Hip Muscular Anatomy

Flexors

Psoas Major Origin Insertion Action Nerve Supply Palpation Adjacent margins of the bodies of the vertebra and discs and anterior medial transverse processes from the body of T12 to the body of L5. Insertion Tip and posterior aspect of lesser trochanter of the femur Action Flexion of the hip and lumbar spine Nerve Supply Anterior rami of L1-L3/4 Palpation Model supine with hip and knee flexion, feet resting on table. Therapist places fingers 2 inches Lateral to umbilicus on Lateral edge of rectus abdominis. Pressure is applied towards to spinal column. Model can perform hip flexion to confirm palpation. Iliopsoas tendon palpated Lateral to femoral artery inferior to inguinal ligament

Anterior aspect of ilium just medial to the ASIS Iliacus Origin Upper and posterior two thirds of the iliac fossa, ala of the sacrum and anterior sacroiliac ligament. Insertion Lesser trochanter of the femur. A few fibres attach to the hip joint capsule Action Hip Flexion. When the origin and insertion are reversed so the lower point is fixed iliacus is a lumbar flexor and anteriorly tilts the pelvis. Nerve Supply Femoral nerve Palpation Anterior aspect of ilium just medial to the ASIS

Psoas Minor Origin Insertion Action Nerve Supply Palpation Sides of the bodies of T12 and L1 and intervertebral disc. Insertion Iliopubic eminence and iliac fascia Action Weak flexor of the lumbar spine Nerve Supply Anterior primary ramus of L1 Palpation N/A

Rectus Femoris Origin Insertion Action Nerve Supply Palpation Straight Head: Anterior inferior iliac spine Reflected Head: Superior to the acetabulum Insertion Upper border of the patella and merges around patella to form parts of the ligamentum patellae Action Hip flexion, Knee Extension Nerve Supply Femoral Nerve Palpation Model: Straight leg raise

Anterior superior iliac spine and area just below Sartorius Origin Anterior superior iliac spine and area just below Insertion Vertical line of the upper medial surface of the tibia shaft. Some fibres merge with the MCL Action Hip flexion, Lateral rotation and abduction. Knee flexion and tibial medial rotation. Nerve Supply Femoral Nerve Palpation Model actively holds leg in hip flexion, abduction and slight Lateral rotation. Belly palpated close to ASIS

Extensors

Gluteus Medius Origin Insertion Action Nerve Supply Palpation Outer surface of the ilium from the iliac crest and posterior gluteal line   Insertion Superolateral surface of the greater trochanter Action Abduction of the hip. Anterior fibres assist with femoral medial rotation. Posterior fibres assist with Lateral rotation. Stabilise the pelvis on the femur during single leg stance. Nerve Supply Superior Gluteal Nerve L4-L5, S1 Palpation Model side lying. Place hand between the iliac crest and greater trochanter of the femur. Ask model to abduct the femur.

Semitendinosus Origin Insertion Action Nerve Supply Palpation Lower medial facet of the lateral section of the ischial tuberosity Insertion Vertical line of the anterior medial superior aspect of the medial condyle of the tibia Action Hip Extension, Knee Flexion and Tibial medial Rotation Nerve Supply Tibial Division of Sciatic Nerve Palpation  

Semimembranosus Origin Insertion Action Nerve Supply Palpation Upper lateral facet of the ischial tuberosity Insertion Posteromedial surface of the medial tibial condyle and oblique popliteal ligament Action Hip Extension, Knee Flexion and Tibial medial Rotation Nerve Supply Tibial Division of Sciatic Nerve Palpation

Biceps Femoris Origin Insertion Action Nerve Supply Palpation Long Head: Lower medial facet of the ischial tuberosity and sacrotuberous ligament Short Head: Lower half of the lateral lip of the linea aspera and the lateral supracondylar line of the femur Insertion Head of the fibula Action Hip Extension, Knee flexion and Tibial Lateral Rotation Nerve Supply Long Head: Tibial Division of Sciatic Nerve Short Head: Common Peroneal Division Palpation Short Head: Lower half of the Lateral lip of the linea aspera and the lateral supracondylar line of the femur

Adductors

Gracilis Origin Insertion Action Nerve Supply Palpation Front body and inferior ramus of the pubis and the ramus of the ischium Insertion Vertical line of the upper medial surface of the tibia shaft Action Hip adduction. Knee Flexion and Tibial medial Rotation Nerve Supply Anterior division of the obturator nerve Palpation Distal Tendon: Resist knee flexion and tibial IR. Tendon is medial to the tendon of semitendinosis Proximal belly: Place thigh into hip flexion, abduction, ER. Place flat palm along adductors. Immediate muscle mass is adductor longus. Straighten knee. Mass then found posteriorly is gracilis.

Lateral surface of the body of the pubis and inferior pubic ramus Adductor Brevis Origin Lateral surface of the body of the pubis and inferior pubic ramus Insertion Posterior surface of the proximal femur and upper one third of linea aspera Action Hip adduction Nerve Supply Obturator Nerve Palpation

Adductor Magnus Origin Insertion Action Nerve Supply Palpation Adductor Part – Ischiopubic ramus Hamstring Part – Ischial tuberosity Insertion Adductor Part – posterior surface of proximal femur, linea aspera, medial supracondylar line Hamstring Part – adductor tubercle and supracondylar line Action Adductor Part – Adduction of the hip. Flexion of the hip Hamstring Part – Extension of the hip Nerve Supply Adductor Part - Obturator Nerve Hamstring Part – Sciatic Nerve Palpation

Adductor Longus Origin Insertion Action Nerve Supply Palpation Lateral surface of the body of pubis Insertion Linea aspera on middle one third of the shaft of femur Action Hip Flexion, adduction, medial rotation Nerve Supply Obturator Nerve Palpation

Pectineus Origin Insertion Action Nerve Supply Palpation Pectineal line and adjacent bone of pelvis Insertion Oblique line extending from base of lesser trochanter to linea aspera on posterior surface of proximal femur Action Hip adduction and flexion Nerve Supply Femoral Nerve Palpation

Abductors

Gluteus Maximus Origin Insertion Action Nerve Supply Palpation Posterior gluteal line of the ilium, tendon of sacrospinalis, dorsal surface of the sacrum, coccyx and sacrotuberous ligament Insertion Gluteal tuberosity of the femur and iliotibial tract of fascia lata   Action Extension of the femur, Lateral stabilisation of the hip. Inferior fibres can assist with adduction and Lateral rotation of the femur. Superior fibres can assist with abduction and medial rotation of the femur. Nerve Supply Inferior Gluteal Nerve (L5-S2) Palpation Prone lying with one knee joint flexed to 90. Apply max resistance to posterior surface of thigh and ask for hip extension.

Gluteus Minimus Origin Insertion Action Nerve Supply Palpation Lateral surface of ilium between inferior and anterior gluteal lines Insertion Linear facet on the anterolateral aspect of the greater trochanter and the hip capsule Action Superior gluteal nerve Nerve Supply Palpation

Tensor Fascia Latae Origin Insertion Action Nerve Supply Palpation Lateral aspect of crest of ilium between anterior superior iliac spine and tubercle of the crest Insertion Iliotibial tract of fascia lata Action Abduction and Medial Rotation of the hip Nerve Supply Superior Gluteal Nerve Palpation

Lateral Rotators

Superior border of the greater trochanter of the femur. Piriformis Origin Anterior surface of the sacrum between and Lateral to anterior sacral foramen, capsule of sacroiliac articulation, margin of the greater sciatic foramen and sacrotuberous ligament Insertion Superior border of the greater trochanter of the femur. Action Extension and Lateral rotation of the hip in hip extension or neutral. medial rotation and abduction in 90° of hip flexion. Nerve Supply Sacral plexus, L5, S1, S2 Palpation Model in side lying on uninvolved side with hip flexed to 90°. Palpate in a line from the greater trochanter to the palpable border of the sacrum. Model in prone. Knee flexed to 90°. Palpate in a line from greater trochanter to palpable border of the sacrum. medial and Lateral rotation of the hip can be used to confirm palpation.

Gemellus Superior Origin Insertion Action Nerve Supply Palpation External surface of ischial spine Insertion Along length of superior surface of the obturator internus tendon and into the medial side of the greater trochanter of the femus with the obturator internus tendon Action Laterally rotates the extended hip joint Aducts the flexed hip joint Nerve Supply Nerve to Obturator Internus Palpation

Obturator Internus Origin Insertion Action Nerve Supply Palpation Medial surface of the obturator membrane, the ischium near the membrane and the rim of the pelvis Insertion Medial side of the greater trochanter of the femur and the hip joint Action Laterally rotates the extended hip joint Aducts the flexed hip joint Nerve Supply Nerve to obturator internus Palpation

Gemellus Inferior Origin Insertion Action Nerve Supply Palpation Upper aspect of ischial tuberosity Insertion Along length of inferior surface of the obturator internus tendon and into the medial side of the greater trochanter of the femus with the obturator internus tendon Action Laterally rotates the extended hip joint Aducts the flexed hip joint Nerve Supply Neve to quadratus femoris Palpation

Quadratus Femoris Origin Insertion Action Nerve Supply Palpation Lateral aspect of the ischium just anterior to the ischial tuberosity Insertion Quadrate tubercle on the intertrochanteric crest of the proximal femur Action Laterally rotates the hip Nerve Supply Nerve to quadratus femoris Palpation

Obturator Externus Origin Insertion Action Nerve Supply Palpation Lateral surface of obturator membrane and adjacent bone Insertion Trochanteric fossa Action Adduction, and Lateral rotation of the hip Nerve Supply Obturator Nerve Palpation

Flexors Psoas Major Iliacus Psoas Minor Rectus Femoris Sartorius Pectineus Gracilis Tensor Fascia Latae Adductor Longus Adductor Brevis

Extensors Gluteus Maximus Semimembranosus Semitendinosus Biceps Femoris Adductor Magnus

Gluteus Maximus (Superior Fibres) Abductors Gluteus Medius Gluteus Minimus Tensor Fascia Latae Sartorious Piriformis Obturator Internus Gemellus Superior Gemellus Inferior Gluteus Maximus (Superior Fibres)

Gluteus Maximus (Inferior Fibres) Adductors Pectineus Adductor Longus Adductor Brevis Adductor Magnus Gracilis Obturator Externus Gluteus Maximus (Inferior Fibres)

Gluteus Maximus (Superior Fibres) Medial Rotation Gluteus Medius Gluteus Minimus Tensor Fascia Latae Semimembranosus Semitendinosus Adductor Magnus Adductor Longus Gluteus Maximus (Superior Fibres)

Lateral Rotation Piriformis Obturator Internus Obturator Externus Gemellus Superior Gemellus Inferior Quadratus Femoris Sartorius Gluteus Maximus (Inferior Fibres) Gluteus Medius (Posterior Fibres)