Hip Iliofemoral Joint PTA Students Curtis Tonya Emilee

Hip (Iliofemoral) Joint PTA Students Curtis, Tonya, Emilee, & Zeke

Bones Them Bones…. . …Of the iliofemoral joint. And one extra.

Bones Os Coax: The Pelvic Trifecta

Bones Medial View

Bones Lateral View, with a side of landmarks

Bones Find the Angry Bird

Bones The Femur: Foreplay for cave men

Bones Tibia- Not part of the hip, but it was on the list, so here goes….

Ligaments �Iliofemoral ligament �Pubofemoral ligament

Ligaments �Ischiofemoral ligament

Ligaments �Sacrotuberous ligament

Ligaments & Cartilage � Transverse acetabular ligament � Acetubular labrum � Articular cartilage of head of femur � Ligament of head of femur

Articular Capsule �Synovial membrane �Fibrous layer

Ligaments �Zona orbicularis

Bursae �Trochanteric bursa Deep Superficial

Bursae Gluteofemoral bursa Ischial Bursa

Muscles Anterior Compartment Thigh Muscles Pectineus � � � Innervation: Femoral Nerve, also fibers from obturator nerve Origin: Superior Ramus of Pubis Insertion: Pectineal line inferior to lesser trochanter of femur Action: Flexes, adducts and assists with medial rotation Synergist: Flexion = Rectus Femoris and Iliopsoas Adduction = Adductors (all 3) and gracilis Medial Rotation = Gluteus Minimus Antagonist: Extension = Gluteus Maximus, Semimembranosus, Semitendinosus, and Biceps Femoris Abduction = Gluteus Medius and Minimus Lateral Rotation = Gluteus Maximus

Muscles Anterior Compartment Thigh Muscles Sartorius � � � Innervation: Femoral Nerve Origin: Anterior superior iliac spine Insertion: Upper medial surface of body of tibia Action: Flexes knee Flexes, abducts and laterally rotates hip Synergist: Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Hip Abduction = Gluteus Medius and Minimus Antagonist Knee Extension = Quadriceps muscles Hip Extension = Gluteus maximus, Semimembranosus, Semitendinosus & Biceps Femoris Hip Adduction = Adductors (all 3), Pectineus & Gracilis

Muscles Anterior Compartment Thigh Muscles Iliopsoas � � � Psoas Major & Iliacus Innervation: Lumbar Nerves Femoral Nerves Origin: Transverse Process of T 12 -L 5 Iliac Crest, Iliac Fossa, Anterior Sacroiliac Ligament Insertion: Lesser Trochanter Action: Hip/Thigh Flexion Synergist: Hip Flexion = Rectus Femoris & Pectineus Antagonist: Hip Extension = Gluteus Maximus, Semimembranosus, Semitendinosus & Biceps Femoris

Muscles Anterior Compartment Thigh Muscles Quadriceps Femoris: Rectus Femoris � Innervation: Femoral Nerve � Origin: Anterior inferior iliac spine � Insertion: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament � Action: Knee Extension and Hip Flexion � Synergist: Knee Extension = Vastus Medialis, Intermedialis & Lateralis Hip Flexion = Iliopsoas & Pectineus � Antagonist: Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris Hip Extension = Gluteus Maximus, Semimembranosus, Semitendinosus & Biceps Femoris

Muscles Anterior Compartment Thigh Muscles Quadriceps Femoris: Vastus Medialis � Innervation: Femoral Nerve � Origin: Linea Aspera of the femur � Insertion: Patella via the quadriceps tendon and then tibial tuberosity via the patellar ligament � Action: Knee Extension � Synergist: Knee Extension = Rectus Femoris, Vasus Lateralis and Intermedius � Antagonist: Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris

Muscles Anterior Compartment Thigh Muscles Quadriceps Femoris: Vastus Lateralis � � � Innervation: Femoral Nerve Origin: Intertrochanteric line and linea aspera of the femur Insertion: Patella via the quadriceps tendon and then tibial tuberosity via the patellar ligament Action: Knee Extension Synergist: Knee Extension = Rectus Femoris, Vastus medialis and intermedialis Antagonist: Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris

Muscles Anterior Compartment Thigh Muscles Quadriceps Femoris: Vastus Intermedius � � � Innervation Femoral Nerve Origin Anterior 2/3 and lateral shaft of femur Insertion Patella via quadriceps tendon and then tibial tuberosity via patellar ligament Action Knee Extension Synergist Knee Extension = Rectus Femoris, Vastus Lateralis and Medialis Antagonist Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris

Muscles Medial Thigh Muscles Adductor Brevis � Innervation: Obturator Nerve � Origin Anterior surface of the inferior ramus of the pubis � Insertion Superior half of linea aspera of femur � Action Adducts, flexes and helps to laterally rotate the hip � Syngerist Hip Adduction = Adductors longus and magnus, Gracilis & Pectineus Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Lateral Rotation = Gluteus Maximus � Antagonist Hip Abduction = Gluteus medius and minimus Hip Extension = Gluteus maximus, Semimembranosus, Semitendinosus & Biceps Femoris Medial Rotation = Gluteus Minimus

Muscles Medial Thigh Muscles Adductor Longus � � � Innervation: Obturator Nerve Origin: Body of pubis inferior to pubic crest and lateral pubic symphysis Insertion: Middle 1/3 of linea aspera of the femur Action: Adducts, flexes & laterally rotates the hip Synergist: Hip Adduction = Adductors longus and magnus, Gracilis & Pectineus Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Lateral Rotation = Gluteus Maximus Antagonist: Hip Abduction = Gluteus medius and minimus Hip Extension = Gluteus maximus, Semimembranosus, Semitendinosus & Biceps Femoris Medial Rotation = Gluteus Minimus

Muscles Medial Thigh Muscles Adductor Magnus � � � Innervation: Obturator and Tibial Nerves Origin: Inferior ramus of pubis and ischium to ischial tuberosity Insertion: Linea aspera of the femur and medial supracondylar line Action: Adducts thigh, superior horizontal fibers flex the thigh and posterior portion extends thigh at hip joint Syngerist: Hip Adduction = Adductors longus and brevis, Gracilis & Pectineus Hip Flexion = Rectus femorus, Iliopsoas & Pectineus Antagonist: Hip Abduction = Gluteus medius and minimus Hip Extension = Gluteus Maximus, Semimembranosus, Semitendinosus & Biceps Femoris

Muscles Medial Thigh Muscles Gracilis � � � Innervation: Obturator Nerve Origin: Body and inferior ramus of pubis Insertion: Anterior medial proximal tibis Action: Adducts and medial rotates hip Knee Flexion Synergist: Hip Adduction = Adductors Brevis, Longus & Magnus, Pectineus Medial rotation of hip = Gluteus Minimus Knee Flexion = Semimembranosus, Semitendinosus & Biceps Femoris Antagonist: Hip Abduction = Gluteus Medius and Minimus Lateral rotation of hip = Gluteus Maximus Knee Extension = Rectus Femoris & Vastus medialis, lateralis & intermedius

Muscles Gluteal Region Tensor Fasciae Latae � Innervation: Superior Gluteal Nerve � Origin: Anterior superior iliac spine and anterior iliac crest � Insertion: Tibia by way of the iliotibial tract � Action: Flexes and abducts the thigh at the hip joint and helps to stabilize and stead the hip and knee joints by putting tension on the iliotibial band of fascia � Synergist: Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Hip Abduction = Gluteus medius and minimus � Antagonist: Hip Extension = Gluteus Maximus, Semimembranosus, Semitendinosus & Biceps Femoris Hip Adduction = All 3 Adductors, Gracilis & Pectineus

Muscles Gluteal Region Gluteus Maximus � Innervation: Inferior Gluteal Nerve � Origin: Iliac crest, Sacrum, Coccyx & Aponeurosis of Sacrospinalis � Insertion: Iliotibial tract of fascia lata and lateral part of linea aspera under greater trochanter (gluteal tuberosity) of the femur � Action: Extends the thigh at the hip and laterally rotates thigh – middle fibers abduct the hip � Synergist: Hip Extension = Semimembranosus, Semitendinosus & Biceps Femoris Hip Abduction = Gluteus medius and minimus � Antagonist: Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Hip Adduction = Adductors longus and brevis, Gracilis & Pectineus Medial Rotation of Hip = Gluteus Minimus

Muscles Gluteal Region Gluteus Medius � Innervation: Superior Gluteal Nerve � Origin: Dorsal ilium inferior to the iliac crest � Insertion: Greater Trochanter of the Femur � Action: Abducts and medially rotates the hip � Synergist: Gluteus Minimus (for both) � Antagonist: Hip Adduction = All 3 Adductors, Gracilis & Pectineus Lateral Rotation of the Hip = Gluteus Maximus

Muscles Gluteal Region Gluteus Minimus � Innervation: Superior Gluteal Nerve � Origin: Dorsal Ilium between inferior and anterior gluteal lines � Insertion: Greater trochanter of the femur � Action: Abducts and medially rotates the hip � Synergist: Gluteus Medius (for both) � Antagonist: Hip Adduction = All 3 Adductors, Gracilis & Pectineus Lateral Rotation of the Hip = Gluteus Maximus

Muscles Gluteal Region Piriformis � Innervation: Piriformis Nerve � 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 the greater trochanter � Action: Laterally rotates and abducts the thigh at the hip joint � Synergist: Hip Abduction = Gluteus medius and minimus Lateral Rotation of Hip = Gluteus Maximus � Antagonist: Hip Adduction = All 3 Adductors, Gracilis & Pectineus Medial Rotation of Hip = Gluteus medius and minimus

Muscles Posterior Thigh Muscles Biceps Femoris � � � Innervation: Tibial Nerve Origin: Long Head: Ischial Tuberosity Short Head: Linea aspera of the femur Insertion: Head of fibula and lateral condyle of the tibia Action: Long Head: Extends hip and flexes knee Short Head: Flexes knee and laterally rotates hip Synergist: Hip Extension = Gluteus Maximus Extension of Hip and Flexion of Knee = Semitendinosus and semimembranosus Lateral Rotation of Hip = Gluteus Maximus Antagonist: Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Knee Flexion = Vastus (lateralis, medialis & intermedialis) Medial Rotation = Gluteus Minimus

Muscles Posterior Thigh Muscles Semitendinosus � Innervation: Tibial Nerve � Origin: Ischial Tuberosity � Insertion: Proximal part of medial surface of shaft � Action: Knee Flexion Extends and medially rotates hip � Synergist: Knee Flexion = Biceps Femoris, Semimembranosus Hip Extension = Gluteus Maximus, Biceps Femoris & Semimembranosus Medial Rotation of Hip = Gluteus Minimus � Antagonist: Knee Extension = Rectus Femoris, Vastus (medialis, lateralis & intermdialis) Hip Flexion = Rectus Femoris, Iliopsoas & Pectineus Lateral Rotation of Hip = Gluteus Maximus

Muscles Posterior Thigh Muscles Semimembranosus � Innervation: Tibial Nerve � Origin: Ischial Tuberosity � Insertion: Posterior medial condyle of tibia � Action: Knee Flexion Extends and medially rotates the hip � Synergist: Knee Flexion = Biceps femoris & Semitendinosus Medial Rotation = Gluteus minimus � Antagonist: Knee Extension = Rectus Femoris & Vastus (medialis, lateralis & intermedialis) Lateral Rotation of Hip = Gluteus maximus

Nerves �Femoral Nerve �Obturator Nerve

Nerves �Sciatic Nerve �Superior Gluteal nerve �Inferior gluteal nerve �Common peroneal nerve

Arteries �Femoral artery �Lateral circumflex artery �Obturator artery �Deep femoral (Profunda) artery

Arteries �Superior Gluteal Artery �Inferior Gluteal Artery

Veins �Femoral Vein �Profunda (Deep Femoral) Vein �Great Saphenous Vein

Surface Anatomy -Gluteal fold/Gluteal Sulcus -Sacrum -Posterior superior iliac spine -Tip of Greater trochanter -Intergluteal cleft -Iliac crest

Surface Anatomy -Supracristal plane -Anterior superior iliac spine -Inguinal ligament

Clinical Concern – Piriformis Syndrome � Piriformis Syndrome-is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the Piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg.