3. ❖ La trancision entre el tronco y el muslo es la region
glutea ligament ext
converting th
vided by the s
ating the grea
sciatic foram
or leaving the
sciatic foram
leaving the pe
It is helpf
as the “door”
nerves leave
piriformis mu
the gluteal re
fills most of it
Level of
iliac crests
Intergluteal
cleft
Ischial
tuberosity
Gluteal fold
B Buttocks, H Hips, T Thigh
Greater
trochanter
BB
H
T
HHH
T
BB
TT
4. Supraspinous
ligament
Posterior superior
iliac spine
Greater sciatic
foramen
Ischiofemoral
ligament
Sacrotuberous
ligament
Ischial
tuberosity
Lesser sciatic
foramen
Sacrospinous
ligament
Posterior
sacrococcygeal
ligaments
Posterior
sacro-iliac
ligament
Iliolumbar
ligament
Posterior view
Ischial spine
FIGURE 5.33. Ligaments of pelvic girdle. The sacrotuberous and sacrospinous ligaments convert the greater and lesser sciatic notches into foramina.
Chap05.indd 563Chap05.indd 563 12/10/2012 5:54:512/10/2012 5:54:5
Ligamento sacroiliaco posterior
Ligamento sacrotuberoso
Agujero ciatico mayor
Agujero ciatico menor
5. Músculos
❖ Estan separados en 1 mismo compartimento, pero
separados en 2 capas, superficiales y profundos
GLUTEUS MA
The gluteus m
(Figs. 5.34C an
coarsely fibere
covers all of the
superior third o
The ischial t
the inferior par
of the gluteal fo
inferior border
ing the ischial tu
gluteus maxim
ischial bursa th
The gluteus
Gluteus
maximus
(cut and
reflected)
Gluteus
maximus
Gluteus
medius
Iliotibial
tract
Tensor
fasciae
latae
Piriformis
Sciatic
nerve
Outline of
sacrotuberous
ligament
Quadratus
femoris
Posterior view
Attachment of inferior half of deep part
of gluteus maximus to gluteal tuberosity
6. Musculos superficiales
❖ Gluteos
❖ Mayor,
❖ Medio
❖ Menor
❖ Tensor de la fascia lata
nsor
ciae latae
adratus
moris
Gluteus medius (cut)
s medius
eus minimus
uteus
edius
eus
mus
Attachment
to anterior
gluteal line
Gluteus
minimus
Gluteus
maximus
(cut and
reflected)
Piriformis
Posterior gluteal line
Gluteus
medius
Gluteus
minimus
Anterio
iliac sp
Tensor
fasciae latae
Ischial
tuberosity
Obturator
internus
inside
pelvis
Superior
gemellus
Obturator
internus
Inferior
gemellus
Attach-
ment to
tendon of
obturator
Quadratus
femoris
Piriformis
mis
(C) Posterior view (D) Lateral view (E) Lateral view
Greater
trochanter
of femur
Piriformis
8. us are extension
distal attachment
xtends the trunk
st extensor of the
rapid movement
s maximus func-
anding (straight)
e sitting position,
alking uphill and
fly during casual
motionless.
t seriously affect
yourhandonyour
maximus contracts
phase(fromheel
resist further flex-
limb) (Fig. 5.20A
ur hands on your
ntract strongly.
nee and attaches
rdy) (Figs. 5.34J
nsor fasciae latae
e extended knee
to do so during
Iliac crest Gluteus
medius (cut)
Gluteus
minimus
Piriformis
Tensor
fasciae latae
Gluteofemoral
bursa
Gluteus
maximus
Intertro-
chanteric
crest
Iliotibial tract
(and cut edge)
Hamstring
muscles
Femur
Posterior view
Quadratus
femoris
Ischial bursa
Trochanteric
bursa
Sacro-
tuberous
ligament
Bursa of
obturator
internus
Tendon of
obturator
internus
Sacro-
spinous
ligament
Gluteus
maximus (cut)
FIGURE 5.37. Gluteal muscles and bursae. Three bursae (trochanteric,
9. Chapter 5 • Lower Limb 567
Posterior superior
iliac spine
Gluteus minimus
Gluteus medius
Obturator externus
Medial circumflex femoral artery
Gluteus maximus
Posterior cutaneous
nerve of thigh
1st perforating arterySemimembranosus
Semitendinosus
Biceps femoris, long head
Posterior cutaneous
nerve of thigh
Inferior gluteal
nerve and artery
Tip of coccyx
Internal pudendal artery
Sacrotuberous
ligament
Superior gluteal
artery and nerve
Pudendal nerve
Sciatic nerve
Piriformis
Obturator internus and gemelli
Greater trochanter
Quadratus femoris
Sciatic nerve
Artery to sciatic nerve
Nerve to obturator
internus
10. Iliac crest
Ala (wing) of ilium
Greater sciatic
foramen
Ischium
Capsule of hip joint
Tendon of piriformis
Greater trochanter
Obturator externus
Obturator internus
Lesser trochanter
Ischial
tuberosity
(B) Posterior view
Sacrospinous ligament
Trochanteric fossa
Superior gemellus
Inferior gemellus
Sacrotuberous ligament
Sacrum
Course of
obturator
internus
through lesser
sciatic foramen
Triceps
coxae
Obturator
internus inside
pelvis
gluteal region
the gluteus
ed, and seg-
sed, to reveal
he gluteal
igh. The
) to and is
s maximus
oris. B. This
eral rotators
the triceps
ent into the
at of the
11. Antero-
lateral
tubercle
of tibia
tuberosityinside
pelvis
internus
Inferior
gemellus
Attach-
ment to
tendon of
obturator
internus
Quadratus
femoris
Gluteus
minimus
(B) Anterior view (F) Posterior
view
(G) Anterior
view (H) Posterior view (I) Posterior view
(J) Anterior view
FIGURE 5.34. Muscles of gluteal region: abductors and lateral rotators.
Muscle Proximal Attachment Distal Attachment Innervationa
Main Action
Gluteus maximus
(Fig. 5.34A & C)
Ilium posterior to posterior
gluteal line; dorsal surface of
sacrum and coccyx; sacrotu-
berous ligament
Most fibers end in iliotibial
tract, which inserts into
lateral condyle of tibia;
some fibers insert on
gluteal tuberosity
Inferior gluteal nerve
(L5, S1, S2)
Extends thigh (especially
from flexed position) and
assists in its lateral rotation;
steadies thigh and assists in
rising from sitting position
Gluteus medius
(Fig. 5.34A, C, & E)
External surface of ilium
between anterior and
posterior gluteal lines
Lateral surface of greater
trochanter of femur
Superior gluteal
nerve (L5, S1)
Abduct and medially
rotate thigh; keep pelvis
level when ipsilateral
limb is weight-bearing
and advance opposite
(unsupported) side during
its swing phase
Gluteus minimus
(Fig. 5.34A–D)
External surface of ilium
between anterior and inferior
gluteal lines
Anterior surface of greater
trochanter of femur
Tensor fasciae
latae (Fig. 5.34J)
Anterior superior iliac spine;
anterior part of iliac crest
Iliotibial tract, which attaches
to lateral condyle of tibia
Piriformis
(Fig. 5.34F & G)
Anterior surface of sacrum;
sacrotuberous ligament
Superior border of greater
trochanter of femur
Branches of anterior
rami of S1, S2
Laterally rotate extended
thigh and abduct flexed
thigh; steady femoral
head in acetabulum
Obturator internus
(Fig. 5.34H)
Pelvic surface of obturator
membrane and surrounding
bones
Medial surface of greater tro-
chanter (trochanteric fossa)
of femurb
Nerve to obturator
internus (L5, S1)
Superior and
inferior gemelli
(Fig. 5.34H)
Superior: ischial spine
Inferior: ischial tuberosity
Medial surface of greater tro-
chanter (trochanteric fossa)
of femurb
Superior gemellus:
same nerve supply
as obturator internus
Inferior gemellus:
TABLE 5.6. MUSCLES OF GLUTEAL REGION: ABDUCTORS AND ROTATORS OF THIGH
12. Musculos profundos
❖ Piriforme
❖ Gemelos superior e inferior
❖ Cuadrado femoral
❖ Obturador interno
ratus
ris
eus
us
s
us
Gluteus
maximus
(cut and
reflected)
Piriformis
Tensor
fasciae latae
Ischial
tuberosity
Obturator
internus
inside
pelvis
Superior
gemellus
Obturator
internus
Inferior
gemellus
Attach-
ment to
tendon of
obturator
internus
Quadratus
femoris
Piriformis
s
(C) Posterior view (D) Lateral view (E) Lateral view
(F) Posterior
view
(G) Anterior
view (H) Posterior view (I) Posterior view
(J) Anterior
Greater
trochanter
of femur
FIGURE 5.34. Muscles of gluteal region: abductors and lateral rotators.
Proximal Attachment Distal Attachment Innervationa
Main Action
Ilium posterior to posterior
gluteal line; dorsal surface of
sacrum and coccyx; sacrotu-
berous ligament
Most fibers end in iliotibial
tract, which inserts into
lateral condyle of tibia;
some fibers insert on
Inferior gluteal nerve
(L5, S1, S2)
Extends thigh (espec
from flexed position)
assists in its lateral ro
steadies thigh and as
ES OF GLUTEAL REGION: ABDUCTORS AND ROTATORS OF THIGH
14. Antero-
lateral
tubercle
of tibia
tuberosityinside
pelvis
internus
Inferior
gemellus
Attach-
ment to
tendon of
obturator
internus
Quadratus
femoris
Gluteus
minimus
(B) Anterior view (F) Posterior
view
(G) Anterior
view (H) Posterior view (I) Posterior view
(J) Anterior view
FIGURE 5.34. Muscles of gluteal region: abductors and lateral rotators.
Muscle Proximal Attachment Distal Attachment Innervationa
Main Action
Gluteus maximus
(Fig. 5.34A & C)
Ilium posterior to posterior
gluteal line; dorsal surface of
sacrum and coccyx; sacrotu-
berous ligament
Most fibers end in iliotibial
tract, which inserts into
lateral condyle of tibia;
some fibers insert on
gluteal tuberosity
Inferior gluteal nerve
(L5, S1, S2)
Extends thigh (especially
from flexed position) and
assists in its lateral rotation;
steadies thigh and assists in
rising from sitting position
Gluteus medius
(Fig. 5.34A, C, & E)
External surface of ilium
between anterior and
posterior gluteal lines
Lateral surface of greater
trochanter of femur
Superior gluteal
nerve (L5, S1)
Abduct and medially
rotate thigh; keep pelvis
level when ipsilateral
limb is weight-bearing
and advance opposite
(unsupported) side during
its swing phase
Gluteus minimus
(Fig. 5.34A–D)
External surface of ilium
between anterior and inferior
gluteal lines
Anterior surface of greater
trochanter of femur
Tensor fasciae
latae (Fig. 5.34J)
Anterior superior iliac spine;
anterior part of iliac crest
Iliotibial tract, which attaches
to lateral condyle of tibia
Piriformis
(Fig. 5.34F & G)
Anterior surface of sacrum;
sacrotuberous ligament
Superior border of greater
trochanter of femur
Branches of anterior
rami of S1, S2
Laterally rotate extended
thigh and abduct flexed
thigh; steady femoral
head in acetabulum
Obturator internus
(Fig. 5.34H)
Pelvic surface of obturator
membrane and surrounding
bones
Medial surface of greater tro-
chanter (trochanteric fossa)
of femurb
Nerve to obturator
internus (L5, S1)
Superior and
inferior gemelli
(Fig. 5.34H)
Superior: ischial spine
Inferior: ischial tuberosity
Medial surface of greater tro-
chanter (trochanteric fossa)
of femurb
Superior gemellus:
same nerve supply
as obturator internus
Inferior gemellus:
TABLE 5.6. MUSCLES OF GLUTEAL REGION: ABDUCTORS AND ROTATORS OF THIGH
sacrum and coccyx; sacrotu-
berous ligament
lateral condyle of tibia;
some fibers insert on
gluteal tuberosity
assists in its lateral rotation;
steadies thigh and assists in
rising from sitting position
Gluteus medius
(Fig. 5.34A, C, & E)
External surface of ilium
between anterior and
posterior gluteal lines
Lateral surface of greater
trochanter of femur
Superior gluteal
nerve (L5, S1)
Abduct and medially
rotate thigh; keep pelvis
level when ipsilateral
limb is weight-bearing
and advance opposite
(unsupported) side during
its swing phase
Gluteus minimus
(Fig. 5.34A–D)
External surface of ilium
between anterior and inferior
gluteal lines
Anterior surface of greater
trochanter of femur
Tensor fasciae
latae (Fig. 5.34J)
Anterior superior iliac spine;
anterior part of iliac crest
Iliotibial tract, which attaches
to lateral condyle of tibia
Piriformis
(Fig. 5.34F & G)
Anterior surface of sacrum;
sacrotuberous ligament
Superior border of greater
trochanter of femur
Branches of anterior
rami of S1, S2
Laterally rotate extended
thigh and abduct flexed
thigh; steady femoral
head in acetabulum
Obturator internus
(Fig. 5.34H)
Pelvic surface of obturator
membrane and surrounding
bones
Medial surface of greater tro-
chanter (trochanteric fossa)
of femurb
Nerve to obturator
internus (L5, S1)
Superior and
inferior gemelli
(Fig. 5.34H)
Superior: ischial spine
Inferior: ischial tuberosity
Medial surface of greater tro-
chanter (trochanteric fossa)
of femurb
Superior gemellus:
same nerve supply
as obturator internus
Inferior gemellus:
same nerve supply
as quadratus femoris
Quadratus femoris
(Fig. 5.34I)
Lateral border of ischial
tuberosity
Quadrate tubercle on inter-
trochanteric crest of femur
and area inferior to it
Nerve to quadratus
femoris (L5, S1)
Laterally rotates thighc;
steadies femoral head in
acetabulum
a The spinal cord segmental innervation is indicated (e.g., “S1, S2” means that the nerves supplying the piriformis are derived from the first two sacral segments of
the spinal cord). Numbers in boldface (S1) indicate the main segmental innervation. Damage to one or more of the listed spinal cord segments, or to the motor nerve
roots arising from them, results in paralysis of the muscles concerned.
b The gemelli muscles blend with and share the tendon of the obturator internus as it attaches to the greater trochanter of the femur, collectively forming the triceps coxae.
c There are six lateral rotators of the thigh: piriformis, obturator internus, superior and inferior gemelli, quadratus femoris, and obturator externus. These muscles also
stabilize the hip joint.
15. Capsla articular y Ligamentos
Iliofemoral
Pubofemoral
Chapter 5 • Lower
Iliolumbar ligament
Anterior sacro-iliac ligament
Iliofemoral ligament
Pubofemoral ligament
Intertrochanteric line
Pubic
symphysis
Obturator
membrane
Head of femur (joint
capsule removed)
Sacrotuberous and
sacrospinous ligaments
Greater sciatic foramen
Anterior superior iliac spine
Iliac crest
Transverse process of
L5 vertebra
(A) Anterior view
Lunate surface
Acetabular fossa
Acetabular notch
Fovea for
ligament
of head
R
Head of femu
Neck of femu
Iliofemoral ligam
site on intertrocha
Il
li
a
s
Lateral
Anterior view
Iliopsoas
16. Acetabular labrum
* Head of femur
Pectineus
Pectineal fascia
Pectineal ligament
Pubic tubercle
Obturator externus
Obturator nerve, anterior
and posterior divisions
ule (floor of iliopectineal bursa)
re Course of obturator externus
Obturator internus bursa
Obturator internus tendon
(reflected medially)
Sacrospinous ligament
and ischial spine
(D) Posterior view
Rectus femoris,
reflected head
Iliofemoral
ligament
Ischiofemoral ligament
Orbicular zone
Neck of femur
Intertro-
chanteric
crest
Synovial
protrusion
Psoas major and
lesser trochanter
Sacrotuberous
ligament
Posterior view
(B)
of pelvis and hip joint. A. Weight transfer from the vertebral column to the pelvic girdle is a function of the sacro-iliac ligaments.
Isquiofemoral
17. Anterior views
(C)
are (A) those of the pelvic girdle connecting the free lower
limb to the vertebral column, (B) the knee and tibiofibular
joint, and (C) tibiofibular syndesmosis, ankle joint, and the
many joints of the foot.
Lunate surface
(articular area)
of acetabulum
Greater
trochanter
Articular cartilage
Head of femur
Artery to head
of femur
Ligament of
head of femur
(cut)
Neck of femur
Fibrous layer of
joint capsule (cut)
Lesser trochanter
Lateral view
Fat pad in acetabular
fossa (covered by
synovial membrane)
Acetabular labrum
on acetabular rim
Transverse acetabular
ligament bridging
acetabular notch*
Obturator artery
Fovea for
ligament of
head
* Shown retracted
superiorly to reveal
obturator artery and
artery to head of femur
FIGURE 5.78. Hip joint. The
joint was disarticulated by cutting
the ligament of the head of the
femur and retracting the head from
the acetabulum. The transverse ace-
tabular ligament is retracted supe-
riorly to show the obturator canal,
which transmits the obturator nerve
and vessels passing from the pelvic
cavity to the medial thigh.
_Chap05.indd 627_Chap05.indd 627 12/10/2012 5:56:55 PM12/10/2012 5:56:55 PM
Ligamento acetabular
transverso
18. (B) Win
stru
(A) Superior view
Iliofemoral
Anterior Ligaments
Posterior
Sacro-iliac
joint
Ischial
spine
Margin of
pelvic inlet
MMeedd.. rr
oottaattoorrss
PPuubbooffeemmoorraall
LLaatteerraall rroottaattoorrss
IIsscchhiiooffeemmoorr
aall
Med. r
otators
Pubofemoral
Lateral rotators
Ischiofemor
al
19. Pubic
symphysis
Obturator
membrane
(A) Anterior view
Lesser trochanter
Inter-
trochanteric
line
Greater
trochanter
Iliofemoral
ligament
Rectus femoris,
direct head
Anterior inferior
iliac spine
Anterior
superior
iliac spine
(C) Anterior view
Acetabular labrum
* Head of femur
Pectineus
Pectineal fascia
Pectineal ligament
Pubic tubercle
Obturator externus
Obturator nerve, anterior
and posterior divisions
*Thin area of joint capsule (floor of iliopectineal bursa) Obturator internus bursa
Obturator internus tendon
(reflected medially)
Sacrospinous ligament
and ischial spine
Sacrotuberous
ligament
Groove for obturator internu
Fovea for
ligament
of head
of femur
Position of free ed
of joint capsule
site on
Anterior view
(B)
Iliopsoas
21. Femoral vein (2)
Sciatic nerve (12)
Inferior gluteal
vessels
Posterior femoral
cutaneous nerve
Pudendal nerve
Internal pudendal vessels
Obturator bursa
Obturator internus
and its fascia (13)
Ligament of
head of femur in
acetabular fossa (15)
Obturator vessels
and nerve (16)
Pectineus and
its fascia (1)
Lacunar ligament
Spermatic cord
Fat and lymph node
at femoral canal
Femoral artery (2)
Femoral nerve (3)
Iliopsoas and its fascia (4)
Sartorius (5)
Rectus femoris (6)
Tensor fasciae latae (7)
Iliofemoral ligament (8)
Gluteus medius (9)
Iliotibial tract
Greater trochanter (10)
Superior gemellus
Gluteus maximus (11)
Femoral sheath
(A) Inferior view of right side
Head
of femur
(14)
* Lunate surface of acetabulum
*
*
22. (C)
(B) Inferior view of right side
1
2
3
4
5
6
7
9
8
10
11
12
13
16
14
* Lunate surfa
*
*
15
FIGURE 5.80. Se
anatomy of gluteal
anterior thigh at lev
descriptive drawing
study of an anatom
shown. Numbers in
structures identifie
drawing shows the l
23. Chapter 5 • Lower Limb 633
Femoral artery
Pectineus (4)
Femoral nerve
Head of
femur (H)
Rectus femoris
(tendon)(3t)
Acetabulum
Iliopsoas (1)
Sartorius (2)
Femoral vein
Rectus
femoris (3)
Gluteus medius (14)
Iliac crest
Gluteus minimus (15)
Gluteus maximus (12)
Piriformis (9)
Obturator internus
and gemelli (10)
Sciatic nerve
Obturator
externus (8)
Quadratus
femoris (11)
Hamstrings (13)
Adductor brevis (6)
Adductor magnus (7)
Adductor longus (5)
(A) Lateral view of sagittal section through femoral head
(B) MRI of hip joint, lateral view
(Is, Ischium)
Iliopsoas group (internally)
Gluteal group (externally)
Iliopsoas (1)
Sartorius (2)
Tensor fasciae latae
Rectus femoris (3) tendon (3t)
Pectineus (4)
Adductor longus (5)
Adductor brevis (6)
Adductor magnus—anterior part (7)
Gracilis
Flexors
Pectineus (4)
Adductors
Functional groups of muscles
acting at hip joint
IL
H
H
1514
9
10
Is
12
13
8
11
5
4
7 6 3
2
3t
1
IL
Femoral artery
Pectineus (4)
Femoral nerve
Head of
femur (H)
Rectus femoris
(tendon)(3t)
Sartorius (2)
Femoral vein
Rectus
femoris (3)
0)
3)
is (6)
nus (7)
us (5)
ew of sagittal section through femoral head
ABDUCTORS
Anterior
(B) MRI of hip joint, lateral view
(Is, Ischium)
Iliopsoas group (internally)
Gluteal group (externally)
Circular Zones =
The zones represent
the position of origin of
functional groups
relative to center of
femoral head in
Iliopsoas (1)
Sartorius (2)
Tensor fasciae latae
Rectus femoris (3) tendon (3t)
Pectineus (4)
Adductor longus (5)
Adductor brevis (6)
Adductor magnus—anterior part (7)
Gracilis
Flexors
Pectineus (4)
Adductor longus (5)
Adductor brevis (6)
Adductor magnus (7)
Obturator externus (8)
Gracilis
Adductors
Obturator externus (8)
Piriformis (9)
Obturator internus (10)
Gemelli (10)
Quadratus femoris (11)
Gluteus maximus (12)
Lateral rotators
Functional groups of muscles
acting at hip joint
MEDIAL ROTATORS
H
Is
13
8
11
5
4
7 6 3
2
24. Chapter 5 • Lower Limb 633
Femoral artery
Pectineus (4)
Femoral nerve
Head of
femur (H)
Rectus femoris
(tendon)(3t)
Acetabulum
Iliopsoas (1)
Sartorius (2)
Femoral vein
Rectus
femoris (3)
Gluteus medius (14)
Iliac crest
Gluteus minimus (15)
Gluteus maximus (12)
Piriformis (9)
Obturator internus
and gemelli (10)
Sciatic nerve
Obturator
externus (8)
Quadratus
femoris (11)
Hamstrings (13)
Adductor brevis (6)
Adductor magnus (7)
Adductor longus (5)
(A) Lateral view of sagittal section through femoral head
(B) MRI of hip joint, lateral view
(Is, Ischium)
Iliopsoas group (internally)
Gluteal group (externally)
Iliopsoas (1)
Sartorius (2)
Tensor fasciae latae
Rectus femoris (3) tendon (3t)
Pectineus (4)
Adductor longus (5)
Adductor brevis (6)
Adductor magnus—anterior part (7)
Gracilis
Flexors
Pectineus (4)
Adductors
Functional groups of muscles
acting at hip joint
IL
H
H
1514
9
10
Is
12
13
8
11
5
4
7 6 3
2
3t
1
ILFLEXORS
ABDUCTORS
ADDUCTORS
Adductor group
Anterior
teral view
d
roup
Circular Zones =
The zones represent
the position of origin of
functional groups
relative to center of
femoral head in
acetabulum (point
of rotation). Pull is
applied on the femur
(femoral trochanters
or shaft) from
these positions.
Colored Arrows =
The arrows show
the direction of rotation
of femoral head
caused by activity
of functional groups.
Adductor brevis (6)
Adductor magnus (7)
Obturator externus (8)
Gracilis
Obturator externus (8)
Piriformis (9)
Obturator internus (10)
Gemelli (10)
Quadratus femoris (11)
Gluteus maximus (12)
Lateral rotators
Gluteus maximus (12)
Hamstrings: (13)
Semitendinosus
Semimembranosus
Long head, biceps femoris
Adductor magnus—posterior part
Extensors
Gluteus medius (14)
Gluteus minimus (15)
Tensor fasciae latae
Abductors
Gluteus medius (14)
Gluteus minimus (15)
Tensor fasciae latae
Medial rotators
Anterior parts
MEDIAL ROTATORS
of hip joint and muscles producing movements of joint. A. Sagittal section of the hip joint showing the muscles, vessels, and
scles are color coded to indicate their function(s). Applying Hilton’s law, it is possible to deduce the innervation of the hip joint
directly cross and act on the joint and their nerve supply. B. The relative positions of the muscles producing movements of the hip
25. EXTENSORS
FLEXORS
ABDUCTORS
LATERALRO
T
ATORS
ADDUCTORS
Adductor group
Anterior
(C) Diagrammatic lateral view
Posterior
Hamstrings and
lateral rotator group
Iliopsoas group (internally)
Gluteal group (externally)
Circular Zones =
The zones represent
the position of origin of
functional groups
relative to center of
femoral head in
acetabulum (point
of rotation). Pull is
applied on the femur
(femoral trochanters
or shaft) from
these positions.
Colored Arrows =
The arrows show
the direction of rotation
of femoral head
caused by activity
of functional groups.
Adductor brevis (6)
Adductor magnus—
Gracilis
Pectineus (4)
Adductor longus (5
Adductor brevis (6)
Adductor magnus (
Obturator externus
Gracilis
Adductors
Obturator externus
Piriformis (9)
Obturator internus
Gemelli (10)
Quadratus femoris
Gluteus maximus (
Lateral rotators
Gluteus maximus (
Hamstrings: (13)
Semitendinosus
Semimembrano
Long head, bice
Adductor magnus—
Extensors
Gluteus medius (14
Gluteus minimus (1
Tensor fasciae lata
Abductors
Gluteus medius (14
Gluteus minimus (1
Tensor fasciae lata
Medial rotators
MEDIAL ROTATORS
FIGURE 5.83. Relations of hip joint and muscles producing movements of joint. A. Sagittal section of the hip joint showing t
nerves related to it. The muscles are color coded to indicate their function(s). Applying Hilton’s law, it is possible to deduce the in
27. Chapter 5 • Lower Limb
Posterior aspect of condyles
Femur
Patella (2)
Lateral condyle
of femur (1)
Lateral condyle
of tibia
Head of fibula
Shaft of fibula
Adductor tubercle
Medial condyle
of femur (3)
Medial and lateral
intercondylar
tubercles of
intercondylar
eminence
Shaft of tibia
(A) Anterior view (B) AP projection
Medial epicondyle
Medial thigh
Lateral femorotibial
articulation Medial femorotibial
articulation
1
2
3
. Radiography of knee joint. A and B. The orientation drawing depicts the structures visible in the AP radiograph of the right kn
28. Medial head of
gastrocnemius
Tibial collateral
ligament
Adductor magnus
Vastus medialis
Adductor hiatus
Tendon of
“hamstring”
portion of
adductor magnus
Adductor
tubercle
Semimembranosus
tendon
Pes anserinus
Tendinous arch
of soleus
Semimembranosus
contribution to
fascia of popliteus
Soleus
Oblique popliteal
ligament
Fibrous layer
extending across
intercondylar fossa
(B) Posterior view
Rectus femoris
(cut away)
Vastus intermedius
(cut away)
Vastus lateralis
Femur
Articularis genu
Quadriceps femoris
tendon
Iliotibial tract
Patellar retinacula
Fibular collateral
ligament
Tibia
Patellar ligament
Vastus
medialis
Suprapatellar bursa
Tibial collateral
ligament
Pes anserinus
(A) Anterior view
29. Linea
aspera
Lateral
intermuscular
septum
covering
vastus lateralis
Popliteal surface
of femur
Lateral head of
gastrocnemius
Medial head of
gastrocnemius
Plantaris
Fibular collateral
ligament
Tibial collateral
ligament
Adductor magnus
Vastus medialis
Adductor hiatus
Tendon of
“hamstring”
portion of
adductor magnus
Adductor
tubercle
Semimembranosus
tendon
Pes anserinus
Tendinous arch
of soleus
Semimembranosus
contribution to
fascia of popliteus
Soleus
Common
fibular nerve
Biceps femoris
tendon
Popliteus
Arcuate popliteal
ligament and opening
for popliteus tendon
Oblique popliteal
ligament
Fibrous layer
extending across
intercondylar fossa
(B) Posterior view
apsule of knee. The fibrous layer of the joint capsule is relatively thin in some places and thickened in others to
30. Synovial fold
Intercondylar
fossa
Tibial collateral
ligament
Medial
meniscus
Fibrous layer*
* Of joint
capsule
Subcutaneous
prepatellar bursa
(opened)
Patella
Articular cartilage
Infrapatellar fat pad
Articular
cartilage
Junction of
membrane
with cartilage
Synovial
membrane*
Iliotibial tract
Fibrous layer*
Lateral alar fold
Subcutaneous
prepatellar bursa
Infrapatellar
synovial fold
Medial alar fold
(A) Anterior view of flexed knee
31. Patellar ligament
Alar folds
Fibrous layer (blue)
Synovial membrane (red)
Anterior intercondylar area
Lateral patellar retinaculum
* Of joint
capsule
Subcutaneous
prepatellar bursa
(opened)
(A) Anterior view of flexed knee
(B) Superior view of superior articular
surface of tibia (tibial plateau)
Infrapatellar
synovial
fold
Medial patellar
retinaculum
Articular
surface of
medial condyle
Joint capsule
Site of attachment of
anterior cruciate ligament
Articular surface of lateral condyle
Site of attachment of
posterior cruciate ligament
Gap in fibrous capsule for popliteus tendon Posterior intercondylar area
GURE 5.87. Internal aspect of joint capsule of knee: layers, articular cavity, and articular surfaces. A. The joint capsule was incised transversely,
lla was sawn through, and then the knee was flexed, opening the articular cavity. The infrapatellar fold of synovial membrane encloses the cruciate
ments, excluding them from the joint cavity. All internal surfaces not covered with or made of articular cartilage (blue, or gray in the case of the meni
ined with synovial membrane (mostly purple, but transparent and colorless where it is covering non-articular surfaces of the femur). B. The attach-
ts of the fibrous layer and synovial membrane to the tibia are shown. Note that although they are adjacent on each side, they part company centra
ccommodate intercondylar and infrapatellar structures that are intracapsular (inside the fibrous layer) but extra-articular (excluded from the articu
32. Gastrocnemius
Fibular collatera
ligament
Lateral part of
tibial plateau
Biceps femoris
Fibular collatera
ligament
Popliteus
Gastrocnemius
lateral head,
turned superiorly
Quadriceps
femoris muscle
and tendon
Suprapatellar bursa
Patella
Subcutaneous
prepatellar bursa
Lateral
meniscus
Patellar
ligament
Iliotibial tract
(turned inferiorly)
Fibrous layer of
capsule of proximal
tibiofibular joint
Fibular collateral
ligament (FCL)
(A)
Popliteus
muscle and
tendon
Biceps femoris
(turned inferiorly)
A - C Lateral views
Suprapatellar
bursa
33. (C)
P
l
Fibular collateral
ligament
Fibrous layer of
capsule of proximal
tibiofibular joint
Adductor
magnus
tendon
Vastus
medialis
Medial superior
genicular artery
Gastrocnemius tendon
(of proximal attachment)
Adductor
Gas
Joint cavity
Fibrous layer of
joint capsule
Articular cartilage
Patella
Suprapatellar
bursa
(B)
34. (C)
Gastrocnemius
Fibular collateral
ligament
Lateral part of
tibial plateau
Biceps femoris
Iliotibial tract
Patellar
ligament
Fibular collateral
ligament
Popliteus
Quadriceps
femoris muscle
and tendon
Suprapatellar bursa
Patella
Subcutaneous
prepatellar bursa
Lateral
meniscus
Patellar
ligament
Fibrous layer of
capsule of proximal
tibiofibular joint
Patella
lar
35. Adductor
magnus
tendon
Vastus
medialis
Medial superior
genicular artery
Gastrocnemius tendon
(of proximal attachment)
Semimembranosus
tendon
Meniscus
Tibial collateral
ligament (TCL)
Coronary ligament
(in which a window
has been cut)
Medial inferior
genicular artery
Gracilis
Semitendinosus
Sartorius
Popliteus fascia
overlying popliteus
muscle
Patellar
ligament
Sartorius
Gracilis
Semi-
tendinosus
Pes anserinus
D - E Medial views
(E)
(D)
Joint cavity
Fibrous layer of
joint capsule
Articular cartilag
(B)
36. Adductor
magnus
tendon
Vastus
medialis
Medial superior
genicular artery
Gastrocnemius tendon
(of proximal attachment)
Semimembranosus
tendon
Meniscus
Tibial collateral
ligament (TCL)
Coronary ligament
(in which a window
has been cut)
Medial inferior
genicular artery
Gracilis
Semitendinosus
Sartorius
Popliteus fascia
overlying popliteus
muscle
Adductor magnus
Gastrocnemius
Tibial
collateral
ligament
Tibial
collateral
ligament
Semi-
membranosus
Tibial collateral
ligament
Patellar
ligament
Sartorius
Gracilis
Semi-
tendinosus
Pes anserinus
D - E Medial views
(E)
joint capsule
Articular cartilage
(B)
rsae of knee joint. A. Fibular collateral ligament. Purple latex was injected to demonstrate the extensive and
embrane extends superiorly deep to the quadriceps, forming the suprapatellar bursa. B. Arthrogram, knee joint
37. e lateral head of gastrocnemius (see blue
astrocnemius;” Fig. B5.21 on p. 606). Both
ught to contribute to posterolateral stability
The cruciate ligaments (L. crux, a cross
the joint capsule of the joint but outside th
(Figs. 5.89 and 5.90). The cruciate ligamen
Groove for medial
meniscus
Patellar surface
Anterior intercondylar
area
Lateral intercondylar
tubercle
Articular surface of
lateral condyle
Posterior
intercondylar area
Articular surface of
medial condyle
Medial intercondylar
tubercle
(A) Superior view of superior articular
surface of tibia (tibial plateau)
Medial meniscus
Attachment of:
Lateral meniscus
Posterior cruciate
ligament
Anterior cruciate
ligaments
38. Groove for medial
meniscus
Notch for anterior
cruciate ligament
Anterior cruciate
ligament
Medial meniscus
Coronary ligament
(cut edge)
Tibial collateral
ligament
Sartorius tendon
Apex of patella
(patella is inverted)
Nonarticular area
Medial vertical facet
1
2
3 6
5
7
4
Base of patella
Quadriceps tendon
Biceps femoris,
extension to deep
fascia of leg
Fibular collateral
ligament
Coronary ligament
(cut edge)
Lateral meniscus
Tendon of
popliteus
Groove for lateral
meniscus
Patellar surface
(B) Anterior view with knee flexed
Posterior cruciate
ligament
Patellar ligament
1, 2, 3 Superior, middle,
and inferior
lateral facets
4, 5, 6, 7 Superior, middle,
inferior and vertical
medial facets
Facets:
39. Lateral view
Medial view
(D)
Gastrocnemius, lateral head
(reflected superiorly)
Fibular collateral ligament
Posterior meniscofemoral
ligament
Lateral meniscus
Popliteus tendon
and muscle
Biceps femoris
(reflected inferiorly)
Popliteus bursaInvesting popliteus fascia
and popliteus muscle
Posterior cruciate
ligament
Medial meniscus
Semimembranosus
bursa
Semimembranosus
(cut)
Gastrocnemius bursa
Gastrocnemius,
medial head
(reflected superiorly)
Posterior view
Synovial membrane
of joint capsule
41. (C) Coronal MRI of right knee joint
Femur
Tibia
1
2
3
4
5
5
6
7
Medial
meniscus (4)
Tibial
collateral
ligament (5)
Posterior
cruciate
ligament (7)
Tibia
Bursa deep to
tibial collateral
ligament
(D) Anterior view of coronal
section of right knee joint
Femur
Lateral
meniscus (1)
Anterior
cruciate
ligament (6)
Fibular
collateral
ligament (2)
Tibiofibular
joint
Head of fibula (3)
A) Superior view
(B) Posterior view
ligament
Popliteal surface
of tibia Head of fibula
Posterior ligaments
(of fibular head)
tendon
Fibula
Posterior meniscofemoral
ligament
gament
oronary
ament
Posterior cruciate ligament
GURE 5.90. Menisci of knee joint. A. The quadriceps tendon is cut, and the patella and patellar ligament are reflected inferiorly and anteriorly. The
enisci, their attachments to the intercondylar area of the tibia, and the tibial attachments of the cruciate ligaments are shown. B. The band-like tibial
llateral ligament is attached to the medial meniscus. The cord-like fibular collateral ligament is separated from the lateral meniscus. The posterior
eniscofemoral ligament attaches the lateral meniscus to the medial femoral condyle. C and D. The numbers on the MRI study refer to the structures
beled in the corresponding anatomical coronal section. (Part C courtesy of Dr. W. Kucharczyk, Professor and Neuroradiologist Senior Scientist, Depart-
ent of Medical Resonance Imaging, University Health Network, Toronto, Ontario, Canada.)
42. penetrate the fibrous layer of the joint capsule and supply
the cruciate ligaments, synovial membrane, and peripheral
margins of the menisci.
branches to the vasti), tibial, and common fibular nerves sup-
ply its anterior, posterior, and lateral aspects, respectively. In
addition, however, the obturator and saphenous (cutaneous)
nerves supply articular branches to its medial aspect.
(A) Extension (B) Flexion (C) Medial rotation of leg,
knee joint flexed 90°
(D) Lateral rotation of leg,
knee joint flexed 90°
FIGURE 5.91. Movements of knee joint.
Movement Degrees Possible
Muscles Producing Movement
Factors Limiting
(Checking) Movement CommentsPrimary Secondary
Extension Normal knees
extend to 0° (straight
alignment of axes of
tibia and femur)a
Quadriceps femoris Weakly: tensor
fasciae latae
Anterior edge of lateral
meniscus contacts shallow
groove between tibial and
patellar surfaces of femoral
condyles; anterior cruciate
ligament contacts groove in
intercondylar fossa
Ability of quadriceps to
produce extension is most
effective when hip joint is
extended; flexion dimin-
ishes its efficiency
Flexion 120° (hip extended);
140° (hip flexed);
160° passively
Hamstrings (semi-
tendinosus, semi-
membranosus, long
head of biceps);
short head of biceps
Gracilis,
sartorius,
gastrocnemius,
popliteus
Calf of leg contacts thigh;
length of hamstrings is also
a factor—more knee flexion
is possible when hip joint is
flexed; cannot fully flex knee
when hip is extended
Normally, role of gastroc-
nemius is minimal, but in
presence of a supracon-
dylar fracture, it rotates
(flexes) distal fragment
of femur
Medial
rotation
10° with knee
flexed; 5° with knee
extended
Semitendinosus
and semimembra-
nosus when knee
is flexed; popliteus
when non-bearing
knee is extended
Gracilis,
sartorius
Collateral ligaments, loose
during flexion without rotation,
become taut at limits
of rotation
When extended knee is
bearing weight, action of
popliteus laterally rotates
femur; when not bearing
weight, popliteus medially
rotates patella
Lateral
rotation
30° Biceps femoris
when knee is flexed
Collateral ligaments become
taut; anterior cruciate ligament
becomes wound around pos-
terior cruciate ligament
At end of rotation, with no
opposition, tensor fasciae
latae can assist in main-
taining position
TABLE 5.16. MOVEMENTS OF KNEE JOINT AND MUSCLES PRODUCING THEM
a
Straight alignment of axis of tibia with axis of femur is 0°; normal range extends to −3° (3° of hyperextension).
