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The pelvis and hip


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The pelvis and hip

  1. 1. The Pelvis and Hip
  2. 2. Nervous System  Highly complex  Controls, stimulates, and coordinates all other body systems  Can be divided: – Central Nervous System (CNS) – Peripheral Nervous System (PNS) – Autonomic Nervous System (ANS)
  4. 4. Peripheral Nervous System (PNS)  Composed of all the nervous tissue outside the vertebral canal  Begins at the anterior horn of the spinal cord
  5. 5. Branches of the Spinal Nerves  Posterior primary rami innervate the deep muscles of the back and the skin covering these muscles  Spinal nerve continues as the anterior primary ramus
  6. 6. Branches of the Spinal Nerves (cont’d)  Anterior primary rami innervate all muscles and skin not innervated by the posterior primary rami
  7. 7. Plexus Formation  Anterior branches of spinal nerves in thoracic region give rise to intercostal nerves (not a plexus)  Spinal nerves in other regions combine to form complex networks called plexuses
  8. 8. Plexus Formation (cont’d) 1. Cervical Plexus - C1 - C4 – Innervates neck muscles 2. Brachial Plexus - C5 - T1 – Innervates UE muscles 3. Lumbosacral Plexus - L1 - S5 – Innervates LE muscles – Lumbar portion- L1-L4 Supplies mostly the thigh – Sacral portion - L5-S5  Supplies mostly the leg and foot 
  9. 9. Iliopsoas  Actually two muscles – Separate origin – Common insertion O: Iliacus - iliac fossa Psoas major - anterior and lateral surfaces T12-L5 I: Lesser trochanter A: Hip flexion N: Iliacus - Femoral Nerve Psoas Major - L2-3
  10. 10. Rectus Femoris Part of the quadriceps  Two-joint muscle crosses hip and knee anteriorly O: Anterior inferior iliac spine I: Tibial tuberosity A: Hip flexion, Knee extension N: Femoral Nerve, L2-L4 
  11. 11. Sartorius    Longest muscle in the body Straplike muscle “Tailor’s Muscle” O: Anterior superior iliac spine I: Proximal medial aspect of tibia A: Hip flexion, abduction, lateral rotation N: Femoral Nerve, L2-L3
  12. 12. Pectineus  Located – Medial to the iliopsoas – Lateral to the adductor longus O: I: A: N: Superior ramus of pubis Pectineal line of femur Hip flexion and adduction Femoral Nerve, L2-L4
  13. 13. Adductor Longus (A)  Most superficial – Tendon palpable in anterior- medial groin O: I: A: N: Pubis Middle 1/3 linea aspera Hip adduction Obturator Nerve, L3-L4
  14. 14. Adductor Brevis (B) Shorter  Deep to adductor longus  Superficial to adductor magnus O: Pubis I: Pectineal line and proximal linea aspera A: Hip adduction N: Obturator Nerve, L3-4 
  15. 15. Adductor Magnus (C)   Largest, most massive, and deepest Opening or hiatus in distal attachment between linea aspera and adductor tubercle – Femoral artery and vein pass through opening – After femoral artery and vein pass through, their names change to popliteal artery and vein
  16. 16. Adductor Magnus (C) (cont’d) O: Ischium and pubis I: Entire linea aspera and adductor tubercle A: Hip adduction, extension N: Obturator and sciatic nerve (L3-L4)
  17. 17. Gracilis Two-joint muscle O: Pubis I: Anterior medial surface of proximal end of tibia A: Hip adduction N: Obturator Nerve, L2-L3 
  18. 18. Gluteus Maximus  Large, one-joint, quadrilateral-shaped, thick, superficial muscle  Some fibers attach to iliotibial band O:Posterior sacrum and ilium I: Posterior femur distal to greater trochanter A: Hip extension, hyperextension, lateral rotation N: Inferior gluteal nerve, L5, S1, S2
  19. 19. Deep Rotator Muscles   Number = 6, deep, mostly posterior muscles spanning the hip joint in a horizontal direction Laterally rotate the hip O: Posterior sacrum, ischium, pubis I: Greater trochanter area A: Hip lateral rotation
  20. 20. Deep Rotator Muscles Muscle Proximal Attachment Obturator externus Rami of pubis and ischium Obturator internus Rami of pubis and ischium Quadratus femoris Ischial tuberosity Piriformis Sacrum Gemellus superior Ischium Gemellus inferior Ischial tuberosity Distal Attachment Trochanteric fossa Greater trochanter Innervation Obturator nerve Nerve to obturator internus Intertrochanteric crest Nerve to quadratus femoris Greater trochanter S1, S2 segments Greater trochanter Nerve to obturator internus Greater trochanter Nerve to quadratus femoris
  21. 21. Deep Rotator Muscles (cont’d) “Piece Goods Often Go On Quilts”  Anatomical order superior to inferior – Piriformis – Gemellus superior – Obturator internus – Gemellus inferior – Obturator externus – Quadratus femoris
  22. 22. Hamstrings  Posterior thigh muscles  Two joint muscles except short head of biceps femoris  Ischial tuberosity - common origin A. B. C. Semitendinosus Biceps femoris Semimembranosus
  23. 23. Semimembranosus (C) O: I: A: N: Ischial tuberosity Posterior surface of medial condyle of tibia Extend hip, flex knee Sciatic nerve L5, S1, S2
  24. 24. Semitendinosus (A) O: I: A: N: Ischial tuberosity Anteromedial surface of proximal tibia Extend hip, flex knee Sciatic nerve L5, S1, S2
  25. 25. Biceps Femoris (B) O: I: A: N: Long head: Ischial tuberosity Short head: lateral lip linea aspera Fibular head Long head: Extend hip, flex knee Short head: Flex knee Long head: Sciatic nerve, S1-S3 Short head: Common peroneal nerve, L5-S2
  26. 26. Gluteus Medius  Triangular O: I: A: N: shaped Outer ilium Greater trochanter Hip abduction Superior gluteal nerve L4, L5, S1
  27. 27. Gluteus Minimus  Deep and inferior to the gluteus medius O: I: Lateral ilium Anterior surface of the greater trochanter A: Hip abduction, internal rotation N: Superior gluteal nerve L4, L5, S1
  28. 28. Reversal of Muscle Function  When you stand on one leg: – Distal segment (femur) becomes more stable than the proximal segment (os coxae) – Origin moves toward insertion  Without contracting - pelvis would drop on opposite side  Weakness “Trendelenberg gait” – If weak right hip abductors, stand on right, left side drops
  29. 29. Reversal of Muscle Function (cont’d) A. In reversal of muscle function, the right hip abductors contract to keep the pelvis steady when the left leg is lifted. B. When right hip abductors are weak, the left side of the pelvis drops.
  30. 30. Tensor Fascia Latae   Short muscle Long tendinous attachment O: Anterior superior iliac spine I: Lateral condyle of tibia A: Combined hip flexion and abduction N: Superior gluteal nerve L4-L5
  31. 31. Force-Couple for anterior tilt
  32. 32. Compensation for tight hip flexors
  33. 33. Stabilizing role of abdominals
  34. 34. Poor stabilization of abdominals
  35. 35. Bilateral cooperation of adductors