Quadriceps group <ul><li>Rectus femoris </li></ul><ul><li>Vatus lateralis  </li></ul><ul><li>Vastus medialis </li></ul><ul...
Qduariceps group <ul><li>Action </li></ul><ul><ul><li>All:  Extend the knee </li></ul></ul><ul><ul><li>Rectus femoris:  Fl...
Quadriceps as a group <ul><ul><li>Seated  </li></ul></ul><ul><ul><li>Lay the flat of your hands on the ant. Surface of the...
Test for quadriceps femoris <ul><li>Patient:  Sitting, with the knee over the side of the table and holding on to the tabl...
Rectus femoris <ul><ul><li>Supine with knee bolstered </li></ul></ul><ul><ul><li>Locate the  AIIS  and the  patella </li><...
Rectus femoris <ul><ul><li>Ask pt. to flex his hip and hold his foot up off the table </li></ul></ul>
Vastus medialis <ul><ul><li>Supine with the knee bolstered </li></ul></ul><ul><ul><li>Ask pt. to fully contract his quadri...
Vastus lateralis <ul><ul><li>Sidelying </li></ul></ul><ul><ul><li>Place the flat of your hand on the lat. side of the thig...
Gluteal muscles <ul><li>Gluteus maximus </li></ul><ul><li>Gluteus medius </li></ul><ul><li>Gluteus minimus </li></ul><ul><...
Gluteus maximus <ul><li>Action </li></ul><ul><ul><li>All fibers:  extend the hip, laterally rotate the hip, abduct the hip...
Gluteus maximus <ul><ul><li>Ask pt. to extend his hip </li></ul></ul><ul><ul><li>Palpate the bulging fibers that lead to t...
Gluteus maximus <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Locate  coccyx ,  the edge of sacrum,  PSIS  and the post. 2 ...
Gluteus medius <ul><li>Action </li></ul><ul><ul><li>All fibers:  abduct the hip </li></ul></ul><ul><ul><li>Anterior fibers...
Gluteus minimus <ul><li>Action </li></ul><ul><ul><li>Abduct the hip, medially rotate the hip, flex the hip </li></ul></ul>...
Gluteus medius and minimus <ul><ul><li>Sidelying </li></ul></ul><ul><ul><li>One hand along the  iliac crest  (PSIS~nearly ...
Adductor group <ul><li>Obturator externus </li></ul><ul><li>Pectineus </li></ul><ul><li>Adductor longus </li></ul><ul><li>...
Obturator externus <ul><li>Action </li></ul><ul><ul><li>Adduction and external rotation of the hip joint </li></ul></ul><u...
Pectineus <ul><li>Action </li></ul><ul><ul><li>Adduction, external rotation, and slight flexion of hip joint </li></ul></u...
Pectineus <ul><ul><li>Supine with the hip slightly flexed and laterally rotated </li></ul></ul><ul><ul><li>Place hand on t...
Adductor longus <ul><li>Action </li></ul><ul><ul><li>Adduction and flexion (up to 70°) of the hip joint (extends the hip p...
Adductor brevis <ul><li>Action </li></ul><ul><ul><li>Adduction and flexion (up to 70°) of the hip joint (extends the hip p...
Adductor magnus <ul><li>Action </li></ul><ul><ul><li>Adduction, external rotation, and extension of the hip joint </li></u...
Adductor magnus <ul><ul><li>Sidelying with top hip flexed </li></ul></ul><ul><ul><li>Begin by locating ischial tuberosity ...
Gracilis <ul><li>Action </li></ul><ul><ul><li>Hip joint:  Adduction and flexion </li></ul></ul><ul><ul><li>Knee joint:  Fl...
Test for hip adduction range of motion  <ul><li>Test </li></ul><ul><ul><li>The movable arm of the aliper is held in line w...
Sartorius <ul><li>Action </li></ul><ul><ul><li>Flex, laterally rotate and abduct the hip, flex the knee, medially rotate t...
Sartorius <ul><ul><li>Supine  </li></ul></ul><ul><ul><li>Ask pt. to position his foot resting his opposite knee </li></ul>...
Test for sartorius
Test for sartorius <ul><li>Patient:  Supine </li></ul><ul><li>Test:  Lateral rotation, abduction, and flexion of the thigh...
Adductor group <ul><ul><li>Supine with the hip slightly flexed and laterally rotated </li></ul></ul><ul><ul><li>Place your...
Gracillis and adductor longus <ul><ul><li>Supine with the hip slightly flexed and laterally rotated </li></ul></ul><ul><ul...
Tensor fasciae latae <ul><li>Action </li></ul><ul><ul><li>Tenses the fascia lata </li></ul></ul><ul><ul><li>Hip joint: abd...
Tensor fasciae latae <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Locate  ASIS </li></ul></ul><ul><ul><li>Place hand post...
Iliotibial tract <ul><li>Sidelying </li></ul><ul><li>Locate  biceps femoris   tendon   just proximal to the back of the kn...
Test for tensor fasciae latae  & iliotibial track <ul><li>Ober test </li></ul><ul><ul><li>The right leg is flexed to a rig...
Test for tensor fasciae latae  & iliotibial track <ul><li>Modified Ober test </li></ul><ul><ul><li>Knee extended </li></ul...
Piriformis <ul><li>Action </li></ul><ul><ul><li>External rotation, abduction, and extension of the hip joint </li></ul></u...
Piriformis <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Locate the  coccyx ,  PSIS  and  greater trochanter .  These landm...
Quadratus femoris <ul><li>Action </li></ul><ul><ul><li>Laterally rotate the hip </li></ul></ul><ul><li>Origin </li></ul><u...
Quadratus femoris <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Locate the distal, posterior aspect of the  greater trochan...
Test for lateral rotators <ul><li>Patient:  Sitting on a table, with the knees bent over the side and the subject holding ...
Posterior thigh <ul><li>Biceps femoris </li></ul><ul><li>Semimembranosus </li></ul><ul><li>Semitendinosus </li></ul><ul><l...
Biceps femoris <ul><li>Action </li></ul><ul><ul><li>Hip joint (long head):  Extend the hip, stabilize the pelvis in the sa...
Semimembranosus <ul><li>Action </li></ul><ul><ul><li>Hip joint:  Extends the hip, stbilize the pelvic in the sagittal plan...
Semitendinosus <ul><li>Action </li></ul><ul><ul><li>Hip joint:  Extends the hip, stabilize the pelvis in the sagittal plan...
Popliteus <ul><li>Action </li></ul><ul><ul><li>Flexion and internal rotation of the knee joint (stabilizes the knee) </li>...
Hamstrings as a group <ul><ul><li>Prone  </li></ul></ul><ul><ul><li>Ask pt. to flex his knee, holding his foot off the tab...
Hamstrings as a group <ul><ul><li>Locate  ischial tuberosity </li></ul></ul><ul><ul><li>Slide distally one inch and strum ...
Test for shortness of hamstring  <ul><li>Normal hamstring length </li></ul><ul><li>Excessive hamstring length </li></ul>
Test for shortness of hamstring  <ul><li>Apparently short, actually normal </li></ul><ul><li>Apparently normal, actually e...
Test for semimembranosus  and semitendinosus
Test for semimembranosus  and semitendinosus <ul><li>Patient:  Prone </li></ul><ul><li>Fixation:  The examiner should hold...
Tendons of the post. knee
Lateral tendons <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Ask pt. to flex and hold his knee at 45° </li></ul></ul><ul><...
Medial tendons <ul><ul><li>Supine  </li></ul></ul><ul><ul><li>Palpate thin, prominent  semitendinosus  tendon </li></ul></...
Psoas major <ul><li>Action </li></ul><ul><ul><li>Hip joint:  Flexion and external rotation </li></ul></ul><ul><ul><li>Lumb...
Psoas major <ul><ul><li>Supine with hip slightly flexed and laterally rotated </li></ul></ul><ul><ul><li>Locate the navel ...
Psoas major <ul><ul><li>Sidelying with hip flexed: less invasive position </li></ul></ul>
Iliacus <ul><li>Action </li></ul><ul><ul><li>Hip joint:  Flexion and external rotation </li></ul></ul><ul><ul><li>Lumbar s...
Iliacus <ul><ul><li>Supine with hip slightly flexed and laterally rotated </li></ul></ul><ul><ul><li>Located anterior port...
Iliacus
Test for iliopsoas
Test for iliopsoas <ul><li>Patient:  Supine </li></ul><ul><li>Fixation:  The examiner stabilizes the opposite iliac crest....
Other structures of the pelvis and thigh Sacrotuberous ligament Post. Sacroiliac ligaments
Other structures of the pelvis and thigh <ul><li>Iliolumbar ligament </li></ul><ul><ul><li>Prone </li></ul></ul><ul><ul><l...
Other structures of the pelvis and thigh <ul><li>Trochanteric bursa </li></ul><ul><ul><li>Post/lat aspect of greater troch...
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Pelvis And Thigh 2

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  • Pelvis And Thigh 2

    1. 1. Quadriceps group <ul><li>Rectus femoris </li></ul><ul><li>Vatus lateralis </li></ul><ul><li>Vastus medialis </li></ul><ul><li>Vastus intermedius </li></ul>
    2. 2. Qduariceps group <ul><li>Action </li></ul><ul><ul><li>All: Extend the knee </li></ul></ul><ul><ul><li>Rectus femoris: Flex the hip </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>RF: ASIS </li></ul></ul><ul><ul><li>VL: Lateral lip of linea aspera, gluteal tuberosity </li></ul></ul><ul><ul><li>VM: Medial lip of linea aspera </li></ul></ul><ul><ul><li>VI: Anterior and lateral shaft of the femur </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Tibial tuberosity </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Femoral (L2-4) </li></ul></ul>
    3. 3. Quadriceps as a group <ul><ul><li>Seated </li></ul></ul><ul><ul><li>Lay the flat of your hands on the ant. Surface of the thigh </li></ul></ul><ul><ul><li>Ask pt. to alternately extend and relax his knee slowly </li></ul></ul>
    4. 4. Test for quadriceps femoris <ul><li>Patient: Sitting, with the knee over the side of the table and holding on to the table </li></ul><ul><li>Fixation: The examiner may put a hand under the distal end of the thigh to cushion that part against table pressure. </li></ul><ul><li>Test: Full extension of the knee joint, without rotation of the thigh </li></ul><ul><li>Pressure: Against the leg, above the ankle, in the direction of flexion </li></ul>
    5. 5. Rectus femoris <ul><ul><li>Supine with knee bolstered </li></ul></ul><ul><ul><li>Locate the AIIS and the patella </li></ul></ul><ul><ul><li>Draw imaginary line b/w these two point </li></ul></ul><ul><ul><li>Palpate along this line and strum across the rectus fibers </li></ul></ul>
    6. 6. Rectus femoris <ul><ul><li>Ask pt. to flex his hip and hold his foot up off the table </li></ul></ul>
    7. 7. Vastus medialis <ul><ul><li>Supine with the knee bolstered </li></ul></ul><ul><ul><li>Ask pt. to fully contract his quadriceps by extending knee </li></ul></ul><ul><ul><li>Palpate just medial and proximal to the patella </li></ul></ul><ul><ul><li>Locate the rectus and sartorius – “teardrop” shape </li></ul></ul>
    8. 8. Vastus lateralis <ul><ul><li>Sidelying </li></ul></ul><ul><ul><li>Place the flat of your hand on the lat. side of the thigh while pt. slowly extends and relaxes his knees </li></ul></ul>
    9. 9. Gluteal muscles <ul><li>Gluteus maximus </li></ul><ul><li>Gluteus medius </li></ul><ul><li>Gluteus minimus </li></ul><ul><li>Tensor fasciae latea </li></ul>
    10. 10. Gluteus maximus <ul><li>Action </li></ul><ul><ul><li>All fibers: extend the hip, laterally rotate the hip, abduct the hip </li></ul></ul><ul><ul><li>Lower fibers: adduct the hip </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Coccyx, edge of sacrum, posterior illiac crest, sacrotuberous and sacroilliac ligaments </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Gluteal tuberosity and iliotibial tract </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Inferior gluteal (L5-S2) </li></ul></ul>
    11. 11. Gluteus maximus <ul><ul><li>Ask pt. to extend his hip </li></ul></ul><ul><ul><li>Palpate the bulging fibers that lead to the gluteal tuberosity </li></ul></ul>
    12. 12. Gluteus maximus <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Locate coccyx , the edge of sacrum, PSIS and the post. 2 inches of the iliac crest </li></ul></ul><ul><ul><li>Locate the insertion of maximus at the gluteal tuberosity </li></ul></ul><ul><ul><li>Connect its origin to its insertion and then palpate </li></ul></ul>
    13. 13. Gluteus medius <ul><li>Action </li></ul><ul><ul><li>All fibers: abduct the hip </li></ul></ul><ul><ul><li>Anterior fibers: flex the hip, medially rotate the hip </li></ul></ul><ul><ul><li>Posterior fibers: extend the hip, laterally rotate the hip </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Gluteal surface of the ilium b/w iliac crest and the post. and ant. gluteal lines </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Greater trochanter </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Superior gluteal (L4-S1) </li></ul></ul>
    14. 14. Gluteus minimus <ul><li>Action </li></ul><ul><ul><li>Abduct the hip, medially rotate the hip, flex the hip </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Gluteal surface of the ilium b/w the anterior and inferior gluteal lines </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Ant. border of greater trochanter </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Superior gluteal (L4-S1) </li></ul></ul>
    15. 15. Gluteus medius and minimus <ul><ul><li>Sidelying </li></ul></ul><ul><ul><li>One hand along the iliac crest (PSIS~nearly ASIS) while other hand locates the greater trochanter </li></ul></ul><ul><ul><li>Pie-shaped outline of the gluteus medius </li></ul></ul><ul><ul><li>Sink your fingers deep to the gluteus medius lto explore the gluteus minimus </li></ul></ul>
    16. 16. Adductor group <ul><li>Obturator externus </li></ul><ul><li>Pectineus </li></ul><ul><li>Adductor longus </li></ul><ul><li>Adductor brevis </li></ul><ul><li>Adductor magnus </li></ul><ul><li>Adductor minimus </li></ul><ul><li>Gracilis </li></ul>
    17. 17. Obturator externus <ul><li>Action </li></ul><ul><ul><li>Adduction and external rotation of the hip joint </li></ul></ul><ul><ul><li>Stabilizes the pelvis in the sagittal plane </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Outer surface of the obturator membrane and its bony boundaries </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Trochanteric fossa of the femur </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Obturator nerve (L3-4) </li></ul></ul>
    18. 18. Pectineus <ul><li>Action </li></ul><ul><ul><li>Adduction, external rotation, and slight flexion of hip joint </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Pecten pubis </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Pectineal line and the proximal linea aspera of the femur </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Femoral, obturator nerve (L2,3) </li></ul></ul>
    19. 19. Pectineus <ul><ul><li>Supine with the hip slightly flexed and laterally rotated </li></ul></ul><ul><ul><li>Place hand on the middle of medial thigh </li></ul></ul><ul><ul><li>Ask pt. to adduct his hip slightly </li></ul></ul><ul><ul><li>Locate the prominent tendon of adductor longus or gracillis </li></ul></ul><ul><ul><li>Slide off laterally toward ASIS </li></ul></ul><ul><ul><li>Slowly sink into the belly of pectineus </li></ul></ul>
    20. 20. Adductor longus <ul><li>Action </li></ul><ul><ul><li>Adduction and flexion (up to 70°) of the hip joint (extends the hip past 80° of flexion) </li></ul></ul><ul><ul><li>Stabilize the pelvis in the coronal and sagittal plane </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Superior puic ramus and anterior side of the symphysis </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Linea aspera: mediallip in the middle third of the femur </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Obturator nerve (L2-4) </li></ul></ul>
    21. 21. Adductor brevis <ul><li>Action </li></ul><ul><ul><li>Adduction and flexion (up to 70°) of the hip joint (extends the hip past 80° of flexion) </li></ul></ul><ul><ul><li>Stabilize the pelvis in the coronal and sagittal plane </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Inrefior pubic ramus </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Linea aspera: mediallipin the upper third of the femur </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Obturator nerve (L2-4) </li></ul></ul>
    22. 22. Adductor magnus <ul><li>Action </li></ul><ul><ul><li>Adduction, external rotation, and extension of the hip joint </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Inferior pubic ramus, ischial ramus, and ischial tuberosity </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Deep part: Medial lip of lenea aspera </li></ul></ul><ul><ul><li>Superficial part: Medial epicondyle of the femur </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Deep part: Obturator (L2-4) </li></ul></ul><ul><ul><li>Superficial part: Tibial nerve (L4) </li></ul></ul>
    23. 23. Adductor magnus <ul><ul><li>Sidelying with top hip flexed </li></ul></ul><ul><ul><li>Begin by locating ischial tuberosity </li></ul></ul><ul><ul><li>Ask pt. to adduct his hip slightly </li></ul></ul><ul><ul><li>Locate the prominent tendon of adductor longus or gracillis. </li></ul></ul><ul><ul><li>Slide off the tendon posteriorly </li></ul></ul><ul><ul><li>Palpate the wide tendon of adductor magnus as it stretches to the ischial tuberosity </li></ul></ul>
    24. 24. Gracilis <ul><li>Action </li></ul><ul><ul><li>Hip joint: Adduction and flexion </li></ul></ul><ul><ul><li>Knee joint: Flexion and internal rotation </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Infrior pubic ramus below the symphysis </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Medial border of the tibial tuberosity </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Obturator nerve </li></ul></ul>
    25. 25. Test for hip adduction range of motion <ul><li>Test </li></ul><ul><ul><li>The movable arm of the aliper is held in line with the thigh as the left leg is passively and slowly moved into adduction without any rotation. </li></ul></ul><ul><ul><li>At the moment the pelvis starts to move downward on the side of the adducted leg, the movement of the leg in adduction is stopped. </li></ul></ul>
    26. 26. Sartorius <ul><li>Action </li></ul><ul><ul><li>Flex, laterally rotate and abduct the hip, flex the knee, medially rotate the flexed knee </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>ASIS </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Proximal, medial shaft of the tibia at pes anserinus tendon </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Femoral (L2,L3) </li></ul></ul>
    27. 27. Sartorius <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Ask pt. to position his foot resting his opposite knee </li></ul></ul><ul><ul><li>Place your hand along the middle of the medial thigh </li></ul></ul><ul><ul><li>Ask pt. to raise his knee toward the ceiling (contracting sartorius) </li></ul></ul>
    28. 28. Test for sartorius
    29. 29. Test for sartorius <ul><li>Patient: Supine </li></ul><ul><li>Test: Lateral rotation, abduction, and flexion of the thigh, with flexion of the knee </li></ul><ul><li>Pressure: Against the anterolateral surface of the lower thigh,, in the direction of hip extension, adduction, and medial rotation, and against the leg, in the direction of knee extension. </li></ul>
    30. 30. Adductor group <ul><ul><li>Supine with the hip slightly flexed and laterally rotated </li></ul></ul><ul><ul><li>Place your hand along the med. thigh </li></ul></ul><ul><ul><li>Ask pt. to adduct his hip against your resistance </li></ul></ul>
    31. 31. Gracillis and adductor longus <ul><ul><li>Supine with the hip slightly flexed and laterally rotated </li></ul></ul><ul><ul><li>Ask pt. to adduct his hip slightly </li></ul></ul><ul><ul><li>Slide your fingers proximally to the pubic bone and locate the prominent tendons extending off of the pubic tubercle </li></ul></ul>
    32. 32. Tensor fasciae latae <ul><li>Action </li></ul><ul><ul><li>Tenses the fascia lata </li></ul></ul><ul><ul><li>Hip joint: abduction, felexion, internal rotation </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>ASIS </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Iliotibial track </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Superior gluteal (L4-S1) </li></ul></ul>
    33. 33. Tensor fasciae latae <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Locate ASIS </li></ul></ul><ul><ul><li>Place hand posterior and distal to the ASIS and iliac crest </li></ul></ul><ul><ul><li>Ask pt. to alternate medial rotation with relaxation of the hip </li></ul></ul><ul><ul><li>Upon medial rotation, TFL will contract into a solid, oval mound </li></ul></ul>
    34. 34. Iliotibial tract <ul><li>Sidelying </li></ul><ul><li>Locate biceps femoris tendon just proximal to the back of the knee </li></ul><ul><li>Slide anteriorly from the biceps femoris tendon to the lateral thigh </li></ul><ul><li>Follow it distally as it disappears toward the tibial tubercle </li></ul>
    35. 35. Test for tensor fasciae latae & iliotibial track <ul><li>Ober test </li></ul><ul><ul><li>The right leg is flexed to a right angle at the knee </li></ul></ul><ul><ul><li>The right thigh is abducted widely then hyperextended in the abducted position </li></ul></ul>
    36. 36. Test for tensor fasciae latae & iliotibial track <ul><li>Modified Ober test </li></ul><ul><ul><li>Knee extended </li></ul></ul>
    37. 37. Piriformis <ul><li>Action </li></ul><ul><ul><li>External rotation, abduction, and extension of the hip joint </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Pelvic surface of the sacrum </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Apex of the greater trochanter of the femur </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Direct branches from the sacral plexus (L5-S2) </li></ul></ul>
    38. 38. Piriformis <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Locate the coccyx , PSIS and greater trochanter . These landmarks form a “T”. </li></ul></ul><ul><ul><li>Piriformis is located along the base of the “T” </li></ul></ul>
    39. 39. Quadratus femoris <ul><li>Action </li></ul><ul><ul><li>Laterally rotate the hip </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Lateral border of ischial tuberosity </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Intertrochanteric crest, b/w the greater and lesser trochanters </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Branch of sacral plexus </li></ul></ul>
    40. 40. Quadratus femoris <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Locate the distal, posterior aspect of the greater trochanter and the ischial tuberosity </li></ul></ul><ul><ul><li>Place finger b/w these two landmarks </li></ul></ul><ul><ul><li>Pressing through the gluteus maximus fibers </li></ul></ul><ul><ul><li>Flex knee and ask pt. to laterally rotate his hip against your resistance </li></ul></ul>
    41. 41. Test for lateral rotators <ul><li>Patient: Sitting on a table, with the knees bent over the side and the subject holding on to the table </li></ul><ul><li>Test: Lateral rotation of the thigh, with the leg in a position of completion of the inward arc of motion </li></ul><ul><li>Pressure: With one hand, the examiner applies counter pressure at the lateral side of the lower end of the thigh. With the other hand, the examiner applies pressure to the medial side of the leg, above the ankle, pushing the leg outward in an effort to rotate the thigh medially </li></ul>
    42. 42. Posterior thigh <ul><li>Biceps femoris </li></ul><ul><li>Semimembranosus </li></ul><ul><li>Semitendinosus </li></ul><ul><li>Popliteus </li></ul>
    43. 43. Biceps femoris <ul><li>Action </li></ul><ul><ul><li>Hip joint (long head): Extend the hip, stabilize the pelvis in the sagittal plane </li></ul></ul><ul><ul><li>Knee joint(entire muscle): Flexion and external rotation </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Long head: Ihchial tuberosity, sacrotuberous ligament (common head with semitendinosus) </li></ul></ul><ul><ul><li>Short head: Lateral lip of the linea aspera in the middle third of the femur </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Head of fibula </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Long head: Tibial nerve (L5-S2) </li></ul></ul><ul><ul><li>Short head: Common fibular nerve (L5-S2) </li></ul></ul>
    44. 44. Semimembranosus <ul><li>Action </li></ul><ul><ul><li>Hip joint: Extends the hip, stbilize the pelvic in the sagittal plane </li></ul></ul><ul><ul><li>Knee joint: Flexion and internal rotation </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Ischial tuberosity </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Medial tibial condyle, oblique popliteal ligament, popliteus fascia </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Tibial nerve (L5-S2) </li></ul></ul>
    45. 45. Semitendinosus <ul><li>Action </li></ul><ul><ul><li>Hip joint: Extends the hip, stabilize the pelvis in the sagittal plane </li></ul></ul><ul><ul><li>Knee: Flexion and internal rotation </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Ischial tuberosity and sacrotuberous ligament (comon head with long head of biceps femoris) </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Medial to the tibial tuberosity in the pes anserinus (along with the tendons of gracilis and sartorius) </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Tibial nerve (L5-S2) </li></ul></ul>
    46. 46. Popliteus <ul><li>Action </li></ul><ul><ul><li>Flexion and internal rotation of the knee joint (stabilizes the knee) </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Lateral femoral condyle, posterior horn of the lateral meniscus </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Posterior tibial surface (above the origin of soleus) </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Tibial nerve (L4-S1) </li></ul></ul>
    47. 47. Hamstrings as a group <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Ask pt. to flex his knee, holding his foot off the table </li></ul></ul><ul><ul><li>As the hamstrings contract, explore their mass and width </li></ul></ul>
    48. 48. Hamstrings as a group <ul><ul><li>Locate ischial tuberosity </li></ul></ul><ul><ul><li>Slide distally one inch and strum across the tendon of hamstrings </li></ul></ul>
    49. 49. Test for shortness of hamstring <ul><li>Normal hamstring length </li></ul><ul><li>Excessive hamstring length </li></ul>
    50. 50. Test for shortness of hamstring <ul><li>Apparently short, actually normal </li></ul><ul><li>Apparently normal, actually excessive </li></ul>
    51. 51. Test for semimembranosus and semitendinosus
    52. 52. Test for semimembranosus and semitendinosus <ul><li>Patient: Prone </li></ul><ul><li>Fixation: The examiner should hold the thigh down firmly on the table. </li></ul><ul><li>Test: Flexion of the knee between 50° and 70°, with the thigh in medial rotation and the leg medially rotated on the thigh </li></ul><ul><li>Pressure: Against the leg, proximal to the ankle, in the direction of knee extension. Do not apply pressure against the rotation compartment. </li></ul>
    53. 53. Tendons of the post. knee
    54. 54. Lateral tendons <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Ask pt. to flex and hold his knee at 45° </li></ul></ul><ul><ul><li>The most prominent tendons : biceps femoris </li></ul></ul><ul><ul><li>Move laterally 1 inch from biceps and palpate the iliotibial tract </li></ul></ul>
    55. 55. Medial tendons <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Palpate thin, prominent semitendinosus tendon </li></ul></ul><ul><ul><li>Slide off anteriorly and palpate </li></ul></ul><ul><ul><li>gracillis tendon </li></ul></ul><ul><ul><li>Situated anterior to gracillis : sartorius </li></ul></ul><ul><ul><li>Follow the three tendons distally as they blend together to become the pes anserinus tendon </li></ul></ul>
    56. 56. Psoas major <ul><li>Action </li></ul><ul><ul><li>Hip joint: Flexion and external rotation </li></ul></ul><ul><ul><li>Lumbar spine: Unilateral contraction bends the trunk laterally to the same side,bilateral contraction raises the trunk from the supine position </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Bodies and transverse processes of lumbar vertebrae </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Common insertion on the lesser trochanter of the femur as the iliopsoas </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Direct branches from the lumbar plexus (L1-3) </li></ul></ul>
    57. 57. Psoas major <ul><ul><li>Supine with hip slightly flexed and laterally rotated </li></ul></ul><ul><ul><li>Locate the navel and ASIS, placing your fingerpads hand-on-hand b/w these point </li></ul></ul><ul><ul><li>Slowly compress into abdomen </li></ul></ul><ul><ul><li>Ask pt. to flex hip slighlty </li></ul></ul>
    58. 58. Psoas major <ul><ul><li>Sidelying with hip flexed: less invasive position </li></ul></ul>
    59. 59. Iliacus <ul><li>Action </li></ul><ul><ul><li>Hip joint: Flexion and external rotation </li></ul></ul><ul><ul><li>Lumbar spine: Unilateral contraction bends the trunk laterally to the same side,bilateral contraction raises the trunk from the supine position </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Iliac fossa </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Common insertion on the lesser trochanter of the femur as the iliopsoas </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Femoral nerve </li></ul></ul>
    60. 60. Iliacus <ul><ul><li>Supine with hip slightly flexed and laterally rotated </li></ul></ul><ul><ul><li>Located anterior portion of iliac crest </li></ul></ul><ul><ul><li>Place your finger pads an inch medial to its ridge </li></ul></ul><ul><ul><li>Slowly curl your fingers into the iliac fossa </li></ul></ul><ul><ul><li>Ask pt. to flex his hip slightly and feel the contraction </li></ul></ul>
    61. 61. Iliacus
    62. 62. Test for iliopsoas
    63. 63. Test for iliopsoas <ul><li>Patient: Supine </li></ul><ul><li>Fixation: The examiner stabilizes the opposite iliac crest. </li></ul><ul><li>Test: Hip flexion in a position of slight abduction and slight lateral rotation. </li></ul><ul><li>Pressure: Against the anteromedial aspect of the leg, in the direction of extension and slight abduction, directly opposite the line of pull of the psoas major from the origin of the lumbar spine to the insertion on the lesser trochanter of the femur </li></ul>
    64. 64. Other structures of the pelvis and thigh Sacrotuberous ligament Post. Sacroiliac ligaments
    65. 65. Other structures of the pelvis and thigh <ul><li>Iliolumbar ligament </li></ul><ul><ul><li>Prone </li></ul></ul><ul><ul><li>Locate PSIS </li></ul></ul><ul><ul><li>Slide thumb straight superior from the PSIS to the level of L4 and L5 </li></ul></ul>
    66. 66. Other structures of the pelvis and thigh <ul><li>Trochanteric bursa </li></ul><ul><ul><li>Post/lat aspect of greater trochanter </li></ul></ul><ul><ul><li>Reduce friction b/w trochanter and gluteus maximus </li></ul></ul><ul><ul><li>Normally impalpable </li></ul></ul>

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