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Pelvis. Muscles of the Lower Limb. Walking

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Pelvis. Muscles of the Lower Limb. Walking Pelvis. Muscles of the lower limb. Walking Sándor Katz M.D.,Ph.D. Pelvis Pelvic ligaments Pelvis Hip muscles: iliopsoas (psoas major and iliacus) iliacus Origin: psoas major: vertebral bodies of the T12-L4 vertebrae and costal processes of the L1-5 vertebrae iliacus: iliac fossa Insertion: lesser trochanter Action: flexion of the hip joint; lateral flexion of the lumbar spine Innervation:spinal nerves and femoral nerve Hip muscles - gluteus maximus • Origin: dorsal to the posterior gluteal line of the ilium, sacrum and thoracolumbar fascia • Insertion: gluteal tuberosity, iliotibial tract • Action: Hip joint: adbuction-adduction, extension and lateral rotation. Knee joint: stabilisation when the knee is extended. • Innervation: inferior gluteal nerve Hip muscles - gluteus medius • Origin: between the anterior and posterior gluteal lines of the ilium • Insertion: greater trochanter • Action: abduction and rotation. • Innervation: superior gluteal nerve Hip muscles - gluteus minimus • Origin: between the anterior and inferior gluteal lines of the ilium • Insertion: greater trochanter • Action: abduction and rotation. • Innervation: superior gluteal nerve Hip muscles Piriformis • Origin: 2nd-4th sacral pelvic foramina • Insertion: tip of the greater trochanter • Action: abduction and lateral rotation. • Innervation: sciatic nerve Obturator internus • Origin: inner surface o f t h e o b t u r a t o r foramen and obturator membrane • I n s e r t i o n : trochanteric fossa • Action: adduction and lateral rotation. • Innervation: sacral plexus Obturator externus • Origin: outer surface o f t h e o b t u r a t o r foramen and obturator membrane • I n s e r t i o n : trochanteric fossa • Action: adduction and lateral rotation. • Innervation: lumbar plexus Gemellus superior • Origin: ischial spine • I n s e r t i o n : trochanteric fossa • Action: adduction and lateral rotation. • Innervation: sacral plexus Gemellus inferior • O r i g i n : ischial tuberosity • I n s e r t i o n : trochanteric fossa • Action: adduction and lateral rotation. • Innervation: sacral plexus Quadratus femoris • O r i g i n : ischial tuberosity • I n s e r t i o n : intertrochanteric crest • Action: adduction and lateral rotation. • Innervation: sacral plexus Pelvis Hip extensors - knee flexors Biceps femoris • Origin: long head: ischial tuberosity, short head: lateral lip of linea aspera • Insertion: head of fibula • Action: Hip joint: extension. Knee joint: flexion. • Innervation: sciatic nerve Semitendinosus • O r i g i n : ischial tuberosity • Insertion: superficial pes anserinus (under the medial tibial condyle) • Action: Hip joint: extension. Knee joint: flexion. • Innervation: sciatic nerve Semimembranosus • O r i g i n : ischial tuberosity • Insertion: deep pes anserinus (under the superficial pew anserinus) • Action: Hip joint: extension. Knee joint: flexion. • Innervation: sciatic nerve Hip extensors-knee flexors (semitendinosus, semimembranosus, biceps femoris) Adductors Adductors - gracilis • Origin: inferior pubic ramus • Insertion: superficial pes anserinus (under the medial tibial condyle) • Action: Hip joint: adduction and flexion. Knee joint: flexion and medial rotation. • I n n e r v a t i o n : obturator nerve Adductors - adductor longus • Origin: pubic bone, symphysis • Insertion: medial lip of the linea aspera • Action: Hip joint: adduction and flexion. • I n n e r v a t i o n : obturator nerve Adductors - adductor brevis • Origin: inferior pubic ramus • Insertion: medial lip of the linea aspera • Action: Hip joint: adduction and flexion. • I n n e r v a t i o n : obturator nerve Adductors - adductor magnus • Origin: inferior pubic r a m u s , i s c h i a l tuberosity • Insertion: Fleshy part: medial lip of the l i n e a a s p e r a . Tendinous part: adductor tubercle. • Action: Hip joint: adduction and flexion. • I n n e r v a t i o n : obturator nerve Pectineus • Origin: pecten pubis • Insertion: greater trochanter • Action: Hip joint: adduction and flexion. • I n n e r v a t i o n : obturator and femoral nerves Adductor brevis, gracilis and pectineus Hip flexors - knee extensors Quadriceps femoris • O r i g i n : r e c t u s femoris: inferior anterior iliac spine, v a s t u s m e d i a l i s : medial lip of the linea a s p e r a , vastus lateralis: lateral lip of the linea aspera, vastus intermedius: anterior shaft of the femur • I n s e r t i o n : tibial tuberosity • Action: Hip joint: flexion. Knee joint: extension. • Innervation: femoral nerve Hip flexors-knee extensors (quadriceps femoris) Sartorius • Origin: anterior superior iliac spine • Insertion: superficial pes anserinus • Action: Hip joint: flexion and abduction. Knee joint: flexion. • Innervation: femoral nerve Tensor fasciae latae • Origin: anterior superior iliac spine • Insertion: iliotibial tract • Action: Hip joint: flexion and abduction. Knee joint: stabilisation. • Innervation: superior gluteal nerve Tensor fasciae latae and sartorius Femoral trigone Base: inguinal lig. Medial wall: adductor longus Lateral wall: sartorius Floor: iliopsoas, pectineus Componets: Femoral artery / vein Femoral nerve Adductor canal Superior wall: sartorius, vastoadductor membrane Medial wall: adductor longus, adductor magnus Lateral wall: vastus medialis Exit: adductor hiatus Contents: Femoral vessels Saphenus nerve Descending genicular artery Triceps surae: superficial flexor of the leg - knee flexor Triceps surae • O r i g i n : gastrocnemius: femoral condyles, soleus: soleal line and fibula, plantaris: lateral femoral condyle • Insertion: calcaneal tuberosity • Action: Knee joint: flexion. Talocrural joint: plantarflexion. Talocalcaneonavicular joint: supination. • Innervation: tibial nerve Triceps surae Deep flexors on the posterior side Tibialis posterior • Origin: interosseous membrane, tibia and fibula • Insertion: navicular • Action: Talocrural joint: plantarflexion. Talocalcaneonavicular joint: supination. • Innervation: tibial nerve Flexor hallucis longus • Origin: interosseous membrane and fibula • I n s e r t i o n : distal phalanx of the 1st toe • Action: Talocrural joint: plantarflexion. Talocalcaneonavicular joint: supination. Flexion of the 1st toe. • Innervation: tibial nerve Flexor digitorum longus • Origin: tibia and fibula • I n s e r t i o n : distal phalanx of the 2nd-5th toes • Action: Talocrural joint: plantarflexion. Talocalcaneonavicular joint: supination. Flexion of the 2nd-5th toes. • Innervation: tibial nerve Deep flexors Extensors on the anterior side Tibialis anterior • Origin: interosseous membrane and tibia • I n s e r t i o n : 1st metatarsal and medial cuneiform • Action: Talocrural joint: dorsiflexion. Talocalcaneonavicular joint: supination. • Innervation: deep fibular nerve Extensor hallucis longus • Origin: interosseous membrane and tibia • I n s e r t i o n : distal phalanx of the 1st toe • Action: Talocrural joint: dorsiflexion. Talocalcaneonavicular j o i n t : p r o n a t i o n . Ex ten s io n o f th e hallux. • Innervation: deep fibular nerve Extensor digitorum longus • Origin: interosseous membrane, tibia and fibula • I n s e r t i o n : distal phalanx of the 2nd-5th toes • Action: Talocrural joint: dorsiflexion. Talocalcaneonavicular j o i n t : p r o n a t i o n . Ex ten s io n o f th e 2nd-5th toes. • Innervation: deep fibular nerve Extensors Pronators Fibularis longus • Origin: fibula and head of fibula • I n s e r t i o n : 1st metatarsal and medial cuneiform • Action: Talocrural joint: plantarflexion. Talocalcaneonavicular joint: pronation. • I n n e r v a t i o n : superficial fibular nerve Fibularis brevis • Origin: distal half of the fibula • I n s e r t i o n : 5 t h metatarsal • Action: Talocrural joint: plantarflexion. Talocalcaneonavicular joint: pronation. • I n n e r v a t i o n : superficial fibular nerve Pronators Foot muscles - dorsal side extensors Extensor digitorum brevis • Origin: calcaneus • Insertion: middle phalanx of the 2nd-4th toes • Action: Extension of the 2nd-4th toes. • Innervation: deep fibular nerve Extensor hallucis brevis • Origin: calcaneus • Insertion: proximal phalanx of the 1st toe • Action: Extension of the 1st toe. • Innervation: deep fibular nerve Foot muscles Foot muscles - plantar side Foot muscles - plantar side Foot muscles - plantar side Foot muscles - plantar side Foot muscles - plantar side Foot muscles - interossei Plantar architecture Arches of the foot The weight of the body is transmitted to the talus from the tibia. Then it is transmitted posteriorly to the calcaneal tubercle and anteriorly to the heads of the 1st-5th metatarsals. The cuneiforms and the bases of the metatarsals together form the transverse arch. Its uppermost point is the medial cuneiform. Arches of the foot - ligaments • Plantar aponeurosis: from calcaneal tubercle to the plantar surfaces of toes. Works when the body is standing; stabilizes the transverse arch as well. • Long plantar ligament: from calcaneus to the bases of metatarsals. Stabilizes the bones at the lateral side. • Plantar calcaneocuboid ligament: from calcaneus to the cuboid bone. Stabilizes the bones at the lateral side. • Plantar calcaneonavicular ligament: extendes the articular surface for the head of talus. Arches of the foot - muscles • Tibialis ant. + post.: at the medial side • Tibialis ant. + fibularis l o n g u s : stabize the transverse arch • Fibularis tertius + fibularis brevis: at the lateral side • Other stabilizers: • flexor hallucis longus • abductor hallucis • abductor digiti minimi • flexor digitorum brevis Walking During walking,
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