1. The Gluteal Region And Thigh
Dr. Fadel Naim
Orthopedic Surgeon
Faculty of Medicine
IUG

2. The bulky region of hip (the buttocks)
Gluteal Region
The bulky region of hip (the buttocks)
Dr. Vohra

3. Fascia Of The Buttock
The superficial fascia is thick and impregnated with large quantities of fat.
It contributes to the prominence of the buttock.
It is continuous below with the deep fascia of the thigh (fascia lata).
It is attached to the iliac crest.
The deep fascia forms sheaths, which enclose
The tensor fasciae latae
The gluteus maximus

4. Gluteal Muscles
The gluteal muscles share a common compartment but are organized into two layers, superficial and deep:
The superficial layer consists of:
The three large glutei (maximus, medius, and minimus)
The tensor of the fascia lata.

5. The deep layer consists of:
Gluteal Muscles
The deep layer consists of:
Smaller muscles covered by the inferior half of the gluteus maximus
Piriformis
Obturator internus
Gemelli
Quadratus femoris
All have distal attachments on or adjacent to the intertrochanteric crest of the femur.
Lateral rotators of the thigh
Stabilize the hip joint

6. Gluteus Maximus The largest muscle in the body.
Superficial in the gluteal region
largely responsible for the prominence of the buttock.
Origin:
the outer surface of the ilium
the posterior surface of the sacrum and coccyx
the sacrotuberous ligament
Insertion:
The fibers pass downward and laterally
Most are inserted into the iliotibial tract
Some of the deeper fibers are inserted into the gluteal tuberosity of the femur.
Nerve supply:
Inferior gluteal nerve.

7. Gluteus Maximus • Action:
It extends and laterally rotates the hip joint
Through the iliotibial tract it helps maintain the knee joint in extension.
It is most commonly used as an extensor of the trunk on the thigh
( raising the trunk from the sitting or stooping positions)

8. Gluteus Medius The gluteus medius is a thick, fan-shaped muscle
Its posterior part is covered by the gluteus maximus
origin:
From the outer surface of the ilium.
Insertion:
The fibers pass downward and laterally
Attached to the lateral surface of the greater trochanter.
Nerve supply:
Superior gluteal nerve.
Action:
Acting with the gluteus minimus
Powerfully abducts the thigh at the hip joint.
Most important action takes place in walking or running
The anterior fibers also medially rotate thigh.

9. Gluteus Minimus
The gluteus minimus is fan shaped and lies deep to the gluteus medius.
Insertion:
The fibers pass downward and laterally
Attached to the lateral surface of the greater trochanter.
Nerve supply:
Superior gluteal nerve.
Action:
Acting with the gluteus medius
Powerfully abducts the thigh at the hip joint.
The anterior fibers also medially rotate thigh.

10. Action of abductors of thigh when walking
The three muscles contract and steady the pelvis on the lower limb
While walking the pelvis is held in position and does not tilt downward on the unsupported

11. Tensor Fasciae Latae Origin: Insertion: Nerve supply: Action:
From the outer edge of the iliac crest between the anterior superior iliac spine and the iliac tubercle
Insertion:
The fibers run downward and backward
inserted into the iliotibial tract.
Nerve supply:
Superior gluteal nerve.
Action:
It exerts traction on the iliotibial tract
assists the gluteus maximus muscle in maintaining the knee in the extended position.
As long as the iliotibial tract remains in front of the axis of flexion of the knee, it assists in keeping the knee extended.

12. The Iliotibial Tract
On the lateral surface of the thigh, thickened to form a strong, wide band
From the tubercle of the iliac crest and below to the lateral condyle of the tibia
Forms a sheath for the tensor fasciae latae muscle
Receives the greater part of the insertion of the gluteus maximus

13. The quadriceps muscles may be relaxed.
Tensor Fasciae Latae
In standing upright, the upward pull of the iliotibial tract is the most important factor in keeping the knee extended
The quadriceps muscles may be relaxed.

14. Piriformis Origin: Insertion: Nerve supply: Action:
From the anterior surface of the 2nd, 3rd, and 4th sacral vertebrae within the pelvis.
Insertion:
The fibers pass downward and laterally through the greater sciatic foramen
Attached to the upper border of the greater trochanter.
Nerve supply:
Anterior rami of the first and 2nd sacral nerves.
Action:
Lateral rotator of the thigh at the hip joint.

15. The quadratus femoris is a quadrilateral-shaped muscle. Origin:
From the lateral border of the ischial tuberosity.
Insertion:
The fibers pass laterally to be inserted into the quadrate tubercle on the intertrochanteric crest of the femur.
Nerve supply:
A branch from the sacral plexus.
Action:
Lateral rotator of the thigh at the hip joint.

16. Triceps coxae Obturator Internus Gemelli Superior Gemelli inferior
These small muscles form a tricipital muscle (triceps coxae) located between the piriformis and quadratus femoris.
The common tendon of the triceps runs horizontally to the greater trochanter of the femur.

17. Obturator Internus
A fan-shaped muscle that lies partly within the pelvis at its origin.
It emerges through the lesser sciatic foramen to enter the gluteal region.
Origin:
From the pelvic surface of the obturator membrane and the surrounding bones
Insertion:
The tendon passes out of the pelvis through the lesser sciatic foramen and is joined by the superior and inferior gemelli.
The common tendon is inserted into the upper border of the greater trochanter.
Nerve supply:
Nerve to the obturator internus from the sacral plexus.
Action:
Lateral rotator of the thigh at the hip joint.

18. Gemellus Superior The gemellus superior is a small muscle. Origin:
Spine of the ischium.
Insertion:
With the tendon of the obturator internus
Nerve supply:
Nerve to the obturator internus from the sacral plexus.
Action:
Lateral rotator of the thigh at the hip joint.

19. Gemellus Inferior The gemellus inferior is a small muscle. Origin:
Upper margin of the ischial tuberosity.
Insertion:
With the tendon of obturator internus
Nerve supply:
Nerve to the quadratus femoris from the sacral plexus.
Action:
Lateral rotator of the thigh at the hip joint.

20. SIX LATERAL ROTATORS Piriformis. Obturator internus.
Gemelli (superior and inferior ).
Obturator externus.
Quadratus femoris.

21. DEEP FASCIA OF THE THIGH (FASCIA LATA)
The deep fascia encloses the thigh like a trouser leg
At its upper end is attached to the pelvis and the inguinal ligament
On its lateral aspect, it is thickened to form the iliotibial tract
The iliotibial tract receives the insertion of
Tensor fasciae latae
Greater part of the gluteus maximus muscle
DR FADEL NAIM
IUG

22. FASCIAL COMPARTMENTS OF THE THIGH
Three fascial septa pass from the inner aspect of the deep fascial sheath of the thigh to the linea aspera of the femur
the thigh is divided into three compartments, each having muscles, nerves, and arteries.
The compartments are
Anterior
Medial
posterior
DR FADEL NAIM
IUG

23. CONTENTS OF THE ANTERIOR FASCIAL COMPARTMENT OF THE THIGH
Muscles:
Sartorius
Iliacus
Psoas
Pectineus
quadriceps femoris.
Blood supply:
Femoral artery.
Nerve supply:
Femoral nerve.
DR FADEL NAIM
IUG

24. Sartorius
A narrow, strap-shaped muscle that covers the femoral artery in the middle one third of the thigh.
Origin:
From the anterior superior iliac spine.
Insertion:
The muscle fibers run downward and medially
Attached to the upper part of the medial surface of the shaft of the tibia.
Nerve supply:
Femoral nerve.
Action:
At the hip joint
Flexes
Abducts
Laterally rotates the thigh
At the knee joint
Medially rotates the leg.
DR FADEL NAIM
IUG

25. Iliacus Origin: Insertion: Nerve supply: Action:
This fan-shaped muscle arises from the iliac fossa within the abdomen
Insertion:
The fibers converge and join the tendon of the psoas to form the iliopsoas muscle
Nerve supply:
A branch of the femoral nerve within the abdomen.
Action:
Flexes the thigh on the trunk at the hip joint
If the thigh is fixed, it flexes the trunk on the thigh
Medially rotates the thigh.
DR FADEL NAIM
IUG

26. Psoas
A long fusiform muscle that arises within the abdomen and descends into the thigh.
Origin:
From the 12th thoracic to the 5th lumbar vertebrae
From the roots of the transverse processes,
The sides of the vertebral bodies
The intervertebral discs,
Insertion:
The fibers run downward and laterally
Leave the abdomen to enter the thigh by passing behind the inguinal ligament.
The iliopsoas tendon is attached to the lesser trochanter of the femur.
A bursa intervenes between the tendon and the hip joint
May communicate with the joint.
Nerve supply:
Branches from the lumbar plexus.
Action:
The iliopsoas flexes the thigh on the trunk at the hip joint
If the thigh is fixed, it flexes the trunk on the thigh.
DR FADEL NAIM
IUG

27. DR FADEL NAIM
IUG

28. Pectineus Origin: Insertion: Nerve supply: Action:
From the superior ramus of the pubis
Insertion:
The muscle fibers pass downward, backward,and laterally
Attached to the upper end of the linea aspera just below the lesser trochanter.
Nerve supply:
Femoral nerve
Occasionally, it receives a branch from the obturator nerve
Action:
Flexes and adducts the thigh at the hip joint
DR FADEL NAIM
IUG

29. Quadriceps Femoris
The quadriceps femoris muscle consists of four parts:
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
A common tendon of insertion into the upper, lateral, and medial borders of the patella
Via the ligamentum patellae, into the tubercle of the tibia.
DR FADEL NAIM
IUG

30. Rectus Femoris Origin: Insertion: Nerve supply:
A straight head from the anterior inferior iliac spine
A reflected head from the ilium above the acetabulum
Insertion:
The two heads unite in front of the hip joint,
The bipennate muscle is inserted into the quadriceps tendon and so into the patella.
Nerve supply:
Femoral nerve
DR FADEL NAIM
IUG

31. Vastus lateralis Origin: Insertion: Nerve supply:
From the intertrochanteric line
The base of the great trochanter
The linea aspera of the femur
Insertion:
The fibers pass downward and forward to be inserted into the quadriceps tendon and so into the patella.
Some of the tendinous fibers join the capsule of the knee joint and strengthen it.
Nerve supply:
Femoral nerve
DR FADEL NAIM
IUG

32. Vastus Medialis Origin: Insertion: Nerve supply:
From the intertrochanteric line
the linea aspera of the femur
Insertion:
The fibers pass downward and forward
inserted into the quadriceps tendon and so into the patella.
Some of the tendinous fibers join the capsule of the knee joint and strengthen it.
The lowest muscle fibers are almost horizontal in direction and prevent the patella from being pulled laterally during contraction of the quadriceps muscle.
Nerve supply:
Femoral nerve
DR FADEL NAIM
IUG

33. Vastus Intermedius Origin: Insertion: Nerve supply:
From the anterior and lateral surfaces of the shaft of the femur
Insertion:
The fibers pass downward
join the deep aspect of the quadriceps tendon.
Nerve supply:
Femoral nerve
The articularis genus
a small part of the vastus intermedius
inserted into the upper part of the synovial membrane of the knee joint.
It serves to retract the synovial membrane superiorly during extension of the knee joint.
DR FADEL NAIM
IUG

34. Action of Quadriceps Femoris Muscle (Quadriceps Mechanism)
a powerful extensor of the knee joint.
Some of the tendinous fibers of the vastus lateralis and vastus medialis form bands, or retinacula, that join the capsule of the knee joint and strengthen it.
The lowest muscle fibers of the vastus medialis are almost horizontal and prevent the patella from being pulled laterally during contraction of the quadriceps muscle.
The tone of the quadriceps muscle greatly strengthens the knee joint.
The rectus femoris muscle also flexes the hip joint.
DR FADEL NAIM
IUG

35. DR FADEL NAIM
IUG

36. QUADRICEPS FEMORIS AS A KNEE JOINT STABILIZER
The quadriceps femoris is a most important extensor muscle for the knee joint.
Its tone greatly strengthens the joint
Carefully examined
Both thighs should be examined
Size
Consistency
Strength
Reduction in size caused by muscle atrophy can be tested by measuring the circumference of each thigh a fixed distance above the superior border of the patella.
The vastus medialis muscle extends farther distally than the vastus lateralis.
The vastus medialis is the first part of the quadriceps muscle to atrophy in knee joint disease and the last to recover.
DR FADEL NAIM
IUG

37. CONTENTS OF THE MEDIAL FASCIAL COMPARTMENT OF THE THIGH
Muscles:
Gracilis
Adductor longus
Adductor brevis
Adductor magnus
Obturator externus
• Blood supply:
Profunda femoris artery
Obturator artery
• Nerve supply:
Obturator nerve

38. Gracilis Long and strap like
Lies on the medial side of the thigh and the knee
Origin:
The outer surface of the inferior ramus of the pubis
The ramus of the ischium
Insertion:
The fibers pass downward along the medial side of the thigh
Attached to the upper part of the medial surface of the shaft of the tibia
Close to that of the sartorius and the semitendinosus muscles.
Nerve supply:
Obturator nerve.
• Action:
Adducts the thigh at the hip joint
Flexes the leg at the knee joint

39. Adductor Longus Triangular
The most anterior of the three adductor muscles
Origin:
From the front of the body of the pubis below and medial to the pubic tubercle
Insertion:
The muscle fibers diverge as they pass downward and laterally
Attached to the linea aspera
Nerve supply:
Obturator nerve.
• Action:
Adducts the thigh at the hip joint
Assists in lateral rotation

40. Adductor Brevis
lies posterior to the pectineus and the adductor longus.
Origin:
From the outer surface of the inferior ramus of the pubis
Insertion:
The muscle fibers diverge as they pass downward and laterally
attached to the linea aspera
Nerve supply:
Obturator nerve.
Action:
Adducts the thigh at the hip joint
Assists in lateral rotation

41. Adductor Magnus A large, triangular muscle
Consisting of adductor and hamstring portions
Origin:
From the outer surface of the inferior ramus of the pubis
From the ramus of the ischium and the ischial tuberosity.
Insertion:
In the adductor portion:
The muscle fibers diverge as they pass downward and laterally
Attached to the posterior surface of the shaft of the femur.
In the hamstring portion
The fibers that arise from the ischial tuberosity are inserted below on the adductor tubercle on the medial condyle of the femur.
Nerve supply:
The adductor portion: the obturator nerve
The hamstring portion: the sciatic nerve.
Action:
The adductor portion
Adducts the thigh at the hip joint
Assists in lateral rotation.
The hamstring portion
Extends the thigh at the hip joint.

42. Adductor Hiatus A gap is in the attachment of this muscle to the femur
Permits the femoral vessels to pass from the adductor canal downward into the popliteal space

43. Obturator Externus A deeply placed, triangular muscle. Origin:
From the outer surface of the obturator membrane
The pubic and ischial rami.
• Insertion:
The muscle fibers converge as they pass laterally at first below and then behind the hip joint
Inserted onto the medial surface of the greater trochanter.
• Nerve supply:
Obturator nerve.
• Action:
Laterally rotates the thigh at the hip joint.

44. CONTENTS OF THE POSTERIOR FASCIAL COMPARTMENT OF THE THIGH
Muscles:
Biceps femoris
Semitendinosus
Semimembranosus
a small part of the adductor magnus (hamstring muscles).
Blood supply:
Branches of the profunda femoris artery.
Nerve supply:
Sciatic nerve.

45. Biceps Femoris Origin: Insertion: Nerve supply: Action: The long head
The ischial tuberosity
The short head
The linea aspera
The lateral supracondylar ridge of the shaft of the femur.
Insertion:
The two heads unite just above the knee joint
The common tendon is inserted into the head of the fibula.
Nerve supply:
The long head is supplied by the tibial part of the sciatic
The short head is supplied by the common peroneal part of the sciatic.
Action:
Flexes and laterally rotates the leg at the knee joint
The long head also extends the thigh at the hip joint.

46. Semitendinosus Origin: Insertion: Nerve supply: Action:
From the ischial tuberosity
Insertion:
By a long tendon into the upper part of the medial surface of the shaft of the tibia.
Nerve supply:
The tibial portion of the sciatic.
Action:
Flexes and medially rotates the leg at the knee joint
Extends the thigh at the hip joint.

47. Semimembranosus Origin: Insertion: Nerve supply: Action:
From the ischial tuberosity
Insertion:
Into the posteromedial surface of the medial condyle of the tibia.
The oblique popliteal ligament:
A fibrous expansion upward and laterally, which reinforces the capsule on the back of the knee joint
Nerve supply:
The tibial portion of the sciatic.
Action:
Flexes and medially rotates the leg at the knee joint
It also extends the thigh at the hip joint.

48. Adductor Magnus (Hamstring Portion)
Origin:
From the outer surface of the inferior ramus of the pubis
from the ramus of the ischium and the ischial tuberosity.
Insertion:
In the hamstring portion
the fibers that arise from the ischial tuberosity are inserted below on the adductor tubercle on the medial condyle of the femur
Nerve supply:
The tibial portion of the sciatic
Action:
Extends the thigh at the hip joint.

50. Hip Joint
The articulation between the hemispherical head of the 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.
The cavity of the acetabulum is deepened by the presence of a fibrocartilaginous rim called the 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.
The hip joint is a synovial ball-and-socket joint.

52. CAPSULE The capsule encloses the joint
Attached to the acetabular labrum medially
Laterally
To the intertrochanteric line of the femur in front
some of its fibers, accompanied by blood vessels, are reflected upward along the neck as bands called retinacula.
These blood vessels supply the head and neck of the femur.
Halfway along the posterior aspect of the neck of the bone behind.

54. LIGAMENTS OF THE HIP JOINT
The iliofemoral ligament:
Prevents overextension during standing.

55. LIGAMENTS OF THE HIP JOINT
The pubofemoral ligament
This ligament limits extension and abduction.

56. LIGAMENTS OF THE HIP JOINT
The ischiofemoral ligament
This ligament limits extension.

57. LIGAMENTS OF THE HIP JOINT
The transverse acetabular ligament
formed by the acetabular labrum as it bridges the acetabular notch
converts the notch into a tunnel through which the blood vessels and nerves enter the joint.
The ligament of the head of the femur
It is attached by its apex to the pit on the head of the femur (fovea capitis)
its base to the transverse ligament and the margins of the acetabular notch.
It lies within the joint and is ensheathed by synovial membrane

59. The nerve to quadratus femoris
NERVE SUPPLY
Femoral nerve
Obturator nerve
Sciatic nerve
The nerve to quadratus femoris

60. Movements Of The Hip Joint
A wide range of movement, but less so the shoulder joint
Some of the movement has been scarified to provide strength and stability.
The strength of the joint depends largely on:
The shape of the bones taking part in the articulation
The strong ligaments.
When the knee is flexed
Flexion is limited by
the anterior surface of the thigh coming into contact with the anterior abdominal wall.
When the knee is extended
the tension of the hamstring group of muscles.

61. Movements Of The Hip Joint
Flexion
Extension
Abduction
Adduction
Lateral rotation.
Medial rotation.
Circumduction is a combination of the previous movements.
The extensor group of muscles is more powerful than the flexor group
The lateral rotators are more powerful than the medial rotators.

62. Extension is limited by the tension of
The iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
Abduction is limited by the tension of
The pubofemoral ligament
Adduction is limited by
Contact with the opposite limb
The tension in the ligament of the head of the femur
Lateral rotation is limited by
The tension in the iliofemoral ligament
Medial rotation is limited by
The ischiofemoral ligament