Muscles and Neurovascular Structures around the Hip PDF

Muscles and Neurovascular Structures around the Hip Ngozi Onuegbu PhD PT4050/PT7001 Hip Joint Type of joint: Ball-and-socket Articulating surfaces: Acetabulum of the pelvis and head of the femur Functions: Weight-bearing, locomotion, stability, and flexibility Muscles of the Hip Fl...

Muscles and Neurovascular Structures around the Hip Ngozi Onuegbu PhD PT4050/PT7001 Hip Joint Type of joint: Ball-and-socket Articulating surfaces: Acetabulum of the pelvis and head of the femur Functions: Weight-bearing, locomotion, stability, and flexibility Muscles of the Hip Flexors: Iliopsoas, Sartorius, Rectus Femoris Extensors: Gluteus Maximus, Hamstrings Abductors: Gluteus Medius, Gluteus Minimus, Tensor Fascia Latae Adductors: Adductor Longus, Adductor Brevis, Adductor Magnus, Gracilis, Pectineus Internal Rotators: Gluteus Medius (anterior fibers), Gluteus Minimus External Rotators: Piriformis, Obturator Internus, Obturator Externus, Gemelli, Quadratus Femoris  Neurovascular Structures of the Hip Main Nerves Femoral Nerve: Innervates anterior muscles (flexors) Sciatic Nerve: Passes through the gluteal region, innervates posterior compartment (extensors) Obturator Nerve: Supplies adductor muscles Gluteal Nerves: Superior (supplies gluteus medius, minimus), Inferior (supplies gluteus maximus)  Clinical Relevance: Compression or injury to the sciatic nerve may cause sciatica, and damage to Gluteal Nerves the superior gluteal nerve may result in weakened hip abduction, contributing to gait abnormalities. Neurovascular Structures of the Hip Blood Supply Arteries: Femoral artery, obturator artery, superior and inferior gluteal arteries Veins: Femoral vein, great saphenous vein Anterior Muscles (Hip Flexors) Iliopsoas Muscle Origin: Psoas major: Transverse processes of T12-L5 vertebrae Iliacus: Iliac fossa of pelvis Insertion: Lesser trochanter of femur Action: Hip flexion Nerve supply: Femoral nerve (L2-L4) Blood supply: Iliolumbar artery, femoral artery Clinical Relevance: Tightness in the iliopsoas is common in individuals with prolonged sitting postures and can contribute to lower back pain and anterior pelvic tilt. Sartorius Origin: Anterior superior iliac spine (ASIS) Insertion: Pes anserinus (medial surface of tibia) Action: Flexes, abducts, and externally rotates the hip; flexes the knee Nerve supply: Femoral nerve (L2-L3) Blood supply: Femoral artery Clinical Relevance: Pes anserine bursitis, commonly seen in runners, can affect the insertion point of the sartorius along with other muscles in the region.  Rectus Femoris (Part of Quadriceps) Origin: Anterior inferior iliac spine (AIIS) and superior part of the acetabulum Insertion: Tibial tuberosity (via patellar ligament) Action: Hip flexion, knee extension Nerve supply: Femoral nerve (L2-L4) Blood supply: Lateral circumflex femoral artery Clinical Relevance: Rectus femoris strain is common in sports involving kicking or sudden acceleration, causing pain in the anterior thigh. Posterior Muscles (Hip Extensors) Gluteus Maximus Origin: Ilium, sacrum, coccyx, and sacrotuberous ligament Insertion: Gluteal tuberosity of femur and iliotibial tract Action: Hip extension, external rotation Nerve supply: Inferior gluteal nerve (L5-S2) Blood supply: Inferior and superior gluteal arteries Clinical Relevance: Weakness in the gluteus maximus can contribute to conditions such as lower back pain and hip instability. This muscle is often targeted in rehabilitation for patients with weak hip extensors. Lateral Muscles (Hip Abductors and Rotators) Gluteus Medius Origin: Outer surface of ilium Insertion: Greater trochanter of femur Action: Hip abduction and internal rotation Nerve supply: Superior gluteal nerve (L4-S1) Blood supply: Superior gluteal artery Clinical Relevance: Gluteus medius weakness can lead to "Trendelenburg gait," a lateral pelvic drop during walking. It's commonly addressed in hip strengthening exercises. Gluteus Minimus Origin: Outer surface of ilium (below gluteus medius) Insertion: Greater trochanter of femur Action: Hip abduction, internal rotation Nerve supply: Superior gluteal nerve (L4-S1) Blood supply: Superior gluteal artery Clinical Relevance: Gluteus minimus strain or injury may result in referred pain to the hip and buttock area, often mistaken for sciatica. Tensor Fascia Latae Origin: Anterior iliac crest Insertion: Iliotibial tract/band Action: Assists with hip flexion, abduction, and internal rotation Nerve supply: Superior gluteal nerve (L4-S1) Blood supply: Lateral circumflex femoral artery Clinical Relevance: Tightness in the tensor fascia latae (TFL) can contribute to iliotibial band (ITB) syndrome, common in runners and cyclists, causing lateral knee pain. Medial Muscles (Hip Adductors)  Adductor Longus Origin: Pubis (near pubic symphysis) Insertion: Middle third of linea aspera of femur Action: Hip adduction, assists in flexion Nerve supply: Obturator nerve (L2-L4) Blood supply: Deep femoral artery Clinical Relevance: Adductor strains, often called "groin pulls," are common in sports requiring rapid direction changes or side movements (e.g., soccer, hockey). Adductor Magnus Origin: Ischial tuberosity and inferior pubic ramus Insertion: Linea aspera and adductor tubercle of femur Action: Hip adduction, flexion (adductor part), extension (hamstring part) Nerve supply: Obturator nerve (adductor part), sciatic nerve (hamstring part) (L2-S1) Blood supply: Deep femoral artery Clinical Relevance: Adductor magnus can be involved in hip joint pathologies such as osteitis pubis, characterized by inflammation of the pubic symphysis. Hip External Rotators  Piriformis Origin: Anterior surface of the sacrum Insertion: Greater trochanter of femur Action: External rotation of the hip Nerve supply: Nerve to piriformis (S1-S2) Blood supply: Superior and inferior gluteal arteries Clinical Relevance: Piriformis syndrome occurs when the piriformis muscle compresses the sciatic nerve, causing sciatica-like symptoms such as buttock pain radiating down the leg. Common Conditions and Injuries Hip fractures Osteoarthritis Sciatica and Piriformis syndrome Hip labral tears Tendinopathies (e.g., gluteal tendinopathy) SDL Read up on the root, course, branches, function, and clinical anatomy of the Sciatic nerve Read up on the root, course, branches, function, and clinical anatomy of the Femoral nerve Questions? References Kenhub (n.d.) Hip Anatomy and Knee Anatomy Diagrams. Available at: https://www.kenhub.com (Accessed: 14 September 2024). McMinn, R.M.H. (2019) Last’s Anatomy: Regional and Applied. 13th edn. Elsevier Health Sciences. Moore, K.L., Dalley, A.F. and Agur, A.M.R. (2018) Clinically Oriented Anatomy. 8th edn. Wolters Kluwer. Muscolino, J.E. (n.d.) The Muscular System Manual: The Skeletal Muscles of the Human Body. Available at: https://www.learnmuscles.com (Accessed: 14 September 2024). Netter, F.H. (2019) Atlas of Human Anatomy. 7th edn. Elsevier.Physiopedia (n.d.) Hip and Knee Anatomy Overview. Available at: https://www.physio-pedia.com (Accessed: 14 September 2024). Rehab My Patient (n.d.) Anatomy of the Hip and Knee. Available at: https://www.rehabmypatient.com (Accessed: 14 September 2024). Standring, S. (2020) Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd edn. Elsevier.