Pelvis And Thigh 2

Quadriceps group

Rectus femoris

Vatus lateralis

Vastus medialis

Vastus intermedius

Qduariceps group

Action All: Extend the knee Rectus femoris: Flex the hip

Origin RF: ASIS VL: Lateral lip of linea aspera, gluteal

tuberosity VM: Medial lip of linea aspera VI: Anterior and lateral shaft of the femur

Insertion Tibial tuberosity

Innervation Femoral (L2-4)

Quadriceps as a group

Seated

Lay the flat of your hands on the ant. Surface of the thigh

Ask pt. to alternately extend and relax his knee slowly

Test for quadriceps femoris

• Patient:Patient: Sitting, with the knee over the side of the table and holding on to the table

• Fixation:Fixation: The examiner may put a hand under the distal end of the thigh to cushion that part against table pressure.

• Test:Test: Full extension of the knee joint, without rotation of the thigh

• Pressure:Pressure: Against the leg, above the ankle, in the direction of flexion

Rectus femoris

Supine with knee bolstered

Locate the AIIS and the patella

Draw imaginary line b/w these two point

Palpate along this line and strum across the rectus fibers

Rectus femoris

Ask pt. to flex his hip

and hold his foot up

off the table

Vastus medialis

Supine with the knee bolstered

Ask pt. to fully contract his quadriceps by extending knee

Palpate just medial and proximal to the patella

Locate the rectus and sartorius – “teardrop” shape

Vastus lateralis

Sidelying

Place the flat of your

hand on the lat. side

of the thigh while pt.

slowly extends and

relaxes his knees

Gluteal muscles

1. Gluteus maximus

2. Gluteus medius

3. Gluteus minimus

4. Tensor fasciae

latea

Gluteus maximus

Action All fibers: extend the hip,

laterally rotate the hip, abduct the hip

Lower fibers: adduct the hip

Origin Coccyx, edge of sacrum,

posterior illiac crest, sacrotuberous and sacroilliac ligaments

Insertion Gluteal tuberosity and

iliotibial tract

Innervation Inferior gluteal (L5-S2)

Gluteus maximus

Ask pt. to extend his hip

Palpate the bulging fibers that lead to the gluteal tuberosity

Gluteus maximus Prone

Locate coccyx, the edge of sacrum, PSIS and the post. 2 inches of the iliac crest

Locate the insertion of maximus at the gluteal tuberosity

Connect its origin to its insertion and then palpate

Gluteus medius

Action All fibers: abduct the hip Anterior fibers: flex the

hip, medially rotate the hip Posterior fibers: extend

the hip, laterally rotate the hip

Origin Gluteal surface of the ilium

b/w iliac crest and the post. and ant. gluteal lines

Insertion Greater trochanter

Innervation Superior gluteal (L4-S1)

Gluteus minimus

Action Abduct the hip, medially

rotate the hip, flex the hip

Origin Gluteal surface of the

ilium b/w the anterior and inferior gluteal lines

Insertion Ant. border of greater

trochanter


Gluteus medius and minimus

Sidelying

One hand along the iliac crest (PSIS~nearly ASIS) while other hand locates the greater trochanter

Pie-shaped outline of the gluteus medius

Sink your fingers deep to the gluteus medius lto explore the gluteus minimus

Adductor group

1. Obturator externus

2. Pectineus

3. Adductor longus

4. Adductor brevis

5. Adductor magnus

6. Adductor minimus

7. Gracilis

Obturator externus

Action Adduction and external

rotation of the hip joint Stabilizes the pelvis in the

sagittal plane

Origin Outer surface of the

obturator membrane and its bony boundaries

Insertion Trochanteric fossa of the

femur

Innervation Obturator nerve (L3-4)

Pectineus

Action Adduction, external

rotation, and slight flexion of hip joint

Origin Pecten pubis

Insertion Pectineal line and the

proximal linea aspera of the femur

Innervation Femoral, obturator nerve

(L2,3)

Pectineus Supine with the hip slightly

flexed and laterally rotated

Place hand on the middle of medial thigh

Ask pt. to adduct his hip slightly

Locate the prominent tendon of adductor longus or gracillis

Slide off laterally toward ASIS

Slowly sink into the belly of pectineus

Adductor longus

Action Adduction and flexion (up to

70°) of the hip joint (extends the hip past 80° of flexion)

Stabilize the pelvis in the coronal and sagittal plane

Origin Superior puic ramus and

anterior side of the symphysis

Insertion Linea aspera: mediallip in

the middle third of the femur


Adductor brevis

Action Adduction and flexion (up to

70°) of the hip joint (extends the hip past 80° of flexion)

Stabilize the pelvis in the coronal and sagittal plane

Origin Inrefior pubic ramus

Insertion Linea aspera: mediallipin

the upper third of the femur


Adductor magnus

Action Adduction, external rotation,

and extension of the hip joint

Origin Inferior pubic ramus, ischial

ramus, and ischial tuberosity

Insertion Deep part: Medial lip of

lenea aspera Superficial part: Medial

epicondyle of the femur

Innervation Deep part: Obturator (L2-4) Superficial part: Tibial

nerve (L4)

Adductor magnus Sidelying with top hip flexed

Begin by locating ischial tuberosity


Locate the prominent tendon of adductor longus or gracillis.

Slide off the tendon posteriorly

Palpate the wide tendon of adductor magnus as it stretches to the ischial tuberosity

Gracilis

Action Hip joint: Adduction and

flexion Knee joint: Flexion and

internal rotation

Origin Infrior pubic ramus below

the symphysis

Insertion Medial border of the tibial

tuberosity

Innervation Obturator nerve

Test for hip adductionrange of motion

Test 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.

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.

Sartorius

Action Flex, laterally rotate

and abduct the hip, flex the knee, medially rotate the flexed knee

Origin ASIS

Insertion Proximal, medial shaft

of the tibia at pes anserinus tendon

Innervation Femoral (L2,L3)

Sartorius

Supine

Ask pt. to position his foot resting his opposite knee

Place your hand along the middle of the medial thigh

Ask pt. to raise his knee toward the ceiling (contracting sartorius)

Test for sartorius

Test for sartorius

• Patient:Patient: Supine

• Test:Test: Lateral rotation, abduction, and flexion of the thigh, with flexion of the knee

• Pressure: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.

Adductor group

Supine with the hip

slightly flexed and

laterally rotated

Place your hand along

the med. thigh

Ask pt. to adduct his

hip against your

resistance

Gracillis and adductor longus

Supine with the hip slightly flexed and laterally rotated


Slide your fingers proximally to the pubic bone and locate the prominent tendons extending off of the pubic tubercle

Tensor fasciae latae

Action Tenses the fascia lata Hip joint: abduction,

felexion, internal rotation

Origin ASIS

Insertion Iliotibial track


Tensor fasciae latae

Supine

Locate ASIS

Place hand posterior and distal to the ASIS and iliac crest

Ask pt. to alternate medial rotation with relaxation of the hip

Upon medial rotation, TFL will contract into a solid, oval mound

Iliotibial tract• Sidelying

• Locate biceps femoris tendon just proximal to the back of the knee

• Slide anteriorly from the biceps femoris tendon to the lateral thigh

• Follow it distally as it disappears toward the tibial tubercle

Test for tensor fasciae latae & iliotibial track

Ober test The right leg is flexed to a right angle at the knee The right thigh is abducted widely then

hyperextended in the abducted position

Test for tensor fasciae latae & iliotibial track

Modified Ober test Knee extended

Piriformis

Action External rotation,

abduction, and extension of the hip joint

Origin Pelvic surface of the

sacrum

Insertion Apex of the greater

trochanter of the femur

Innervation Direct branches from the

sacral plexus (L5-S2)

Piriformis

Prone

Locate the coccyx,

PSIS and greater

trochanter. These

landmarks form a “T”.

Piriformis is located

along the base of the

“T”

Quadratus femoris

Action Laterally rotate the hip

Origin Lateral border of ischial

tuberosity

Insertion Intertrochanteric crest,

b/w the greater and lesser trochanters

Innervation Branch of sacral plexus

Quadratus femoris Prone

Locate the distal, posterior aspect of the greater trochanter and the ischial tuberosity

Place finger b/w these two landmarks

Pressing through the gluteus maximus fibers

Flex knee and ask pt. to laterally rotate his hip against your resistance

Test for lateral rotators

• Patient:Patient: Sitting on a table, with the knees bent over the side and the subject holding on to the table

• Test:Test: Lateral rotation of the thigh, with the leg in a position of completion of the inward arc of motion

• Pressure: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

Posterior thigh

1. Biceps femoris

2. Semimembranosu

s

3. Semitendinosus

4. Popliteus

Biceps femoris

Action Hip joint (long head): Extend

the hip, stabilize the pelvis in the sagittal plane

Knee joint(entire muscle): Flexion and external rotation

Origin Long head: Ihchial tuberosity,

sacrotuberous ligament (common head with semitendinosus)

Short head: Lateral lip of the linea aspera in the middle third of the femur

Insertion Head of fibula

Innervation Long head: Tibial nerve (L5-S2) Short head: Common fibular

nerve (L5-S2)

Semimembranosus

Action Hip joint: Extends the hip,

stbilize the pelvic in the sagittal plane

Knee joint: Flexion and internal rotation

Origin Ischial tuberosity

Insertion Medial tibial condyle,

oblique popliteal ligament, popliteus fascia

Innervation Tibial nerve (L5-S2)

Semitendinosus

Action Hip joint: Extends the hip,

stabilize the pelvis in the sagittal plane

Knee: Flexion and internal rotation

Origin Ischial tuberosity and

sacrotuberous ligament (comon head with long head of biceps femoris)

Insertion Medial to the tibial

tuberosity in the pes anserinus (along with the tendons of gracilis and sartorius)


Popliteus

Action Flexion and internal

rotation of the knee joint (stabilizes the knee)

Origin Lateral femoral condyle,

posterior horn of the lateral meniscus

Insertion Posterior tibial surface

(above the origin of soleus)


Hamstrings as a group

Prone

Ask pt. to flex his

knee, holding his

foot off the table

As the hamstrings

contract, explore

their mass and width

Hamstrings as a group

Locate ischial

tuberosity

Slide distally one

inch and strum

across the tendon of

hamstrings

Test for shortness of hamstring

• Normal hamstring length

• Excessive hamstring length

Test for shortness of hamstring

• Apparently short, actually normal

• Apparently normal, actually excessive

Test for semimembranosus and semitendinosus

Test for semimembranosus and semitendinosus

• Patient:Patient: Prone

• Fixation:Fixation: The examiner should hold the thigh down firmly on the table.

• Test:Test: Flexion of the knee between 50° and 70°, with the thigh in medial rotation and the leg medially rotated on the thigh

• Pressure:Pressure: Against the leg, proximal to the ankle, in the direction of knee extension. Do not apply pressure against the rotation compartment.

Tendons of the post. knee

Lateral tendons Prone

Ask pt. to flex and hold his knee at 45°

The most prominent tendons : biceps femoris

Move laterally 1 inch from biceps and palpate the iliotibial tract

Medial tendons Supine

Palpate thin, prominent semitendinosus tendon

Slide off anteriorly and palpate

gracillis tendon

Situated anterior to gracillis : sartorius

Follow the three tendons distally as they blend together to become the pes anserinus tendon

Psoas major

Action Hip joint: Flexion and external

rotation Lumbar spine: Unilateral

contraction bends the trunk laterally to the same side,bilateral contraction raises the trunk from the supine position

Origin Bodies and transverse processes

of lumbar vertebraeInsertion

Common insertion on the lesser trochanter of the femur as the iliopsoas

Innervation Direct branches from the lumbar

plexus (L1-3)

Psoas major Supine with hip

slightly flexed and laterally rotated

Locate the navel and ASIS, placing your fingerpads hand-on-hand b/w these point

Slowly compress into abdomen

Ask pt. to flex hip slighlty

Psoas major

Sidelying with hip

flexed: less invasive

position

Iliacus

Action Hip joint: Flexion and

external rotation Lumbar spine: Unilateral

contraction bends the trunk laterally to the same side,bilateral contraction raises the trunk from the supine position

Origin Iliac fossa

Insertion Common insertion on the

lesser trochanter of the femur as the iliopsoas

Innervation Femoral nerve

Iliacus Supine with hip slightly

flexed and laterally rotated

Located anterior portion of iliac crest

Place your finger pads an inch medial to its ridge

Slowly curl your fingers into the iliac fossa

Ask pt. to flex his hip slightly and feel the contraction

Iliacus

Test for iliopsoas

Test for iliopsoas

• Patient:Patient: Supine

• Fixation:Fixation: The examiner stabilizes the opposite iliac crest.

• Test:Test: Hip flexion in a position of slight abduction and slight lateral rotation.

• Pressure: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

Other structures of the pelvis and thigh

Sacrotuberous ligament Post. Sacroiliac ligaments


Iliolumbar ligament Prone

Locate PSIS

Slide thumb straight superior from the PSIS to the level of L4 and L5


Trochanteric bursa Post/lat aspect of

greater trochanter

Reduce friction b/w trochanter and gluteus maximus

Normally impalpable

Technology

Pelvis And Thigh 2