Lectured by: Dr. Jesus J.

Gracilla
Lower Limb 1: Gluteal and Posterior Thigh
Transcribed by: Beverly Yu



Functions of Ligaments
Overview:
o Stability
• Bones
- Iliofemoral becomes taut in extension
• Hip Joint
- Prevents the femur from moving past vertical
• Gluteal muscles
position (resists hyperextension)
• Posterior Thigh muscles
- Maintains hip in locked or stable configuration
• Summary
The Hip Joint

• Type: Ball Socket (Synovial)
* Multi-axial ball and socket synovial joint bet. The head
Location of Pain
of the femur (ball) and the acetabulum (socket)
• Arthritis of the hip
• Fibrous capsule
Anterior Hip or • Labral tear
o Proximal attachment
Deep Groin • Stress Fracture
- encircles rim of acetabulum
(M: ArLabStAv) • Avascular necrosis
o Distal attachment
! Anterior
- greater trochanter and intertrochanteric Lateral Hip • Trochanteric bursitis
line
! Posterior Posterior Hip • Piriformis syndrome
- crosses the neck of femur Far Posterior • Sacroiliac joint
• Ligaments (M: SacLow) • Lower spine conditions
Anterior Posterior
Iliofemoral Pubofemoral Ischiofemoral
• Strongest • Weakest Muscles of Gluteal region

• Y-shaped
• Arises from • Arises from • Arises from 1. Gluteus - Most superficial gluteal muscle
anterior inferior pubic bone ischium Maximus - Largest and heaviest muscle of the
iliac spine and margin of • Inserts into body
• Inserts into the obturator greater Innervation - Inferior gluteal nerve
intertrochanteri foramen trochanter Action - Extension and lateral rotation of
c line • Inserts into of femur thigh
• Prevents femoral neck - Strongest extensor of hip
hyperextension deep to - When acting with its distal
(at the hip) Iliofemoral attachment fixed, it is a strong
• A.k.a Bigelow’s ligament extensor of the pelvis (e.g. when
ligament rising from a seated position)
Arterial Inferior and superior gluteal arteries
supply
st
& 1 perforating branch of the
• Lateral band • Limits • Limits profunda femoris artery
- limits abduction medial
adduction rotation
• Medial band
- limits lateral
rotation


* Ischial tuberosity – “sit” bone

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2. Gluteus Medius - Smaller gluteal muscles Effect of Superior Gluteal Nerve Lesion
and Minimus - Fan shaped
Innervation - Superior gluteal nerve • Trendelenburg gait
Action - Acting from above - Mark downward tilting of the hip on the non weight
: It ABDUCTS the thigh (pulls bearing side due to the inability of the gluteus muscles
upward) to actively abduct the hip on the weight bearing side
- Acting from below during walking
: It keeps the pelvis in the • Trendelenburg sign
horizontal position when - Clinical test to determine the integrity of the
one foot is off the ground as
superior gluteal nerve
in walking and running
- Patient’s hip tilts down when the hip is non-weight
Arterial supply Superior gluteal artery
bearing because of superior gluteal nerve damaged on
weight bearing side.

Glut. Max Glut. Med Glut. Min

- Most superficial - Deep to glut. - Deep to glut.
Max Medius

Tensor Fasciae Latae
• Fascia Lata
o Strong, dense, broad layer
o Iliotibial tract: runs from the iliac crest to
the tibia
o Provides a dense tubular sheath for the
thigh muscles, which prevents them from
bulging excessively when they contract
o Innervation: Femoral nerve
• Muscle
o Fusiform muscle, lies on the lateral side of
the thigh
o Tightens the fascia lata
* Enabling the thigh muscles to act with
increased power
o Tightens the Iliotibial tract
* Enabling the gluteus maximus muscle to
keep the knee joint in the extended position
o Innervation: Superior gluteal nerve

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4. Piriformis - Pear shaped
- Leaves the pelvis thru
the greater sciatic
foramen to reach the
superior border of the
greater trochanter
- Landmark of the gluteal
region
* Determines the names of
the neurovascular
structures

Innervation Nerve to piriformis
Action Lateral rotator of the thigh

5. Obturator Internus and Gemelli muscle

• Form a tricipital muscle (three-headed)

• The triceps coxae (Triceps of the hip)
• Obturator Internus 6. Quadratus Femoris
- leaves the pelvis thru the lesser sciatic foramen to
reach the medial surface of the greater trochanter. - Short, flat quadrangular muscle inferior to the obturator
• Superior and Inferior Gemelli internus and gemelli muscles
- Narrow, triangular extra pelvic reinforcements of
the obturator internus - Innervation: Nerve to Quadratus Femoris
• Innervation
- Action: Strong Lateral rotator of the thigh
o Obturator Internus and Superior Gemelli –
Nerve to Obturator Internus
o Inferior Gemelli – Nerve to Quadratus
Femoris
• Action: Lateral rotator of the thigh

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Hamstring muscles
- Arise from the Ischial tuberosity
- Inserted into the bones beyond the femur
- Supplied by the sciatic nerve carrying fibers to the
tibial nerve
- Flexors of the knee joint and extensors of the hip
joint
Semimembranosus
- Flat, broad muscle Innervation:
Tibial component of
the Sciatic nerve
Semitendinosus
- Half tendinous muscle Innervation:
- The tendon attaches to Tibial component of
the medial surface of the the Sciatic nerve
superior part of the tibia as
part of the pes anserinus
formation;
In conjunction with the
tendinous insertions of the
Sartorius and gracilis
Long head of Biceps Femoris
Long head Innervation:
Tibial component of the Sciatic
nerve
Short head Innervation:
- Not part of the Common peroneal branch of
“true” hamstrings the sciatic nerve
The three muscles of the posterior thigh
(semitendinosus, semimembranosus, biceps femoris
long & short head) flex (bend) the knee, while all but BONES- Hipbone
the short head of biceps femoris extend (straighten) - Ossifies ~20 y.o
the hip. The three 'true' hamstrings cross both the - At birth, it is comprised of three bony parts named the ilium,
hip and the knee joint and are therefore involved in ischium, and pubis, which are separated by cartilage.
knee flexion and hip extension. The short head of the
biceps femoris crosses only one joint (knee) and is Acetabulum
therefore not involved in hip extension. With its - portion of the hip bone that participates in the hip joint
divergent origin and innervation it is sometimes - cup-shaped depression on the lateral surface
excluded from the 'hamstring' characterization - union of 3 bones

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 • Obturator Foramen - articulates with the body of the pubis on
- Large aperture on the lower aspect of the bone. the opposite side.

• Ilium • Sacrospinal ligament
- Most superior, widest portion. - from ischial spine to sacrum
- will form your greater sciatic foramen
• Major Landmarks of the ilium:
o Iliac tubercle • The greater and lesser sciatic notches
o Ala (wing) o Bony margins on the posterior aspect of the
- Expanded end of the body hipbone that extend above and below the ischial
- most of the lateral surf. Is called the spine respectively.
gluteal surface since the three gluteal
muscles originate from it. • Acetabulum
- Inner surface: concave- attachment for o Cup-shaped depression on the lateral side
iliac muscle of the hip bone
o Acetabular rim
o Iliac crest - sharp outer edge of the acetabulum
- demarcated anteriorly and posteriorly by o Articular surface
iliac spines - horse shoe- shaped
- iliac crest + anterior superior iliac spine, - syn. Lunate surface
readily palpated on the body surface - articulates with the head of the femur
- surface of the bone participating in the
• Major Land marks of the ischium articular surface is smooth
o Ischium is L-shaped - in an actual joint, is covered with a layer of
o Vertical limb of the L is called the body hyaline cartilage
o Horizontal limb of the L is called the ischial o Acetabular fossa
ramus - central, non-articulating part
o Ischial tuberosity- roughened area of bone - “bottom of the cup”
covering the posterior side of the body o Acetabular notch
- inferior portion of the acetabulum without
A- Ischial spine a wall.
B- Ischial tuberosity
C- Body • Proximal end of femur
D- Ischial Ramus - The femur transmits forces from the tibia to the hip
joint; longest bone in the body.
o Head of the femur
- near spherical
- articulates with the acetabulum of the hip
bone
o Fovea capitis
- depression on the head that is the
• Major Landmarks of the pubis attachment site of a small ligament
o Superior and inferior rami - not part of the articulating surface
- project from the body of the bone, the o Neck
superior ramus towards the acetabulum - projects inferiorly and laterally from the
and the inferior ramus toward the ischial head
ramus with which it fuses (the fused rami - Adult ave angle of neck is 125° with the
are often referred to as the ischiopubic shaft of the femur
ramus). - the angle is less in females than males,
and is at its greatest in infancy.
o Crest o Trochanters
- top of the pubic body - large projections of bone to which muscles
- Whose lateral margin has a bony elevation attach
called the pubic tubercle. - at the junction of the neck and shaft
o Symphyseal surface - Intertrochanteric crest: the prominent
- medial surface of the body ridge of bone, connecting the trochanters

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 posteriorly • Intertrochlear crest & line
- Intertrochanteric line: the smaller ridge - demarcates jxn between shaft and neck of femur
of bone connecting the trochanters
anteriorly. • Coxavara vs. Coxavalga deformity
- Greater trochanter : attachment of o Coxavara
adductor and lateral rotators - when the femoral neck angle is less than
- Lesser Trochanter : attachment of 125 degrees
iliopsoas o Coxavalga
- Pectineal line : continuation of the - when the femoral neck angle is greater
intertrochanteric line, down the shaft than 125 degrees
o Linea aspera • Intercondylar fossa
- divides proximally into additional ridges - facets for attachment of posterior cruciate
that are attachment sites for muscles. ligament (found on medial wall of fossa)
- ex. Gluteal tuberosity : part of the - facets for attachment of anterior cruciate ligament
insertion site for the gluteus maximus (found on lateral wall of fossa)
muscle.
• Fractures of proximal surface of femur
• Distal end of femur - intracapsular - common in elderly; damages
o Condyle(s) medial femoral circumflex A. " necrosis, shortening
- expanded portion of the distal end of the of the leg, lateral rotation.
femur. - Extracapsular – common in young adults/ children.
- Non articulating sides are called the Blood supply to the femur is intact " shortening of
epicondyles the leg & lateral rotation.
- easily palpated on the sides of your knee
o Intercondylar fossa
- notch, found posteriorly, between the • Intracapsular ligament
two condyles. - from fovea capitis to head of femur
o Note: articular surfaces on the anterior and
posterior sides of the femur are continuous • Hip Joint
with each other over the bottom of the - relaxed capsule while sitting; taut while
condyles. standing.
o Posterior side: articular surfaces of two - Anterior aspect – with fewer muscles and
condyles are separated by Intercondylar stronger ligaments
notch. - posterior aspect- stronger muscles and
o Anterior side: articular surfaces are fewer ligaments.
continuous across the midline; this region - Position of weakness- when the hip joint is
articulates with the patella, called the flexed, adducted, and medially rotated =
patellar surface SITTING POSITION
o Popliteal surface - Hip dislocation: when the head is
- Found posteriorly, this is the area of the dislodged from the socket.
shaft between the two supracondylar ridges - Acquired hip dislocation: commonly seen
o Adductor tubercle in vehicular accidents, where victim is
- small elevation where the medial sitting in the front seat and force of the
supracondylar ridge ends, distally. impact forces the femur posteriorly.
- Insertion site for the tendon of the *The flexion of the hip means that the
adductor magnus muscle. ligaments are lax, and the direction of the
force pushes the head of the femur towards
the weakest and shallowest part of the
Extra Notes acetabulum.


• Quadrate tubercle END OF TRANSCRIPTION
- where quadratus femoris attaches References:
- on the upper half of the greater trochanter • Doc Gracilla’s Powerpoint presentation
• Lecture Notes

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Muscle Function Origin Insertion Innervation Blood Supply
Gluteal Region
Gluteus medius Hip abductor, Hip Dorsal iliac crest Greater trochanter Superior gluteal A.
Gluteus minimus medial rotator Dorsal ilium Superior gluteal
Tensor fascia lata ^ + Stabilizes hip, Ant. Sup. Iliac line Iliotibial tract nerve ^ + lateral
knee circumflex femoral
A.
Mnemonic: Medicine, Minimum Ten years
: All Abduct and medially rotate the hip + VAN = superior gluteal
Gluteus maximus Hip extensor Ilium, sacrum, Iliotibial tract, Gluteal Inferior gluteal Inferior and
Hip lateral rotator coccyx tuberosity of femur superior gluteal
Piriformis Sacrum
Superior gemellus Ischial spine Greater trochanter
Obturator Internus Hip lateral rotator Inner obturator Sacral plexus Inferior gluteal
Inferior gemellus Ischial tuberosity
Quadratus femoris Lateral obturator Intertrochanteric Med. Circum. fem
crest
Obturator Externus Outer Obturator Greater trochanter Obturator Obturator
Med. Circum. fem
Posterior Thigh
Biceps femoris Knee flexor Lateral shaft of Fibula head Fibular
Short head femur
***Biceps femoris Fibula head
Long head Perforating branch
***Semitendinosus Hip extensor Ischial tuberosity Upper medial shaft of profunda
Knee Flexor tibia Tibial femoris
***Semimembranosus Medial condyle tibia
***Hamstring part of Hip extensor Adductor tubercle
adductor magnus
***Hamstring muscles are all hip extensors and knee flexors, from Ischial tuberosity, N=tibial. EXCEPT FOR
Hamstring part of adductor magnus since it only spans hip, it is not a knee flexor.

From medial to lateral:
Semimembranosus, semitendinosus, biceps femoris (M: MTB)


ACTION INNERVATION
Medial rotator Lateral rotator Tibial Fibular Sup. Gluteal Inf.
Gluteal
- Gluteus - Gluteus maximus -Biceps femoris - Biceps - Gluteus medius -Gluteus
medius - piriformis (Long head) femoris - Gluteus minimus maximus
- Gluteus - superior and inferior - Semimembranosus (short - Tensor fascia lata
minimus gemellus - Semitendinosus head)
- Tensor Fascia - obturator internus - Adductor magnus
Lata and externus (hamstring part)
- quadratus femoris

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