HIP JOINT

GLUTEAL REGION ● Posterior aspect of lower

● “Buttocks region”
● Posterior to the pelvic girdle
Cutaneous Innervation
Upper Medial Quadrant
Posterior rami of upper 3
lumbar nerves & sacral
nerves
Lower Medial Quadrant
Branches from posterior
cutaneous nerve of thigh
(S1, 2, & 3, anterior rami)
part of ischial body
■ G & L sciatic foramina (sacrospinous
& sacrotuberous ligaments)
○ Pubis
■ Divided into:
Upper Lateral Quadrant ● Body - 2 pubic bone bodies
Lateral branches of articulate in midline
iliohypogastric (L1) & 12th (anteriorly) = SYMPHYSIS
thoracic nerves (anterior PUBIS
rami) ● Superior ramus - joins ilium
& ischium at
Lower Lateral Quadrant ACETABULUM
● Inferior ramus - joins ischial
Branches of lateral
cutaneous nerve of thigh (L2 ramus at OBTURATOR
& 3, anterior rami) FORAMEN (filled with
obturator membrane)

Fascia ■ Pubic crest (upper border of pubic

● Superficial fascia body) → Pubic tubercle (laterally)
○ Lots of fat (in women)
■ Surfaces
○ Forms buttocks
● Symphysis pubis - upward
● Deep fascia
& backward
○ Continuous with the deep fascia of the thigh
● Sacrum (anterior) -
(Fascia lata)
downward & forward
○ Splits to enclose Gluteus MAXIMUS
○ Continues as single layer to cover outer
○ Acetabulum
surface of Gluteus MEDIUS
■ deep depression on outer surface of
○ Attached to iliac crest
hip bone
● Iliotibial tract or band (ITB)
■ articulates with head of femur = hip
○ Continuation of deep fascia on lateral surface
joint
of thigh
■ Acetabular notch
○ Thickened → strong, wide band ■ Horseshoe-shaped inferior
○ Attached: margin of acetabulum
■ Above: Tubercle of iliac crest covered with hyaline
■ Below: Lateral condyle of tibia cartilage
○ Forms a sheath for the Tensor Fascia Lata & ■ Acetabular fossa
has a greater part of G. Max insertion ● Nonarticular floor of
Bones acetabulum
● Hip bone ● Femur
○ Ilium - upper flattened part ○ Articulates with
■ Iliac crest ■ Acetabulum = hip joint
■ ASIS (front) ■ Tibia & patella = knee joint
■ PSIS (back) ○ Upper end:
■ Iliac tubercles ■ Head
● 2” behind ASIS ● ⅔ of a sphere; articulates
● AIIS (below ASIS) with acetabulum of hip
● PIIS (below PSIS) bone
■ Greater sciatic notch ● Fovea capitis
○ Ischium ○ small depression
■ L shaped in center of head
■ Body (upper thicker part) for attachment of
■ Ramus (lower thinner part) ligamentum teres
■ Ischial spine (LT)
● Posterior border; between ○ Obturator artery
G & L sciatic notches (blood supply) -
■ Ischial tuberosity conveyed along
 LT & enters bone ● Sacrospinous lig: back of sacrum → ischial spine
at fovea
Foramina
■ Neck
● G Sciatic Foramen
● Connects head to shaft
○ G sciatic notch + ST & SS ligs
● Passes down, back, &
○ Exit from pelvis to gluteal region
laterally
○ Structures that exit: (PINS)
● ~125° with long axis of
■ Piriformis
shaft angle (“angle of
■ Post. cutaneous nerve of thigh
inclination” of hip)
■ Pudendal nerve
○ Less in females
■ Internal pudendal artery
■ G & L Trochanters
■ Nerves to obturator internus &
● Large eminences at
quadratus femoris
junction of neck & shaft
■ Sciatic nerve
● Anterior: Intertrochanteric
■ Superior & inferior gluteal nerves,
line (connects the
arteries, veins
trochanters where
● L Sciatic Foramen
Iliofemoral lig attached)
○ L sciatic notch + ST & SS ligs
● Posterior: Intertrochanteric
○ Entrance from gluteal region to perineum
crest & Quadrate tubercle
○ Shaft ■ Nerves & vessels: GSF (above
■ Ant: smooth & rounded pelvic floor) → Perineum (below
■ Post:
● Linea aspera pelvic floor)
○ ridge where ms. ○ Structures that pass: (PINT)
attach ■ Pudendal nerve
○ Margins diverge ■ Internal pudendal artery & vein
above & below ■ Nerve to obturator internus
■ Medial margin: ■ Tendon of obturator internus
Muscles
Med.
Nerve
supracondylar Muscle Origin Insertion Nerve Action
Root

ridge → ADD
Outer Hip
tubercle surface of
Ilium,
ITB & Inferior
Extension
& ER
G. Max Gluteal Gluteal L5; S1-2
■ Lateral margin: Sacrum, Knee
tuberosity Nerve
Coccyx, Extension
Lat. ST lig. (via ITB)
supracondylar
ridge G
● Intermuscular septa G. Med
trochanter
(lat.
● Gluteal tuberosity surface)
Outer Hip ABD
○ Below G surface of L5; S1 Pelvic tilt
trochanter Ilium (walking)
G
Superior
○ Attachment for G G. Min
trochanter
Gluteal
(ant.
Max Nerve
surface)
■ Broader at distal end → forms flat,
Knee
triangular area: Popliteal surface Extension
TFL Iliac crest ITB L4-5
(assist G
○ Lateral & Medial Condyles Max)
■ Lower end; forms knee joint
■ Post: Intercondylar notch Sacral
Ant
■ Ant: articular surface of patella Piriformis surface of
Nerves
L5; S1-2
(1st &
■ Above: Lateral & Medial Sacrum
2nd)
Epicondyles G
trochanter Hip ER
● Med: ADD tubercle Inner (U. border)
Ligaments Obturator
surface of
Sacral
Obturator L5; S1
● Stabilize sacrum & prevent rotation at SI joint by weight Internus
membran
Plexus
of VC. e

● Sacrotuberous lig: back of sacrum → ischial tuberosity

 ○ Posterior Cutaneous Nerve of the Thigh
Gem. Ischial ■ Enters gluteal region via lower part
Superior spine
of GSF below Piriformis
■ Passes down on Post. surface of
sciatic nerve & back of thigh under
Gem. Ischial
Inferior tuberosity deep fascia
■ Supplies skin in popliteal fossa
■ Branches:
Ischial ● Gluteal: skin over lower
Quad. tuberosity Quadrate medial quadrant of buttock
Femoris (lateral tubercle
border) ● Perineal: skin of back of
scrotum or labium majus
● Cutaneous: back of thigh &
Note: upper part of leg
● G Max - largest mm in body; superficial in gluteal; ○ Superior Gluteal Nerve
prominence of buttock ■ Leaves pelvis via U. part of GSF
● TFL - down & back to insertion in ITB tract; assists G above Piriformis
Max in knee extension ■ Forward between G Medius &
● Piriformis Minimus (supplies both) & ends by
○ partly w/n pelvis at origin supplying TSL
○ Inferior Gluteal Nerve
○ through GSF → gluteal region
■ Leaves pelvis via L. part of GSF
○ separates superior and inferior gluteal below Piriformis
vessels & nerves ■ Supplies G Max
● Obturator internus ○ Nerve to the Quadratus Femoris
○ fan-shaped mm w/n pelvis at origin ■ Leaves pelvis via L. part of GSF
○ through LSF → gluteal region ■ Supplies Quad femoris & Inferior
○ tendon joined by superior & inferior gemelli, gemellus
inserted into G trochanter of femur ○ Pudendal Nerve and Nerve to Obturator
● 3 bursae Internus
○ Assoc. with G Max - between: ■ Leave pelvis via L. part of GSF
■ Tendon of insertion & G trochanter below Piriformis
(Trochanteric bursa) ■ Cross ischial spine w/ internal
■ Tendon of insertion & Vastus pudendal artery & re-enter pelvis via
lateralis (Gluteofemoral bursa) LSF then lie in Ischiorectal fossa
■ Overlie ischial tuberosity (Ischial ■ Pudendal N - supplies perineum
bursa) structures
Nerves ■ N to Obturator Internus - supplies
● Lumbosacral plexus Obturator Internus on pelvic surface
○ Sciatic Nerve Arteries
■ Sacral plexus (L4 & 5; S1-3) ● Branches from Internal iliac artery
○ Superior Gluteal A. - U. part of GSF; divides
■ Pelvis → lower part of GSF
into branches distributed throughout gluteal
■ Largest nerve in body region
■ Tibial & Common peroneal nerves ○ Inferior Gluteal A. - L. part of GSF; divides into
(bound with fascia) numerous branches distributed throughout
■ Below Piriformis → curves down & gluteal region
● Trochanteric Anastomosis
laterally → on root of Ischial spine,
○ Main blood supply to femoral head
Superior gemellus, Obturator ○ Nutrient arteries (4) - pass along femoral neck
beneath capsule:
internus, Inferior gemellus, & Quad
■ Gluteal arteries (Sup & Inf)
femoris → back of ADD magnus ■ Femoral circumflex arteries (Med &
■ Post: Posterior cutaneous nerve of Lat)
thigh & G Max ● Cruciate Anastomosis
○ At level of L trochanter
■ Leaves buttock: Long head of biceps
○ Connect Internal iliac & Femoral arteries
femoris → back of thigh (together with Trochanteric Anas.)
■ NO branches in gluteal region ○ Arteries:
 ■ Gluteal artery (Inf)
■ Femoral circumflex artery (Med &
Lat)
■ First perforating artery (branch of
profunda artery)
FRONTAL AND MEDIAL ASPECTS OF THE THIGH
Skin of the Thigh: Cutaneous Nerves
● Lateral Cutaneous Nerve of the Thigh
Branch of L2 & L3
○ Enters thigh behind the lateral end of the
inguinal ligament
○ Anterior and posterior branches
■ Skin of lateral aspect of thigh and
knee
■ Skin of lower lateral quadrant of
buttocks
● Femoral Branch of the Genitofemoral Nerve
Branch of L1 and L2
○ Enters thigh behind the middle of the inguinal
ligament
○ Supply
■ Small area of skin
■ Cremaster muscle (retract the
testes, important in
thermoregulation and
spermatogenesis)
● Ilioinguinal Nerve
Branch of L1
○ Enters thigh through superficial inguinal ring
○ Supply
■ Skin of penis and adjacent part of
scrotum (males)
■ Skin of clitoris and adjacent part of
labium majus (females)
■ Small skin area below the medial
part of the inguinal ligament
● Medial Cutaneous Nerve of the Thigh
Branch of Femoral Nerve
○ Supply
■ Medial aspect of thigh
■ Joins the patellar plexus
● Intermediate Cutaneous Nerve of the Thigh
Branch of Femoral Nerve
○ 2 branches
■ Supply anterior aspect of thigh
■ Joins the patellar plexus
● Obturator Nerve (anterior division)
○ Supply
■ Variable area of skin on medial
aspect of thigh
● Patellar Plexus
○ Formed by:
■ Terminal branches of the lateral,
intermediate and medial cutaneous
nerves of the thigh
■ Infrapatellar branch of saphenous
nerve
○ In front of the knee
Skin of the Thigh: Superficial Veins
● Great Saphenous Vein
○ Drains medial end of dorsal venous arch of
foot → directly in front of medial malleolus
○ Ascends with saphenous nerve in the
superficial fascia over medial side of leg →
behind knee → curve forward around medial
side of thigh → lower part of saphenous
opening in the deep fascia
○ Joins femoral vein about 1.5 inches below
and lateral to pubic tubercle
○ At the saphenous opening in the deep fascia,
GSV receives 3 tributaries
● Superficial circumflex iliac
vein
● Superficial epigastric vein
● Superficial external
pudendal vein
■ Correspond with the 3 branches of
femoral artery found in this region
● Accessory Vein
○ Joins the main GSV vein about the middle of
the thigh or higher up at the saphenous
opening
Superficial Fascia of the Thigh
● Membranous layer of the superficial fascia
○ From anterior abdominal wall → thigh
○ Attached to deep fascia (fingerbreadth below
inguinal ligament)
● Fatty layer → thigh → down over the lower limb without
interruption
Deep Fascia of the Thigh
● Encloses the thigh like a trouser leg
● Upper end
○ Attached to pelvis and inguinal ligament
● Lateral
○ Thickened to form the iliotibial tract
■ Attached above the iliac tubercle →
lateral condyle of tibia
■
Insertion of tensor fasciae latae &
greater part of gluteus maximus
muscle
● Saphenous Opening
 ○ Gap in the deep fascia in the front of the thigh
below inguinal ligament
○ Transmits
■ GSV
■ Some small branches of femoral
artery
■ Lymph vessels
○ Filled with loose connective tissue: cribriform
fascia
○ Falciform Margin
○ Lower lateral border of the opening
○ Lies anterior to the femoral vessels → curves

upward and medially → laterally → behind

1.1 Quadriceps Femoris Muscles
femoral vessels → pectineal life of superior Quadriceps Mechanism
● 4 muscles
pubic ramus
○ Rectus femoris
■ Also flexes hip joint
○ Vastus intermedius
○ Vastus medialis
Fascial Compartments of the Thigh
■ Lower muscle fibers are almost
3 Compartments
horizontal → prevent patella from
1. Anterior Fascial Compartment
being pulled away during contraction
● Muscles
○ Sartorius of QF muscle
○ Iliacus ○ Vastus lateralis
○ Psoas ● Some tendinous fibers of vasti muscles form bands
○ Pectineus (retinacula), which connect to knee joint capsule &
○ Quadriceps femoris strengthen it
● Blood supply
○ Femoral artery 1.2 Femoral Triangle
● Nerve supply ● Upper part of medial aspect of thigh just below the
○ Femoral nerve inguinal ligament
● Contents (NAVEL)
○ Femoral nerve
○ Femoral artery
○ Femoral vein
○ Empty spaces
○ Femoral lymphatics
● Boundaries
○ Superiorly: inguinal ligament
○ Laterally: sartorius muscle
○ Medially: adductor longus
● Floor
○ Gutter shaped
○ Formed from lateral to medial by iliopsoas,
pectineus, and adductor longus
● Roof
○ Formed by skin and fascia of thigh

1.3 Adductor Canal

● Intermuscular cleft
● Situated on medial aspect of middle 3rd of thigh
beneath sartorius muscle
● Starts above at the apex of femoral triangle → below at

the opening in the adductor magnus

● Boundaries
 ○ Anteromedial wall: sartorius muscle & fascia ■ Medial side of knee (between
○ Posterior wall: adductor longus & magnus
○ Lateral wall: vastuc medialis tendons of sartorius and gracilis) →
● Contents (AVLy SaVaO) down medial side of leg with GSV →
○ Terminal part of femoral artery
○ Femoral vein in front of medial malleolus → medial
○ Deep lymph vessels border of foot → ball of big toe
○ Saphenous nerve
○ Muscular branch
○ Nerve to vastus medialis
○ Terminal part of obturator nerve ■ Rectus femoris → hip joint

■ Vasti muscles → knee joint

1.4 Blood Supply (Anterior Fascial Compartment)
● Femoral Artery
2. Medial Fascial Compartment of the Thigh
○ Enters thigh from behind inguinal ligament → ● Muscles
external iliac artery ○ Gracilis
○ Adductor longus
○ Main arterial supply to LE
○ Adductor brevis
○ Descends almost vertically → adductor ○ Adductor magnus
tubercle → opening in the adductor magnus ○ Obturator externus
● Blood supply
muscle by entering popliteal space → popliteal ○ Profunda femoris artery
artery ○ Obturator artery
● Nerve supply
● Femoral Vein
○ Obturator nerve
○ Enters thigh: through the opening in the
adductor magnus (continuation of popliteal
vein)
○ Ascends through thigh (lying on lateral side

first → posterior → finally on medial side)

○ Exit thigh: intermediate compartment of

femoral sheath and passes behind inguinal

ligament → external iliac vein

1.5 Nerve Supply (Anterior Fascial Compartment)

Femoral Nerve
● Largest branch of lumbar plexus (L2,3,4)
● Lateral border of psoas muscle (within abdomen) →
downward in the interval between psoas and iliacus

● Lies behind fascia iliaca → enter thigh lateral to femoral

artery and femoral sheath (behind inguinal ligament)

● Divides into anterior and posterior divisions 1.5 inches
below inguinal ligament
*Note: Does not enter thigh within femoral sheath
● Anterior Division
○ Cutaneous branches
■ Medial and Intermediate Cutaneous
Nerves
■ Skin of medial and anterior thigh
○ 2 muscular branches
■ Sartorius
■ Pectineus
● Posterior Division
○ Cutaneous branch
■ Saphenous nerve

2.4 Nerve Supply (Medial Fascial Compartment)
Obturator Nerve
2.1 Adductor Magnus
● Large, triangular muscle consisting of adductor and
hamstring portions
● Adductor hiatus
○ Gap in the attachment of this muscle to the
femur
○ Permits femoral vessels to pass from
adductor canal → popliteal space
2.3 Blood Supply (Medial Fascial Compartment)
● Profunda Femoris
○ Large artery arises from lateral side of femoral
artery in the femoral triangle
○ Descends in interval between adductor
longus and brevis → lies on adductor magnus
where it ends as 4th perforating artery
● Profunda Femoris Vein
○ Receives tributaries that correspond to
branches of the artery
○ Drains into femoral vein
● Obturator Artery
○ Branch of internal iliac artery
○ Passes forward on lateral wall of pelvis with
Posterior Cutaneous Nerve
obturator nerve → obturator canal
○ On entering medial fascial compartment of
thigh → branch: medial and lateral → pass
around margin of outer surface of obturator
membrane
○ Gives of muscular branches and an articular Superficial Veins
branch to the hip joint
● Obturator Vein
○ Receives tributaries that correspond to
branches of the artery
○ Drains into external iliac vein
● Arises from L2,3,4
● Emerges on medial border of psoas muscle (within
abdomen) → forward on lateral wall of pelvis → upper
part of obturator foramen → anterior and posterior
divisions
● Anterior division
○ Pass downward
■ In front of obturator externus and
adductor brevis
■ Behind pectineus and adductor
longus
○ Muscular branches
■ Gracilis
■ Adductor brevis
■ Adductor longus
■ Occasionally: pectineus
○ Articular branches
■ Hip joint
■ Terminates as small nerve supplying
the femoral artery
■ Contributes a variable branch to
subsartorial plexus and supplies
skin on the medial side of thigh
● Posterior Division
○ Pierces obturator externus → downward
behind adductor brevis → in front of adductor
magnus
○ Terminates by ascending through opening in
the adductor magnus → supply: knee joint
○ Muscular branches
■ Obturator externus
■ Adductor part of adductor magnus
■ Occasionally: adductor brevis
BACK OF THE THIGH
● Branch of sacral plexus
● Leaves gluteal region from under the lower border of G
Max
● Descends on back of thigh; pierces deep fascia &
supplies skin in Popliteal fossa
● Numerous branches to skin of back thigh & U. leg
● Many curve around medial & lateral aspects of thigh →
drain into Great saphenous vein
 ● From lower part of back thigh - join the Small ● Rise from tibial part →
saphenous vein in popliteal fossa
medially
Contents of Posterior Fascial Compartment
● Muscles ARTICULATION OF HIP JOINT
Hip Joint
● Articulation: femoral head and acetabulum of hip bone
● Acetabulum
○ Articular surface
■ Horseshoe shaped
■ Deficient inferiorly at acetabular
notch
■ Covered with hyaline cartilage
○ Cavity
■ Deepened by fibrocartilaginous rim:

acetabular labrum (bridges across

● Note:
○ Biceps femoris - innervated by sciatic nerve notch → transverse acetabular
■ Long head: tibial portion
ligament)
■ Short head: common peroneal
portion ● Synovial ball-and-socket joint
○ Hamstring part of ADD Magnus - N: tibial
portion of sciatic nerve & ADD part of Hip Joint Capsule
obturator nerve ● Medially
○ Semimembranosus (insertion) - sends a ○ Encloses joint
fibrous expansion upward & laterally to ○ Attached to acetabular labrum
reinforce capsule on back of knee joint: ● Laterally
Oblique popliteal ligament ○ Front: attached to intertrochanteric line of
femur
● Blood Supply ○ Behind: halfway along posterior aspect of
○ 4 perforating branches of Profunda femoris femoral neck
artery (rich supply) ● Some fibers (with blood vessels) are reflected upward
○ Profunda femoris vein - drains the greater part along the neck as bands (retinacula)
of blood ○ Blood supply of the head and neck of femur

● Nerve Supply Ligaments

○ Sciatic nerve
■ Branch of Sacral plexus (L4-5; S1-3)
■ Gluteal region → midline of thigh
■ Post. overlapped by: adjacent
margins of Biceps femoris &
Semimembranous ms.
■ Lies on post. aspect of ADD Magnus
■ Lower ⅓ of thigh - ends by dividing
into:
● Tibial nerve - enters
popliteal fossa
● Common peroneal nerve -
enters popliteal fossa on
lateral side of tibial n.
■ Muscular branches
● To: long head of Biceps
femoris, Semitendinosus,
Semimembranosus, &
hamstring part of ADD
magnus
● Iliofemoral ligament
Y ligament or Ligament of Bigelow
○ Reinforces capsule anteriorly
○ Attachment
■ Proximally to the AIIS & crossing
joint anteriorly
○ Split into 2 parts → intertrochanteric line of
femur
○ Limits
■ Hyperextension
■ ER
● Pubofemoral ligament
○ Spans hip joint medially and inferiorly
○ Attachment
■ Medial part of acetabular rim &
superior pubic ramus → down and
back to neck of femur
○ Limits
■ Hyperextension
■ Abduction
 ■ ER ○ Limited by contact to the opposite leg & by
● Ischiofemoral ligament tension of the ligament of the femoral head
○ Covers capsule posteriorly ● Lateral rotation
○ Attachment ○ Limited by iliofemoral and pubofemoral
■ Ischial portion of acetabulum → ligaments
● Medial rotation
cross joint in a lateral and superior ○ Limited by ischiofemoral ligament
direction → femoral neck *Note: Circumduction is a combination of all movements
*Note: extensors are more powerful than flexors; ERs are more
○ Function
powerful than IRs
■ Hyperextension
■ IR
● Combined effect of spiral attachment
○ Limit hyperextension while allowing full flexion
○ Slack in flexion, taught towards
hyperextension
*Note: paraplegic patient can stand in upright position by
thrusting hips forward (rest on iliofemoral ligament)
● Transverse acetabular ligament
○ Formed by acetabular labrum as it bridges the
acetabular notch
○ Converts notch → tunnel
■ Blood vessels and nerves enter joint
● Ligament of the head of femur
○ Flat and triangular
○ Apex: pit on the head of femur (Fovea capitis)
○ Base: transverse ligament and margins of
acetabular notch
○ Lies within joint and is ensheathed by synovial
membrane

Synovial Membrane
● Lines the capsule
● Ensheathes ligament of head of femur
● Covers pad of fat contained in the acetabular fossa
● Psoas bursa
○ Pouch of synovial membrane
○ Frequently protrudes through a gap in the
anterior wall of the capsule between
pubofemoral and iliofemoral ligaments

Nerve Supply
● Femoral nerve
● Obturator nerve
● Sciatic nerve
● Nerve to the QF
Movement
● Flexion
○ Knee flexed: limited by the anterior abdominal
wall
○ Knee extended: limited by tension of
hamstrings
● Extension
○ Limited by the ilio-, pubo-, and ischiofemoral
ligaments
● Abduction
○ Limited by tension of pubofemoral ligament
● Adduction