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Lower Limb: Hip and Thigh by Monica Hsu

Muscles of the Gluteal Region: abductors, medial rotators, and lateral rotators of the thigh
Muscles

Origin
Ilium posterior to posterior gluteal line,
posterior sacrum, sacrotuberous ligament
External surface of ilium between anterior
Gluteus medius
and posterior gluteal lines
External surface of ilium between anterior
Gluteus minimus
and inferior gluteal lines
Anterior sacrum,
Piriformis
sacrotuberous ligament
Pelvic surface of obturator membrane and
Obturator internus
surrounding bones
Gemellus superior Ischial spine
Gemellus inferior Ischial tuberosity
Gluteus maximus

Insertion
Innervation
Iliotibial tract, lateral condyle of
Inferior gluteal nerve
tibia, gluteal tuberosity of femur

Abducts thigh,
medially rotates thigh

Superior gluteal nerve

Greater trochanter of femur

Anterior rami of S12


Nerve to obturator internus
Nerve to obturator internus
Nerve to quadratus femoris

Quadrate tubercle on
intertrochanteric crest of femur

Quadratus femoris Ischial tuberosity

Action
Extends thigh, laterally
rotates thigh

Laterally rotates thigh

Nerve to quadratus femoris

Anterior Thigh Muscles: flexors of the hip joint, extensors of the knee joint

Anterior rami of L12

Tensor fasciae latae

Origin
Insertion
Sides of T12L5 vertebrae,
Lesser trochanter of femur
transverse processes of L15
Sides of T12-L1 vertebrae,
Pectineal line
intervertebral disc
Tendon of psoas major, lesser
Iliac fossa
trochanter
ASIS
Iliotibial tract, lateral condyle of tibia

Sartorius

ASIS

Femoral nerve

Iliopsoas
- Psoas major
- Psoas minor
- Iliacus

Superior part of medial surface of tibia

Innervation

Action

Anterior rami of L13


Flexes thigh,
stabilizes hip joint

Femoral nerve
Superior gluteal nerve

Abducts and medially rotates thigh


Abducts, flexes, and medially rotates
thigh at hip joint
Flexes leg at knee joint

Quadriceps femoris
AIIS, ilium superior to
acetabulum
Greater trochanter of femur,
- Vastus lateralis
lateral lip of linea aspera
Rectus femoris tendon,
patellar ligament, tibial tuberosity
Intertrochanteric line,
- Vastus medialis
medial lip of linea aspera
Anterior and lateral surfaces
- Vastus intermedius
of shaft of femur
- Rectus femoris

Femoral nerve

Extends leg at knee joint


(Note. rectus femoris also flexes thigh)

Medial Thigh Muscles: adductors of the thigh (except obturator externus)


Muscle

Origin

Insertion

Pectineus

Superior pubic ramus

Pectineal line of femur

Adductor longus
Adductor brevis

Adductor magnus

Gracilis
Obturator
externus

Body of pubis inferior to


pubic crest
Body and inferior ramus of
pubis
Adductor part: inferior ramus
of pubis, ramus of ischium
Hamstring part: ischial
tuberosity
Body and inferior ramus of
pubis
Margins of obturator
foramen and obturator
membrane

Innervation
Femoral nerve, maybe
obturator nerve

Action
Adducts and flexes thigh

Middle third of linea aspera of femur


Pectineal line,
proximal part of linea aspera of femur
Adductor part: gluteal tuberosity, linea
aspera, medial supracondylar line
Hamstring part: adductor tubercle of
femur

Obturator nerve

Adducts thigh

Adductor part: obturator


nerve
Adductor part: adducts and flexes thigh
Hamstring part: tibial
Hamstring part: extends thigh
nerve

Superior part of medial surface of tibia

Adducts thigh
Obturator nerve

Trochanteric fossa of femur

Laterally rotates thigh

Posterior Thigh Muscles (Hamstrings): extensors of the hip joint, flexors of the knee joint
Muscle
Semitendinosus

Origin
Ischial tuberosity

Semimembranosus
Biceps femoris

Long head: ischial tuberosity


Short head: linea aspera, lateral
supracondylar line of femur

Insertion
Superior, medial surface
of tibia
Medial condyle of tibia
Lateral head of fibula

Innervation

Action

Tibial nerve

Extends thigh, flexes leg

Long head: tibial nerve


Extends thigh, flexes and medially
Short head: common fibular nerve rotates leg

Lower Limb: Leg by Monica Hsu


Lateral Muscles of the Leg
Muscle
Origin
Fibularis longus Head and superior 2/3 of lateral fibula
Fibularis brevis Inferior 2/3 of lateral fibula

Insertion
Plantar base of 1st metatarsal, medial cuneiform
Tuberosity on base of 5th metatarsal

Innervation
Superficial fibular n.

Action
Everts foot,
weakly plantarflexes ankle

Anterior Muscles of the Leg


Muscle

Origin
Lateral condyle and proximal half
Tibialis anterior
of lateral tibia, interosseous
membrane
Lateral condyle of tibia, proximal
Extensor digitorum longus three quarters of anterior surface
of interosseous membrane
Middle half of anterior surface of
Extensor hallucis longus
fibula, interosseous membrane
Distal third of anterior surface of
Fibularis tertius
fibula, interosseous membrane

Insertion

Innervation

Medial plantar surfaces of medial


cuneiform, base of 1st metatarsal
Middle and distal phalanges of
lateral 4 digits

Action
Dorsiflexes ankle, inverts foot

Deep fibular n.

Dorsiflexes ankle, extends lateral 4 digits

Base of distal phalanx of great toe

Dorsiflexes ankle, extends great toe

Dorsum of base of 5th metatarsal

Dorsiflexes ankle, everts foot

Deep Muscles of the Posterior Leg


Muscle
Popliteus
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus

Origin
Lateral surface of lateral condyle of
femur, lateral meniscus
Posterior tibia below soleal line,
interosseous membrane, posterior fibula
Medial part of posterior tibia inferior to
soleal line
Inferior two-thirds of posterior fibula,
inferior part of interosseous membrane

Insertion

Innervation Action

Posterior tibia above soleal line

Unlocks & weakly flexes knee joint

Navicular tuberosity, cuneiforms,


Plantarflexes ankle
cuboid, bases of 2nd4th metatarsals
Tibial nerve
Plantar bases of distal phalanges
Flexes lateral 4 digits
of lateral 4 digits
Base of distal phalanx of great toe

Flexes great toes

Superficial Muscles of the Posterior Leg


Muscle
Gastrocnemius
Soleus
Plantaris

Origin
Insertion
Innervation Action
Lateral head: lateral aspect of lateral condyle of femur
Plantarflexes ankle
Medial head: popliteal surface above medial condyle of femur
Posterior
surface
of
calcaneus
Soleal line, posterior aspect of head of fibula,
Tibial nerve Plantarflexes ankle
via calcaneal tendon
superior quarter of posterior surface of fibula
Inferior end of lateral supracondylar line of femur, oblique
Weakly assists gastrocnemius
popliteal ligament

Muscles of Sole of the Foot


Muscle
First Layer
Abductor hallucis

Origin

Insertion

Innervation

Action

Medial tubercle of calcaneal


tuberosity, flexor retinaculum,
plantar aponeurosis

Base of proximal phalanx of 1st toe


Both sides of middle phalanges of
2nd-5th toes
Base of proximal phalanx of 5th toe

Medial plantar nerve

Abducts and flexes 1st toe

Medial plantar nerve

Flexes 2nd-5th toes

Quadratus plantae

Medial and lateral sides of


plantar surface of calcaneus

Lateral side of flexor digitorum longus


tendon

Lumbricals

Flexor digitorum longus tendon Medial side of dorsal digital expansions 1st: medial plantar n.

Flexor digitorum brevis


Abductor digiti minimi
Second Layer

Abducts and flexes 5th toe


Assists flexor digitorum longus in
flexing 2nd-5th toes
Flex proximal phalanges, extend
middle and distal phalanges of
2nd-5th toes

Also: tendons of flexor


digitorum longus, tendon
of flexor hallucis longus
Third Layer
Plantar surfaces of cuboid,
lateral cuneiform
Oblique head: bases of 2nd-4th
metatarsals
Adductor hallucis
Transverse head: ligaments of
metatarsalphalangela joints
Flexor digiti minimi brevis Base of fifth metatarsal
Fourth Layer
Bases and medial sides of
Plantar interossei (3)
3rd-5th metatarsals
Flexor hallucis brevis

Dorsal interossei (4)

Adjacent sides of 1st-5th


metatarsals

Base of proximal phalanx of 1st toe

Medial plantar nerve

Flexes proximal phalanx of 1st toe

Base of proximal phalanx of 1st toe

Adducts 1st toe

Base of proximal phalanx of fifth toe

Flexes proximal phalanx of 5th toe

Bases of proximal phalanges of 3rd-5th


toes
1st: medial side of proximal phalanx of
2nd toe
2nd-4th: lateral sides of 2nd-4th toes

Adduct 2nd-4th toes,


flex metatarsophalangeal joints

Everything else is innervated by lateral plantar nerve

Abduct 2nd-4th, flex


metatarsophalangel joints

Ligaments of the Hip Joint


Ligament
Iliofemoral
Ischiofemoral

by Monica Hsu
Attachments
ASIS and acetabulum intertrochanteric line. (Strong; Y-shaped
ligament)
Acetabular rim circles superiorly and laterally to medial base of
greater trochanter

Pubofemoral

Pubic ramus laterally and inferiorly to joint capsule

Transverse acetabular
Ligament of head of femur

Joins the inferior ends of the labrum, crosses acetabular notch


Acetabular notch fovea of femur(Intracapsular but extrasynovial)

Function
Prevents hyperextension
Prevents hyperextension
Screws femoral head into acetabulum
Tightens during extension and abduction Limits
abduction
Completes the acetabular ring
Contains artery to head of femur (minute in adults)

Sacrotuburous ligament
Sacrospinous ligament
Posterior femoral cutaneous nerve  superior and inferior clunial nerves innervate the skin of the gluteal region
Pudental nerve innervates the perineal region it comes from the greater sciatic foramen and goes back via lesser sciatic foramen
Great saphenous vein enters the saphenous opening to join femoral vein

Aorta arch

Thoracic aorta
Superficial epigastric artery

Superficial circumflex iliac artery
Abdominal
aorta
Superficial & deep external pudendal arteries

Descending genicular artery
Common iliac


External iliac artery
Internal iliac artery




Profunda femoris artery
Obturator Superior &
Internal
Femoral artery
(medial, posterior and
artery inferior gluteal pudendal

lateral part of anterior muscles)
arteries
artery
Popliteal artery






Muscular
Lateral
Medial 3 perforating
Posterior tibial artery
Anterior tibial artery
branches circumflex circumflex arteries



femoral
femoral
Fibular Medial & lateral
Dorsalis pedis artery
artery
artery
artery plantar arteries

(hip joint,
(hip joint,
Arcuate artery
lateral area upper adductor

of the hip )
muscles &
Dorsal metatarsal artery
rotators )
Femoral nerve
(anterior thigh muscles)



Nerve to vastus
Saphenous nerve
medialis muscle (skin of medial ankle and foot)

Sciatic nerve (L4S3)


(gluteal region muscles, posterior thigh muscles)


Tibial nerve (L4S3)
(posterior muscles of
thigh, leg and knee joint)

Sural nerve
(skin of posterior
and lateral leg and
lateral foot)


Lateral plantar
nerve

Medial thigh muscles:


Obturator nerve (L24)
Accessory obturator nerve (L34 or L23)
Gluteal region muscles:
Superior gluteal nerve (L4S1)
Inferior gluteal nerve (L5S2)
Sciatic nerve (L4S3)
Posterior cutaneous nerve of thigh (S13 )
(anterior leg muscles,
Pudendal nerve (S24): supplies no
dorsum of foot)
structures in gluteal region or posterior thigh )


Common fibular nerve (L4S2)
(short head of biceps femoris)


Superficial
Deep
fibular nerve
fibular nerve
(lateral leg muscles,
skin of anterior leg
and dorsum of foot)

Fibular = peroneal