Lower Extremity-Hip, Thigh, and Pelvis Basic Areas/Regions Gluteal-of or relating to or near the gluteal muscles Femoral-of or relating to the femur or thigh Pelvis-of or relating to the pelvis The pelvic girdle (pelvis) is made up of the ischium, the ilium and the pubis. On each side, the bones are fused together at the acetabulum. The two sides connect anteriorly at the pubic symphysis and posteriorly at the sacrum at the sacroiliac joints. Bones of the Pelvic Girdle Bone Landmarks Atlas Ilium 1. Iliac crest 2. Iliac tuberosity 3. Iliac fossa 4. Gluteal surface 5. Gluteal lines 6. Auricular surface 7. Arcuate line 8. Greater sciatic notch 9. Acetabulum 10. Acetabular rim 11. Acetabular notch 12. Anterior superior iliac spine (ASIS) 13. Anterior inferior iliac spine (AIIS) 14. Posterior superior iliac spine (PSIS) 15. Posterior inferior iliac spine (PIIS) Ischium 1. Ischial tuberosity 2. Ischial spine 3. Ischial ramus 4. Body of ischium 5. Lesser sciatic notch 6. Obturator foramen Pubis 1. Pubic tubercle 2. Superior pubic ramus 3. Inferior pubic ramus 4. Pubic symphysis 5. Symphyseal surface 6. Pectineal line 7. Body of pubis Femur 1. Head 2. Neck 3. Fovea capitus 4. Greater trochanter 5. Lesser trochanter 6. Intertrochanteric crest 7. Intertrochanteric line 8. Trochanteric fossa 1 9. Shaft of femur 10. Gluteal tuberosity 11. Pectineal line 12. Linea aspera 13. Adductor tubercle 14. Medial condyle 15. Lateral condyle 16. Medial epicondyle 17. Lateral epicondyle 18. Intercondylar notch 19. Intercondylar line 20. Patellar surface 21. Popliteal surface 22. Medial supracondylar line 23. Lateral supracondylar line 2 Joints and Ligaments of the Hip and Pelvic Girdle Remember that joints are bone to bone. Synovial joints have a joint capsule with synovial fluid inside that acts to lubricate the joint. Remember that ligaments connect bone to bone. Joint Ligaments Bones that ligaments connect Atlas Femoralacetabular (Hip) 1. Ligamentum teres (ligament 1. Acetabulum to fovea • Head of femur and to the head of the femur) capitis acetabulum 2. Iliofemoral ligament 2. AIIS to inter- • Ball and socket joint (Y ligament) trochanteric line • Synovial (diarthrotic) 3. Pubofemoral ligament 3. Superior pubic ramus joint to intertrochanteric line 4. Ischiofemoral ligament 4. Ischium to inter- trochanteric line Pubic Symphysis 1. Interpubic disc 1. Pubic bone to pubic • Pubic symphyseal bone surface and pubic symphyseal surface • Immovable • Joint by fibrocartilage disc Sacroiliac 1. Sacrotuberous ligament 1. Sacrum to ischial • Sacrum and ilium 2. Sacrospinous ligament tuberosity • Modified plane joint 3. Anterior/posterior sacroiliac 2. Sacrum to ischial spine (immovable) ligaments 3. Sacrum to ilium • Synovial (ampiarthrotic) joint Additional Ligaments 1. Inguinal ligament 1. ASIS to pubic tubercle 2. Iliolumbar ligament 2. Iliac crest to transverse processes of lumbar vertebrae 3 Muscles of the Hip, Pelvis, and Thigh You are responsible for understanding names of muscles, their origin, insertion, innervations, vascularization, and functional movements they create. This manual is based off your required textbook and is meant to be a guide for what you are responsible for knowing. DO NOT simply memorize, make sure you truly understand the information. Some reminders and tips for understanding include: • Due to the nature of the muscle fibers, muscles are able to change length. The contraction is when it is shortening. • Origin-the immovable part of the muscle • Insertion-the moveable part of the muscle • Function-the origin stays fixed and the insertion is the moving part… the insertion will move towards the origin. • A muscle will move the bone that it inserts on. (ex. If insertion is on humerus, the humerus moves; if insertion is on scapula, scapula moves) • If a muscle crosses more than one joint, it will move more than one joint (ex. Biceps brachii crosses the shoulder and the elbow, therefore it moves both the shoulder and the elbow) • Note the angle/direction of the muscle fibers. It often dictates the function. Notice what happens when the muscle shortens • Always palpate from origin to insertion 4 Anterior Hip Region (Hip flexors) -Iliopsoas Muscle Origin Insertion Function Atlas Psoas Major Bodies, Transverse Lesser Trochanter Hip Flexion Processes, and Intervertebral Disks T12-L5 Psoas Minor Vertebral Bodies and Iliopectineal Arch Pelvis Upward Rotation Intervertebral Disks T12-L1 Iliacus Iliac Fossa Lesser Trochanter Hip Flexion Posterior Hip Region (Gluteals and Rotators) Muscle Origin Insertion Function Atlas Gluteus Maximus Sacrum, Posterior Iliotibial Tract Hip Extension Ilium, Thoracolumbar Gluteal Tuberosity Fascia, Sacrotuberous Ligament Gluteus Medius Posterior Ilium under Greater Trochanter Hip Abduction Iliac Crest Hip Extension Gluteus Minimus Posterior Ilium, Greater Trochanter Hip Abduction beneath Gluteus Hip Extension Medius Tensor Fascia Latae Anterior Superior Iliac Iliotibial Tract Hip Abduction Spine Piriformis Pelvic surface of Superior Greater Hip External Rotation Sacrum Trochanter Adduction Extension Obturator Internus Obturator Membrane Medial Greater Hip External Rotation (within Foramen) Trochanter Adduction Extension Gemellus Superior Ischial Spine Medial Greater Hip External Rotation Trochanter Adduction Extension Gemellus Inferior Ischial Tuberosity Medial Greater Hip External Rotation Trochanter Adduction Extension Quadratus Femoris Lateral Ischial Intertrochanteric Hip External Rotation Tuberosity Crest Adduction Medial Thigh -Superficial Muscle Origin Insertion Function Atlas Pectineus Superior Pubic Ramus Pectineal Line Hip Adduction External Rotation Adductor Longus Superior Pubic Linea Aspera Hip Adduction Ramus, Ant. Symphysis 5 Adductor Brevis Inferior Pubic Ramus Linea Aspera Hip Adduction Gracilis Inferior Pubic Ramus Pes Anserine Hip Adduction (Superior, Medial Flexion Tibia) -Deep Muscle Origin Insertion Function Atlas Obturator Externus Obturator Membrane Trochanteric Fossa Hip Adduction External Rotation Adductor Magnus Imferior Pubic Ramus, Linea Aspera Hip Adduction Ischial Tuberosity Adductor Tubercle Anterior Thigh -Quadriceps/Hip Flexors Muscle Origin Insertion Function Atlas Sartorius Anterior Superior Iliac Pes Anserine Hip Flexion, Abduction Spine (Superior, Medial External Rotation Tibia) Knee Flexion Internal Rotation Rectus Femoris Anterior Inferior Iliac Tibial Tuberosity via Hip Flexion Spine Patellar Tendon Knee Extension Vastus Medialis Linea Aspera Medial Tibial Knee Extension Intertrochanteric Line Condyle via Medial Longitudinal Retinaculum, Tibial Tuberosity via Patellar Tendon Vastus Lateralis Linea Aspera, Greater Lateral Tibial Knee Extension Trochanter Condyle via Lateral Longitudinal Retinaculum, Tibial Tuberosity via Patellar Tendon Vastus Intermedius Anterior Femoral Tibial Tuberosity via Knee Extension Shaft Patellar Tendon Posterior Thigh -Hamstrings/Hip Extensors Muscle Origin Insertion Function Atlas Biceps Femoris -SH -Linea Aspera Head of Fibula Hip Extension - LH -Ischial Tuberosity Knee Flexion External Rotation Semimembranosus Ischial Tuberosity Medial Tibial Hip Extension Condyle Knee Flexion Internal Rotation Semitendinosus Ischial Tuberosity Medial Tibial Hip Extension Condyle, Pes Knee Flexion Anserine Internal Rotation 6 Bursas of the Hip Bursas are found between bones and ligaments or muscles. They are fluid filled sacs that help to reduce friction and lubricate the joint Bursa Location Atlas Greater trochanteric Bursa Over the greater trochanter Ischial Bursa Over the ischial tuberosity 7 8 Lower Extremity-Knee, Tibia and Fibula Basic Areas/Regions Femoral-of or relating to the femur or thigh Patellar-of or relating to the patella Popliteal-of or relating to the popliteal fossa Bones of the Knee and Lower Leg and Foot Bone Landmarks Atlas Femur 1. Adductor tubercle 2. Medial condyle 3. Lateral condyle 4. Medial epicondyle 5. Lateral epicondyle 6. Intercondylar notch 7. Intercondylar line 8. Patellar surface 9. Popliteal surface 10. Medial supracondylar line 11. Lateral supracondylar line Patella 1. Base 2. Apex 3. Anterior surface 4. Articular surface Tibia 1. Tibial plateau 2. Tibial tuberosity 3. Medial condyle 4. Lateral condyle 5. Gerdy’s tubercle 6. Intercondylar eminence 7. Soleal line 8. Medial malleolus 9. Mallolar groove 10. Tibial shaft Fibula 1. Head 2. Neck 3. Shaft 4. Lateral malleolus Tarsal bones 1. Calcaneous -sustentaculum tali -calcaneal tuberosity 2. Talus -talar dome 3. Navicular 4. Cuboid 5. Lateral cuneiform 6. Intermediate cuneiform 7. Medial cuneiform 9 Joints and Ligaments of the Knee and Lower Leg Remember that joints are bone to bone. Synovial joints have a joint capsule with synovial fluid inside that acts to lubricate the joint. Remember that ligaments connect bone to bone. Joint Ligaments Bones that ligaments connect Atlas Tibiofemoral (knee) 1. Medial collateral ligament 5. Medial epicondyle of • Condyles of femur and (MCL) femur to medial tibia tibial plateau 2. Lateral collateral ligament 6. Lateral epicondyle of • Hinge joint (LCL) femur to head of fibula • Synovial (diarthrotic) 3. Anterior cruciate ligament 7. Medial anterior tibia joint (ACL) to posterior lateral condyle of femur 10 4. Posterior cruciate ligament 8. Posterior tibia to (PCL) anterior medial condyle of femur Patellofemoral 1. Patella tendon 2. Quadriceps to tibial • Posterior patella with tuberosity (patella is condyles of femur imbedded in the tendon) Proximal tibiofibular 1. Anterior/Posterior ligament 4. Tibia to head of fibula • Head of