Luke Vetti – NBPME Part 1 – LEA – Anterior Hip + Gluteal Muscles 1
Anterior Hip Muscles
provide stability @ hip joint anteriorly iliopectineal bursa separates muscles from capsule Gluteal Muscles iliopsoas tensor fasciae latae o action lateral rotation of leg o origin o insertion (iliacus + psoas major) lesser trochanter (femur) iliac crest (anterior ¼ of lateral lip) femoral shaft (distal to lesser trochanter) ASIS (lateral) iliacus interspinous fossa o origin fascia lata/gluteal fascia iliac fossa o insertion iliac crest (internal lip) IT band pelvic surface of sacrum (lateral) (travels between 2 layers of fascia lata) ventro sacroiliac ligament o innervation iliolumbar ligament o innervation superior gluteal (L4) L2 ventral rami (dorsal divisions) o blood supply: lateral femoral circumflex and superior gluteal L3 ventral rami L4 ventral rami o actions o blood supply: common, internal, and external iliac (same for psoas major) flexes/abducts the thigh o action tenses fascia lata hip flexor (major) gluteus maximus others… o origin psoas major o origin ilium (posterior to posterior gluteal line) ventral fibers distal 2 sacral segments (dorsal) IV disks coccyx vertebral bodies of T12-L5 aponeurosis of erector spinae dorsal fibers dorsal sacroiliac ligament transverse processes of L1-L5 (inf. edge) sacrotuberous ligament o innervation fascia lata L2 ventral rami (dorsal divisions) o insertion L3 ventral rami superior/superficial fibers IT tract L4 ventral rami deep fibers gluteal tuberosity o action o blood supply flexion of hip flexion of trunk superior gluteal (superficial) others… inferior gluteal psoas minor o innervation o anterior to psoas major inferior gluteal nerve o origin o actions T12, L1 vertebral bodies extension + lateral rotation of hip T12, L1 IV disks superior fibers ABD hip o insertion other fibers ADD hip iliopubic eminence o bursae o innervation L1 ventral rami ischial gluteus maximus + ischial tuberosity o action trochanteric gluteus maximus + greater trochanter (lateral) flexion of trunk (weak) gluteofemoral gluteus maximus + origin of VL NO action @ hip o gluteus maximus gait Luke Vetti – NBPME Part 1 – LEA – Anterior Hip + Gluteal Muscles 2 issue w/inferior gluteal nerve Gluteal Muscles (cont’d) gluteus medius o origin ilium (posterior + anterior gluteal lines) gluteal fascia obturator externus o insertion o origin greater trochanter (diagonal ridge @ lateral surface) obturator foramen (external margin, but not ilium) obturator membrane (external) o blood supply o insertion superior gluteal (deep branch) trochanteric fossa (medial surface of greater trochanter) o innervation o blood supply superior gluteal inferior gluteal o actions o innervation ABD/lat rotation of the hip (stabilization of pelvis) obturator nerve anterior fibers flexion + medial rotation @ hip o action posterior fibers extension + lateral rotation @ hip laterally rotates hip gluteus minimus weak adductor (?) o origin obturator internus + gemelli ilium (anterior + inferior gluteal lines) o origins o insertion obturator internus greater trochanter (depression @ anterior surface) obturator foramen (internal margin) o blood supply obturator membrane (internal) superior gluteal (deep branch) superior gemellus ischial spine o innervation superior edge of the lesser sciatic notch superior gluteal inferior gemellus o actions ischial tuberosity ABD of hip (pelvic stabilization) inferior margin of the lesser sciatic notch flexion + medial rotation of hip o insertion piriformis all combine to common tendon o origin greater trochanter (medial side ant. + sup. to trochanteric fossa) pelvic surface of sacrum (lateral part of S2-S4) o blood supply ventral sacroiliac ligament inferior gluteal sacrotuberous ligament o innervation o insertion obturator internus/superior gemellus greater trochanter (“tip” posterior + superior borders meet) nerve to obturator internus o blood supply inferior gemellus/quadratus femoris inferior gluteal nerve to quadratus femoris + inferior gemellus o innervation o action dorsal division of ventral rami of S1 + S2 (nerve to laterally rotate hip piriformis) ABD thigh when hip is flexed quadratus femoris o actions o origin lateral rotation of hip ischial tuberosity (lateral border) abductor of thigh w/ hip flexed (sitting crossed legged) body of ischium (descending part) o insertion Luke Vetti – NBPME Part 1 – LEA – Anterior Hip + Gluteal Muscles 3 quadrate tubercle (and adjacent bone) o blood supply inferior gluteal o innervation nerve to quadratus femoris + inferior gemellus o action laterally rotates hip weak adductor (?)