The Hip (Iliofemoral) Joint Heather Friedland, Liz Huisman, Josh McCoy

Iliac Crest! (and Inguinal Ligament) Surface Anatomy Iliac Crest? Iliac Crest! (and Inguinal Ligament) Josh McCoy

Surface Anatomy, continued Gluteal Fold/Sulcus Intergluteal Cleft Sacrum Iliac Crest Josh McCoy

Surface Anatomy, continued Anterior Superior Iliac Spine Iliac Crest Tip of Greater Trochanter Josh McCoy

Surface Anatomy, continued Posterior Superior Iliac Spine Josh McCoy

Surface Anatomy, continued Supracristal Plane Inguinal Ligament Josh McCoy

The Hip Joint Liz Huisman

Iliofemoral Ligament (red) Prevents hyperextension Pubofemoral Ligament (green) Prevents overabduction. Liz Huisman

Ishiofemoral ligament Slackens during adduction, tenses during abduction Liz Huisman

Ligaments that support walking posterior anterior Inguinal ligament Sacrotuberous ligament Liz Huisman

Bursae Trochanteric bursa Gluteofemoral bursa Ischial bursa Liz Huisman

Bones of the Hip Joint Heather Friedland

Os Coxa Pubis Inferior ramus Acetabulum Ischial tuberosity Iliac fossa Lesser sciatic notch Superior pubic ramus Pubic (or suprapubic) arch Obturator foramen Superior ramus Obturator foramen Ischium Iliac crest Ischial spine Symphysis pubis Inferior pubic ramus Pubic crest Greater sciatic notch Heather Friedland

Heather Friedland Click to add text

Iliac Spines Anterior superior Anterior Inferior Posterior superior Posterior inferior Heather Friedland

Femur Head Neck Greater Trochanter Lesser Trochanter Linea Aspera Pectineal line Adductor tuberacle Condyles (medial and lateral) Epicondyles (medial and lateral) Heather Friedland

Bones: Tibia Lateral and Medial Condyles Intercondylar Eminence Tibial Tuberosity Crest Josh McCoy

Muscles of the Hamstrings Heather Friedland A&P 106 11/18/2015

Muscles Semitendinosus Semimembranosus Gracilis Pectinius Biceps Femoris Piriformis Heather Friedland

Semitendinosus Nerve: Tibial Nerve Roots: L5, S1 & S2 Origin: Ischial tuberosity Insertion: Proximal medial shaft of the tibia at Pes Anserinus tendon Heather Friedland

Semitendinosus Synergist: Knee Flexion: Biceps femoris, Semimembranosus, gracilis, sartorius, gastrocnemius, popliteus Hip extension: Gluteus Maximus, Biceps femoris, semimembranosus Medial rotation: semimembranosus, gracilus, Sartorius, popliteus, Semimembranosus Antagonist: Knee extension: Rectus femoris, Vastus (medialis, lateralis, and intermedialis) Hip Flexion: Rectus femoris, iliopsoas, pectineus, Sartorius Lateral rotation: Biceps femoris Action: Flexes knee. Medially rotates knee. Extends the knee Heather Friedland

Semimembranosus Heather Friedland

Semimembranosus Nerve: Tibial Nerve Roots: L5, S1 & S2 Origin: Ischial tuberosity Insertion: Posterior medial condyle of the tibia Synergist: Same as Semitendinosis Antagonist: Same as Semitendinosis Action: Flexes knee. Medially rotates flexed knee and extends the hip Heather Friedland

Gracilis Nerve: Obturator nerve Roots: L2 and L3 Origin: Body and inferior ramus of pubis Insertion: Anterior medial proximal tibia Heather Friedland

Gracilis Synergist: Antagonist: Adduction: Adductor(magnus, brevis, and longus), Gracilis, pectineus Medial rotation: Gluteus (medius and minimus), adductor (all 3), Pectinius, TFL, Gracilis Knee flexion: Semimembranosus, Semiteninosis, biceps femoris, gracilis, gastrocnemius, Popliteus, Sartorius Antagonist: Abduction: Gluteus (maximus, medius, and minimus), TFL, Sartorius Lateral Rotation: Gluteus maximus, Sartorius, piriformis, iliopsoas Knee extension: Rectus femoris, Vastus (medialis, lateralis, and intermedialis) Action: Adducts and medially rotates hip. Flexes the knee Heather Friedland

Pectineus Heather Friedland

Pectinius Nerve: Femoral Nerve, also fibers from the Obturator nerve Roots: L2 - L4 Origin: Superior ramus of the pubis Insertion: Pectineal line inferior to lesser trochanter of femur Heather Friedland

Pectineus Synergist: Flexion: Rectus femoris, Iliopsoas, TFL, Sartorius, Adductor (longus & brevis) Adduction: Adductor (longus, brevis, and magnus), Gracilis, Pectineus Medial rotation: Gluteus(medius & minimus), Adductor (longus and brevis), Gracilis Antagonist: Extension: Gluteus maximus, Semimembranosus, Semitendinosis, Biceps femoris, Adductor magnus Abduction: Gluteus(medius and minimus), TFL, Sartorius Lateral Rotation: Gluteus maximus, Piriformis, Sartorius Action: Flexes, adducts, and assists with medial rotation of the hip Heather Friedland

Biceps Femoris Heather Friedland

Biceps Femoris Nerve: Tibial nerve (LH) and Fibular nerve (SH) Roots: L5, S1 & S2 Origin: Long head: Ischial tuberosity Short Head: Linea aspera of femur Insertion: Head of fibula and lateral condyle of tibia Heather Friedland

Biceps Femoris Synergist: Hip Extension: Gluteus maximus, Semitendinosis, Semimembranosis, Adductor Lateral Rotation: Gluteus Maximus, Piriformis, Iliopsoas, Sartorius Knee Flexion: Semitendinosis, Semimembranosis, Gastrocnemius, Gracilis, Sartorius Antagonist: Hip Flexion: Rectus femoris, Iliopsoas, Pectinus, TFL, Sartorius Medial Rotation: Gluteus(medius and minimus), TFL, Adductor (magnus, longus, and brevis), pectineus, Gracilis Knee Extension: Vastus (medialis, lateralis, and intermedialis), Rectus femoris Action: Long head: Extends hip and flexes knee Short Head: Flexes knee and laterally rotates hip Laterally rotates flexed knee Heather Friedland

Piriformis Heather Friedland

Piriformis Nerve: Piriformis Nerve Roots: L5, S1 & S2 Origin: Anterior Surface of lateral process of sacrum and gluteal surface of ilium at the margin of the greater sciatic notch Insertion: Superior border of greater trochanter Heather Friedland

Piriformis Synergist: Abduction: Gluteus (medius, minimus), TFL, Sartorius Lateral rotation: Gluteus maximus, Iliopsoas, piriformis, Sartorius Medial rotation: Glutues (minimus, medius), TFL, Adductor (all 3), Gracilis Antagonist: Adduction: adductors (all 3), Gracilis, Pectinius, Gluteus maximus Medial rotation: Gluteus (Minimus and medius), TFL, Adductor (all 3), Pectinius, Gracilis Action: Laterally rotates and abducts thigh when hip is flexed Heather Friedland

Adductors Brevis & Longus Actions: Adduction Flexion Assists in medial hip rotation Liz Huisman

Adductors Brevis Origin: Insertion: Nerve: Roots: Anterior surface of the inferior ramus of the pubis Insertion: Pectineal line, medial lip of linea aspera of femur. Nerve: Obturator nerve Roots: L2-L4 Liz Huisman

Adductor Brevis Synergists Antagonists Adduction: Adductor (longus & magnus), gracilis, pectineus Medial Rotation: Gluteus (minimus & medius), adductor (longus & magnus), pectineus, tensor fascaie latae, gracilic Flexion: Rectus femoris, Iliopsoas, pectineus, TFL, sartorius Abduction: Gluteus (all 3), TFL, Sartorius Lateral Rotation: Gluteus maximus, Sartorius, piriformis, Iliopsoas Extension: Gluteus maximus, semimembgranosus, semitendinosus, biceps femoris, adductor magnus Liz Huisman

Adductor longus Origin: Insertion: Nerve: Roots: Body of pubis inferior to pubic crest & lateral pubic symphysis. Insertion: Middle 1/3 of linea aspera of the femur Nerve: Obturator nerve Roots: L2-L4 Liz Huisman

Adductor Longus Synergists Antagonists Adduction: Adductors (brevis & magnus), gracilis, pectineus Medial Rotation: Gluteus (minimus &medius), adductor (brevis & magnus), pectineus, TFL, gracilis Flexion: Rectus femoris, Iliopsoas, pectineus, TFL, sartorius Abduction: Gluteus (all 3), TFL, Sartorius Lateral Rotation: Gluteus maximus, Sartorius, piriformis, Iliopsoas Extension: Gluteus maximus, semimembranosus, semitendinosus, biceps femoris, adductor magnus Liz Huisman

Adductor Magnus Origin: Inferior ramus of pubis and ischium to ischial tuberosity. Insertion: Linea aspera of femur. Medial supracondylar line and adductor tubercle. Nerve: Obturator and tibial nerve Roots: L2-L4 Actions: Adducts thigh, superior horizontal fibers flexes thigh, posterior portion extends thigh at hip joint Liz Huisman

Adductor Magnus Synergists Antagonists Adduction: Adductor (longus & brevis), gracilis, pectineus Hip Flexion: Rectus femorus, Iliopsoas, pectineus, TFL, gluteus (medius & minimus), adductor (longus & brevis) Abduction: Gluteus (all 3), TFL, Sartorius Hip Extension: Gluteus maximus, semimembranosus, semitendinosus, biceps femoris Liz Huisman

The Glutes Actions Gluteus medius & minimus Hip abduction Medial rotation of hip Gluteus maximus Extends the hip Liz Huisman

Gluteus Minimus Origin: Dorsal ilium between inferior and anterior gluteal lines Insertion: Greater trochanter of femur Nerve: Superior gluteal nerve Roots: L4 & L5, S1 Liz Huisman

Gluteus Minimus Synergists Antagonists Abduction: Adduction: Gluteus medius, tensor fasciae latae, Sartorius Medial Rotation: Gluteus medius, tensor fasciae latae, Adductor (all 3) Adduction: Adductors (all3), gracilis, pectineus, gluteus maximus Lateral Rotation: Gluteus maximus, piriformis, iliopsoas, sartorius Liz Huisman

Gluteus Medius Origin: Dorsal ilium inferior to iliac crest Insertion: Greater trochanter of femur Nerve: Superior Gluteal nerve Roots: L4 & L5, S1 Liz Huisman

Gluteus Medius Synergists Antagonists Abduction: Adduction: Gluteus (maximus & minimus), tensor fasciae latae, Sartorius Medial Rotation: Gluteus minimus, tensor fasciae latae, adductors (all 3), pectineus, gracilis Adduction: Adductors (all 3), gracilis, pectineus Lateral Rotation: Gluteus maximus, piriformis, iliopsoas, sartorius Liz Huisman

Gluteus Maximus Origin: Iliac crest, sacrum, coccyx and aponeurosis of sacrospinalis Insertion: Lateral part of linea aspera under greater trochanter (gluteal tuberosity) of femur Nerve: Inferior gluteal nerve Roots: L5, S1 & S2 Liz Huisman

Gluteus Maximus Synergists Antagonists Extension: Flexion: Semimembranosus, semitendinosus, biceps femoris, adductor magnus Lateral Rotation: Piriformis, iliopsoas, sartorius Flexion: Gluteus (medius & minimus), rectus femoris, iliopsoas, pectineus, TFL, Sartorius Medial Rotation: Gluteus (medius & minimus), TFL, adductors (all 3), pectineus, gracilis Liz Huisman

Psoas Major (of Iliopsoas) Action: Hip/Thigh Flexion Origin: Transverse Processes of T12-L5 Insertion: Lesser Trochanter Nerve: Lumbar Nerves (L1-L3) Josh McCoy

Iliacus (of Iliopsoas) Action: Hip/Thigh Flexion Origin: Iliac Crest, Fossa, Anterior Sacroiliac Ligament Insertion: Lesser Trochanter Synergist (Iliopsoas): Rectus Femoris, Pectineus Antagonist (Iliopsoas): Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps Femoris Josh McCoy

Rectus Femoris Action: Extension at Knee, Flexion at Hip Origin: Anterior Inferior Iliac Spine Insertion: Patella via Quadriceps Tendon and then Tibial Tuberosity via Patellar Ligament Nerve: Femoral Roots: L2-L4 Josh McCoy

Rectus Femoris, continued Synergist: Hip Flexion: Iliopsoas (Psoas Major and Iliacus), Pectineus Knee Extension: Vastus (Medialis, Lateralis, and Intermedialis) Antagonist: Hip Extension: Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps Femoris Knee Flexion: Semimembranosus, Semitendinosus, Biceps Femoris Josh McCoy

Sartorius Action: Flexes Knee; Flexes, Abducts, and Laterally Rotates Hip Origin: Anterior Iliac Spine Insertion: Upper Medial Surface of Body of Tibia Nerve: Femoral Roots: L2-L3 Josh McCoy

Sartorius, continued Synergist: Antagonist: Hip Flexion: Rectus Femoris, Iliopsoas, Pectineus Knee Flexion: Semimembranosus, Semitendinosus, Biceps Femoris Hip Abduction: Gluteus Minimis and Medius Antagonist: Hip Extension: Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps Femoris Knee Extension: Quadriceps Muscles Hip Adduction: Adductor (Longus, Brevis, and Magnus), Pectineus, Gracillis Josh McCoy

Tensor Fascia Latae (TFL) Action: Flexes and Abducts Thigh at Hip Joint; Helps stabilize and steady the Hip and Knee Joints by putting tension on the Iliotibial Band of Fascia Origin: Anterior Superior Iliac Spine and Anterior Iliac Crest Insertion: Tibia by way of Iliotibial Tract Josh McCoy

Tensor Fascia Latae (TFL), continued Nerve: Superior Gluteal Nerve Roots: L4, L5, S1 Synergist: Flexion: Rectus Femoris, Iliopsoas, Pectineus Abduction: Gluteus Medius and Minimis Antagonist: Extension: Gluteus Maximus, Semimembranosus, Semitendinosus, Biceps Femoris Adduction: Gracillis, Pectineus, Adductors (All Three) Josh McCoy

Nerves Obturator and Femoral Superior and Inferior Gluteal, Sciatic Josh McCoy

More Nerves (are we getting on yours yet?) Common Peroneal Josh McCoy

What are Pirate’s favorite vessels? ARRRRteries! Har har har Femoral Deep Femoral (Profundus) Obturator Medial Circumflex Femoral Lateral Circumflex Femoral Josh McCoy

Posterior Arteries Superior Gluteal Inferior Gluteal Josh McCoy

You’re so VEIN, you probably think this slide is about you You’re so VEIN, you probably think this slide is about you! Don’t you, don’t you? Femoral Great Saphenous Profunda (Deep) Femoral Josh McCoy

Clinical Concerns: Total Hip Replacement Josh McCoy

Clinical Concerns: Total Hip Replacement, continued According to www.medicinenet.com, “A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. The normal hip joint is a ball and socket joint. The socket is a ‘cup- shaped’ component of the pelvis called the acetabulum.” Josh McCoy