus  Origo: Pelvic surface of obturator membrane and surrounding bones  Insertion : medial surface of greater trochanter of femur  Innervation : nerve to obturator internus (L5-S1)  Action : Laterally rotate extended thigh and abduct flexed thigh; steady femoral head in acetabulum Gemelli  Origo: Superior ischial spine; inferior ischial tuberosity  Insertion : medial surface of greater trochanter of femur  Innervation : Superior gemellus same nerve supply as obturator internus ,inferior gemellus same nerve supply as quadratus femoris  Action : Laterally rotate extended thigh and abduct flexed thigh; steady femoral head in acetabulum Quadratus femoris Origo: Superior ischial spine; inferior ischial tuberosity Insertion : medial surface of greater trochanter of femur Innervation : Superior gemellus same nerve supply as obturator internus ,inferior gemellus same nerve supply as quadratus femoris Action : Laterally rotate extended thigh and abduct flexed thigh; steady femoral head in acetabulum Articulation  The hip joint is the articulation between the hemispherical head of femur and the cup shaped acetabulum of the hip bone  The articular surface of the acetabulum is horseshoe shaped and is deficient inferiorly at the acetabular notch Articulation  The cavity of acetabulum is deepened by the presence of a fibrocartilaginous rim called 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 Type & Capsule  It is a synovial ball and socket joint  The capsule encloses the joint and is attached to the acetabular labrum medially  Laterally it is attached to the intertrochanteric line of the femur in front and along the posterior aspect of the neck of the bone behind  Some fibers wind circularly around neck called orbicular zone Iliofemoral Ligaments  It is a strong, inverted Y-shaped ligament  Its base is attached to the anterior inferior iliac spine above  Distally the two limbs of Y are attached to the upper and lower parts of the intertrochanteric line of the femur  The ligament prevents hyperextension during standing Pubofemoral Ligament  It is a triangular ligament  The base of the ligament is attached to the superior ramus of the pubis  The apex is attached below to the lower part of the intertrochanteric line  This ligament limits extension and abduction Ischiofemoral Ligament  It is a spiral shaped ligament  Attached to the body of the ischium near the acetabular rim  Fibers pass upward and laterally and attached to the neck of femur medial to the greater trochanter  This ligament limits the hyperextension Transverse Acetabular Ligament  It is formed by the acetabular labrum as it bridges the acetabular notch  It converts the notch into a tunnel through which blood vessels and nerves enter the joint Ligament of Head of Femur  It is flat and triangular ligament  It is attached by its apex to the pit on the head of the femur (fovea capitis)  Attached to the transverse ligament and the margins of the acetabular notch Synovial Membrane  The synovial membrane lines the capsule  It is attached to the margins of the articular surfaces  It covers the portion of the neck of the femur that lies within the joint capsule Synovial Membrane It covers the pad of fat contained in the acetabular fossa  Retinacular folds are longitudinal fibers along the femoral neck, contain blood vessels to supply head and neck of femur  Nerve Supply  Femoral nerve  Obturator nerve  Sciatic nerve  Nerve to the quadratus femoris Arteries Medial and lateral circumflex femoral arteries  Artery of the head of femur  Movements  The hip joint has a wide range of movement but less so than the shoulder joint  Some of the movement has been sacrificed to provide strength and stability  The strength of the joint depends largely on the shape of the bones taking part in the articulation and on strong ligaments Movements  When the knee is flexed, flexion is limited by the anterior surface of the thigh coming in contact with the anterior abdominal wall  When the knee is extended, flexion is limited by the tension of the hamstring muscles  Abduction is limited by the tension of the pubofemoral ligament Movements  Adduction is limited by contact with the opposite limb and by the tension of the ligament of the head of the femur  Lateral rotation is limited by the tension in the iliofemoral and pubofemoral ligaments  Medial rotation is limited by the ischiofemoral ligament Movements  Flexion: It is performed by the iliopsoas, rectus femoris, sartorius, also by adductor muscles  Extension: it is performed by the gluteus maximus and the hamstring muscles  Abduction: It is performed by the gluteus medius and minimus, assisted by sartorius, tensor fasciae latae, and piriformis Movements  Adduction: It is performed by the adductor longus and brevis and the adductor fibers of the adductor magnus  Lateral rotation: It is performed by the piriformis, obturator internus and externus, superior and inferior gemelli  Medial rotation: It is performed by the anterior fibers of gluteus medius and gluteus minimus and the tensor fasciae latae  Circumduction: It is a combination of the previous movements Movements  The extensor group of muscles is more powerful than the flexor group  The lateral rotators are more powerful than the medial rotators