005 Handout Pelvis and Hip PDF

A&P: Lower Extremity
College of Rehabilitation Sciences

Del La Salle Medical & Health Sciences Institute
De La Salle Medical & Health Sciences Institute

College Of Rehabilitation Sciences
Department Of Physical Therapy
 The lower limb is directly anchored to the axial skeleton by the sacroiliac joint and by strong ligaments, which connects the pelvic
bone to the sacrum.
 The primary function of the lower limbs is to support the weight of the body and to provide a stable foundation in standing, walking,
and running. It is also the function of the lower extremity to move the body through space, which involves the integration of movements
of all the joints of the LE to position the foot on the ground and to move the body over the foot.
 The lower limbs are divided into regions, namely the: (1) pelvis and hip, (2) thigh, (3) knee, (4) leg, and the (5) ankle and foot regions.
PART I: ANATOMY OF THE PELVIS AND HIP REGION
Bones of the Pelvis and Hip Region
 The pelvic girdle is composed of two innominate bones and the sacrum. On the other hand, the term pelvis refers to the complete
ring composed by the innominate bones, pubic symphysis, sacrum, and the coccyx.
 Each innominate bone is the union of three bones: the ilium, ischium, and pubis.
A. ILIUM
 This is the largest of the three innominate bones.
 This is composed of the ala and the inferior body of ilium. The body is one of the components of the acetabulum, the socket for the
head of the femur.
 The superior border of the ilium, the iliac crest, ends anteriorly in a blunt anterior superior iliac spine (ASIS). Below the ASIS is the
anterior inferior iliac spine (AIIS). Posteriorly, the iliac crest ends in a sharp posterior superior iliac spine (PSIS). Below it is the posterior
inferior iliac spine (PIIS). These spines serves as bony attachment for muscles that move the pelvis and ligaments that support and
provide stability to it.
 Medially, the ilium contains the iliac fossa, a smooth concavity that serves as the attachment of the iliacus muscle. Posterior to the
fossa, one can find the iliac tuberosity, a point of attachment of the sacroiliac ligament, and the auricular surface, the part that
articulates with the sacrum to form the sacroiliac joint.
 At the posterior surface of the ilium, there are three arched lines called the anterior gluteal line, posterior gluteal line, and the inferior
gluteal line. The gluteal muscles attach to the ilium between these lines.
 Below the PIIS, the greater sciatic notch can be located, this notch is converted to the greater sciatic foramen by the sacrotuberous
and sacrospinous ligaments.
B. PUBIS
 This is the anterior and inferior part of the innominate bone.
 A superior pubic ramus, inferior pubic ramus, and the body make up the pubis. The superior ramus extends anteriorly from the
anterior wall of the acetabulum to the large, flattened body of pubis. The inferior ramus, on the other hand, extends from the body
of pubis to the point of junction with the ischium.
 The anterior, superior border of the body is called the pubic crest, and at its end is the pubic tubercle. The pubic tubercle is the
beginning of a raised line, called the pectineal line, which extends along the superior ramus to merge with the arcuate line of the
ilium.
C. ISCHIUM
 This is the inferior, posterior portion of the innominate bone, which comprises of a superior body and an inferior ischial ramus. The
ischial ramus extends anteriorly ending at the junction with the inferior pubic ramus. The body of the ischium joins the ilium and pubis
to form the acetabulum.
 The sharp ischial spine projects posteriorly, just inferior to the greater sciatic notch. The lesser sciatic notch is located just inferior to
the spine. This notch is then converted to the lesser sciatic foramen by the sacrospinous and sacrotuberous ligaments.
 The large ischial tuberosity, often called as the sit bone, is a prominent bony landmark at the posteroinferior aspect of the ischium
that serves as attachment site for the hamstring muscles.
 Together with the pubis, the obturator foramen is formed. This serves as the passageway for blood vessels and nerves.
© Ram Janzen C. Fauni, PTRP

Unauthorized use and/or duplication of this material without express and written permission from the owner and/or author is strictly prohibited.
1
D. Acetabulum
 A large cup-shaped fossa located just above the obturator foramen which forms the socket of the hip.
 All three bones of the innominate bone contribute to the formation of the acetabulum: the ilium and ischium contributes to 75% of its
surface, and the remaining 25% is from the pubis.
 The acetabulum is incomplete near its inferior pole for passage of blood vessels and nerves. This is called the acetabular notch.
 The lunate surface of the acetabulum is the part covered by cartilage and is the surface that contacts the femoral head. The
acetabular fossa is the part of the acetabulum that does not articulate with the head of the femur.

2

3
 The femur is the bone of the thigh and is the strongest and longest bone in the body. Its proximal end is characterized by a head
and neck, and two large projections (the trochanters) on the upper half of the shaft.
 The femoral head, which forms about 2/3 of a sphere, projects medially and slightly anteriorly on the proximal end of the femur. On
its articular surface there is a depression called the fovea capitis to which the ligamentum capitis femoris is attached. The femoral
neck connects the head to the shaft of the femur. The neck also serves to displace the femoral shaft laterally away from the joint,
thereby reducing the likelihood of impingement against the pelvis.
 Anteriorly, the intertrochanteric line on the proximal shaft of the femur marks the distal attachment of the capsular ligaments. The
greater trochanter extends laterally and posteriorly from the junction of the femoral neck and head. On the medial surface of the
greater trochanter, there is a small pit called the trochanteric fossa which marks the attachment of the obturator externus muscle.
 Posteriorly, the femoral neck joins the shaft at the raised intertrochanteric crest. On the crest, just inferior to the trochanteric fossa, a
slightly raised area called the quadrate tubercle can be seen. The lesser trochanter projects sharply from the inferior end of the crest
in a posteromedial direction.
 The middle third of the posterior side of the shaft is clearly marked by a vertical ridge called the linea aspera. This serves as an
attachment for muscles of the thigh. Proximally, the linea aspera splits into the pectineal (spiral) line medially and the gluteal tuberosity
laterally.

4
A. Angle of Inclination
 The angle within the frontal plane between the femoral neck and the medial side of the femoral shaft.
 At birth, the angle is about 140 to 150 degrees but normally reduces to its normal adult value of 125 degrees. A deviation from the
normal value may result to either coxa vara (angle of inclination is less than 125 degrees) or coxa valga (angle of inclination greater
than 125 degrees).
B. Femoral Torsion
 This describes the relative rotation (twist) between the bone’s shaft and neck.
 Normally, when viewed above, the femoral neck projects about 15 degrees anterior to a medio-lateral axis throught he femoral
condyles. This is called the normal anteversion.
 Significant torsion greater than 15 degrees is called excessive anteversion. In contrast, torsion significantly less than 15 degrees is
called retroversion.

5
Joints of the Pelvis and Hip Region
 These joints mark the transition between the caudal end of the axial skeleton and the lower appendicular skeleton.
 The tight-fitting sacroiliac joint is designed primarily for stability, ensuring effective transfer of potentially large loads between the
vertebral column, the lower extremities, and ultimately the ground.
Sacroiliac (SI) Joint

Articulation Auricular surface of the ilium and the auricular surface of the sacrum
Type of Joint Modified synarthrodial joint
Movements Sacral nutation and counternutation
 Nutation: the promontory of the sacrum moves anteriorly and inferiorly (sacral nodding)
 Counternutation: sacral promontory moves superiorly and posteriorly.
Ligaments Primary Stabilizers
1. Anterior Sacroiliac ligament – thin ligament situated on the anterior aspect of the joint; reinforces the
anterior side of the SI joint.
2. Posterior Sacroiliac ligament – reinforces the posterior SI joint.
3. Iliolumbar ligament – connects the tip of the 5th lumbar transverse process to the iliac crest; reinforces
the anterior side of the joint; primary function is transmit the weight of the body from the vertebral
column to the bony pelvis.
4. Interosseous ligament – fills the wide gap that exists along the posterior and superior margins of the
joint.
Secondary Stabilizers
1. Sacrotuberous ligament – large ligament arising from the PSIS, lateral sacrum, and coccyx, attaching
distally to the ischial tuberosity.
2. Sacrospinous ligament – located deep to the sacrotuberous ligament, arising from the lateral margin
of the caudal end of the sacrum and coccyx, attaching distally to the ischial spine.

6
Acetabulofemoral Joint
Articulation Head of the femur and the acetabulum of the pelvic bone
Type of Joint Synovial, diarthrodial, ball-and-socket
Degrees of freedom 3 degrees of freedom / triaxial
Movements Hip flexion-extension, abduction-adduction, and internal-external rotations
Ligaments 1. Iliofemoral ligament (Y-ligament) – is a thick and strong sheet of connective tissue resembling an
inverted Y. Proximally, it attaches near the AIIS and along the adjacent margin of the acetabulum. Fiber
from distinct medial and lateral fasciculi, each attaching to either end of the intertrochanteric line of
femur. Taut during hip extension and external rotation.
2. Pubofemoral ligament – attaches along the anterior and inferior rim of the acetabulum and adjacent
superior pubic ramus. The fibers blend with the medial fasciculus of the iliofemoral ligament. This
ligament is taut during hip extension, abduction, and external rotation.
3. Ischiofemoral ligament – attaches from the posterior and inferior rim of the acetabulum, primarily from
the adjacent ischium. This then joins the circular fibers located deeper within the posterior and inferior
capsule. This ligament becomes taut during hip extension, internal rotation, and other more superior
fibers becoming taut during adduction.
Other Structures of the Acetabulofemoral Joint
Acetabular Fibrocartilage rim attached to the margin of the acetabulum that

Labrum enhances its depth.
Other 1. Ligament of the head of the femur (ligamentum teres) –

ligaments flat triangular band that extends from the fossa of the
acetabulum to the fovea capitis of the head of the femur.
Usually contains an artery that supplies the head of the
femur.
2. Transverse ligament of the acetabulum – strong ligament

that crosses over the acetabular notch. It supports part of
the acetabular labrum and is connected with the ligament
of the head of the femur and aticular capsule.

7
Symphysis Pubis
Articulation Joint between the two pubic bones
Type of Joint Symphysis, cartilaginous, amphiarthrodial
Movements Little gliding motions
Muscles of the Pelvis and Hip Region

8

9

10

11

12

13
The Pelvis
 The bony pelvis is divided into superior and inferior portions by a boundary called the pelvic brim that forms the pelvic inlet into the
pelvic cavity.
 The portion of the pelvis superior to the pelvic brim is referred to as the false (greater) pelvis. It is bordered by the lumbar vertebrae
posteriorly, the upper portion of the innominate bones laterally, and the abdominal wall anteriorly. Its function is to support the
abdomen, contain the superior portion of the urinary bladder (when full) and the lower intestines.
 The portion of the pelvis inferior to the pelvic brim is the true (lesser) pelvis. It is bounded by the sacrum and coccyx posteriorly,
inferior portions of the ilium and ischium laterally, and the pubic bones anteriorly. The superior opening of the true pelvis is called the
pelvic inlet; the inferior opening is called the pelvic outlet, which is covered by the muscle at the floor of the pelvis.
Boundaries of the Pelvic Inlet and Outlet

Pelvic Inlet Pelvic Outlet
Bound posteriorly by the sacral promontory, laterally Bound posteriorly by the coccyx, laterally by ischial
by the iliopectineal lines and anteriorly by the tuberosities and anteriorly by the pubic arch.
symphysis pubis.

14

15
 The pelvic floor is formed by the pelvic diaphragm, the perineal membrane, and the muscles in the deep perineal pouch.
 The pelvic diaphragm is the muscular part of the pelvic floor, which stretches from the pubis anteriorly to the coccyx posteriorly, and
from one lateral wall to the other. This arrangement gives it a funnel shaped appearance. This is composed of two muscle groups:
the levator ani and the coccygeus. One of the main function of the pelvic diaphragm is to separate the pelvic cavity above from the
perineum below.
 The anal canal and urethra pierce through the pelvic diaphragm in both sexes, and the vagina also goes through it in females.
A. Levator Ani
 The levator ani muscles originate from each side of the pelvic wall, course medially and inferiorly, and join together in the midline.
At the midline, the muscle blend together posterior to the vagina in women and the anal aperture in both sexes.
 This is the largest and most important muscle of the pelvic floor. it supports the pelvis viscera and resists the inferior thrust that
accompanies increase intraabdominal pressure during function such as coughing, vomiting, urination, and defecation. The muscle
also maintain closure of the rectum and vagina.
 They are innervated directly by the anterior ramus of S4 and the pudendal nerve.
 The muscles can be divided based on their site of origin and the relationship to the viscera in the midline: the pubococcygeus,
puborectalis, and the iliococcygeus muscles.
B. Coccygeus muscle
 These are triangular muscles that overlie the sacrospinous ligaments and complete the posterior part of the pelvic diaphragm.
 It is attached, by their apices, to the tips of the ischial spines and, by their bases, to the lateral margin of the coccyx and the
adjacent margins of the sacrum.

16

17
Foramen of the Pelvis

Boundaries Significance
Greater Sciatic Sacrospinous and sacrotuberous ligament, This provides an exit from the true pelvis into the gluteal region for
Foramen and the greater sciatic notch the sciatic nerve, the pudendal nerve, and the gluteal nerves and
vessels.
Lesser Sciatic Foramen Sacrospinous and sacrotuberous ligament, This provides an entrance into the perineum from the gluteal region
and the lesser sciatic notch for the pudendal nerve and the internal pudendal vessels.
Obturator Foramen Formed by ischium, pubis and inferior This provides a passageway for the obturator nerve and vessels as
portion of the acetabulum and is filled with they leave the pelvis and enter the thigh.
the obturator membrane
Femoral Triangle
 This is a wedge-shaped depression formed by muscles in the upper

thigh at the junction between the anterior abdominal wall and the
lower limb.
 Borders of the femoral triangle:
o Base: inguinal ligament
o Medial border: medial margin of the adductor longus
o Lateral border: medial margin of the Sartorius muscle
o Floor: formed medially by the pectineus and adductor longus
muscles and by the iliopsoas laterally
o Apex: points inferiorly and is continuous with a fascial canal
(adductor canal)
o
 Contents: terminal part of the femoral nerve, the femoral sheath, the
femoral artery, femoral vein, and the inguinal ligaments.

18
Radiographic Anatomy of the Pelvis and Hip

19
Surface Anatomy of the Pelvis and Hip

20

21

005 Handout Pelvis and Hip PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

005 Handout Pelvis and Hip PDF

Uploaded by

Copyright:

Available Formats

A&P: Lower Extremity

College of Rehabilitation Sciences

De La Salle Medical & Health Sciences Institute

PART I: ANATOMY OF THE PELVIS AND HIP REGION

Bones of the Pelvis and Hip Region

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

Joints of the Pelvis and Hip Region

Sacroiliac (SI) Joint

© Ram Janzen C. Fauni, PTRP

Other Structures of the Acetabulofemoral Joint

Acetabular Fibrocartilage rim attached to the margin of the acetabulum that

Other 1. Ligament of the head of the femur (ligamentum teres) –

2. Transverse ligament of the acetabulum – strong ligament

© Ram Janzen C. Fauni, PTRP

Muscles of the Pelvis and Hip Region

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

Boundaries of the Pelvic Inlet and Outlet

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

Foramen of the Pelvis

 This is a wedge-shaped depression formed by muscles in the upper

© Ram Janzen C. Fauni, PTRP

Radiographic Anatomy of the Pelvis and Hip

© Ram Janzen C. Fauni, PTRP

Surface Anatomy of the Pelvis and Hip

© Ram Janzen C. Fauni, PTRP

© Ram Janzen C. Fauni, PTRP

You might also like