Gluteal Region & Posterior Thigh

16 February 2010

Ligaments of Pelvis (posterior)

· Sacroilial

· Sacrospinous

· Sacrotuberous

Netter, 2003 pl. 341; Netter, 2006 pl.353

Ligaments of Pelvis (lateral)

· Sacrospinous

· Sacrotuberous

· Obturator membrane

Netter, 2003 pl. 340; Netter, 2006 pl. 352

Hip Joint

· Articulation between the pelvis & femur

· Head of femur into the acetabulum

· Ball & socket joint, polyaxial motion

· Neck of femur connects shaft & head

· Capsular ligaments of the hip

– Iliofemoral, ischiofemoral & pubofemoral

– Angle of fibers serve to limit extension of hip

· Ligament of the head of the femur

· Acetabular labrum

· Acetabular branch of obturator a.

Netter, 2003 pl. 469, 486; Netter, 2006 pl. 487, 504

Moore & Dalley, Fig 5.53

Ligaments of the Hip

Note angle of fibers

· Iliofemoral ligament

· Pubofemoral ligament

· Ishiofemoral ligament

Iliopectineal bursa

Netter, 2003 pl. 469; Netter, 2006 pl. 487

Femeral Head and Acetabulum (coronal)

· Acetabular labrum

· Ligaments & joint capsule

· Acetabular branch of obturator a.

Netter, 2003 pl. 486; Netter, 2006 pl. 504

Ligament of the Head of the Femur

· Acetabular labrum

· Transverse acetabular ligament

· Acetabular branch of the Obturator a.

Netter, 2003 pl. 469; Netter, 2006 pl. 487

Blood supply of the Femoral Neck

· Deep femoral a.

· Lateral circumflex femoral a.

· Medial circumflex femoral a.

Netter, 2003 pl. 486; Netter, 2006 pl. 504

Gluteal Muscles (note femoral attachments)

· Gluteus Maximus

– Lateral rotator & extensor

– Inferior gluteal n.

· Gluteus Medius

– Abductor & medial rotator

– Superior gluteal n.

· Gluteus Minimus

– Abductor & medial rotator

– Superior gluteal n.

Cutaneous innervation by medial (from dorsal rami) & inferior clunial nn.(from post. femoral cut.)

Agur & Lee, 1999; Fig. 5.27

see Netter 2003 pl. 477; Netter, 2006 pl. 495

Innervation

· Superior gluteal n.

- Gluteus medius & minimus

· Inferior gluteal n.

- Gluteus maximus

· Nerve to Obturator int. & Superior gemellus

· Nerve to Inferior gemellus & Quadratus femoris

· Posterior femoral cutaneus n.

· Pudendal n.

Netter 2003 pl. 485; Netter, 2006 pl. 503

Deep Gluteal Rotators

· Piriformis

– S1 & S2

· Obturator internus

– N. to obturator internus

· Superior & inferior gemelli

– N. to Obturator int. & N. to quadratus femoris

· Quadratus femoris

– N. to Quadratus femoris

· Obturator externus

– Obturator n.

see Netter 2003, Pl. 477, 485; Netter, 2006 pl. 495, 503

Posterior Compartment

· Semimembranosus

· Semitendinosus

· Biceps femoris

– Long head

· All above muscles arise from ischial tuberosity & innervated by tibial n.

– Short head

· Arises from femur

· Innervated by common fibular n.

see Netter 2003, pl. 477; Netter, 2006 pl. 495

Study Moore & Dalley, 1999; Fig. 5.52 (p. 612)

This figure summarizes the interrelated functions of muscles that function at the hip joint. Study this and use it to quiz your study partners.

Organization of Hip Muscles

· Flexors of the hip

– Anterior to joint; quadriceps, iliopsoas, pectineus

· Adductors

– Medial to joint; adductors

· Lateral rotators

– Posterior to joint; Deep gluteal rotators

· Extensors

– Posterior to joint; Gluteus max & hamstrings.

· Abductors

– Lateral to joint; gluteus med & min, TFL

· Medial rotators

– Antero-lateral to joint; gluteus med & min, TFL

Reference

Agur, AMR & MJ Lee, 1999. Grant's Atlas of Anatomy (10th ed.), Lippincott, Williams & Wilkins