Pelvis And Thigh 2

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  • 1. Quadriceps group
    • Rectus femoris
  • Vatus lateralis
  • Vastus medialis
  • Vastus intermedius

2. 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)

3. 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

4. Test for quadriceps femoris

  • Patient:Sitting, with the knee over the side of the table and holding on to the table
  • Fixation:The examiner may put a hand under the distal end of the thigh to cushion that part against table pressure.
  • Test:Full extension of the knee joint, without rotation of the thigh
  • Pressure:Against the leg, above the ankle, in the direction of flexion

5. Rectus femoris

    • Supine with knee bolstered
    • Locate theAIISand thepatella
    • Draw imaginary line b/w these two point
    • Palpate along this line and strum across the rectus fibers

6. Rectus femoris

    • Ask pt. to flex his hip and hold his foot up off the table

7. 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

8. Vastus lateralis

    • Sidelying
    • Place the flat of your hand on the lat. side of the thigh while pt. slowly extends and relaxes his knees

9. Gluteal muscles

  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
  • Tensor fasciae latea

10. 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)

11. Gluteus maximus

    • Ask pt. to extend his hip
    • Palpate the bulging fibers that lead to the gluteal tuberosity

12. Gluteus maximus

    • Prone
    • Locatecoccyx ,the edge of sacrum,PSISand the post. 2 inches of theiliac crest
    • Locate the insertion of maximus at thegluteal tuberosity
    • Connect its origin to its insertion and then palpate

13. 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)

14. 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
  • Innervation
    • Superior gluteal (L4-S1)

15. Gluteus medius and minimus

    • Sidelying
    • One hand along theiliac crest(PSIS~nearly ASIS) while other hand locates thegreater trochanter
    • Pie-shaped outline of the gluteus medius
    • Sink your fingers deep to the gluteus medius lto explore the gluteus minimus

16. Adductor group

  • Obturator externus
  • Pectineus
  • Adductor longus
  • Adductor brevis
  • Adductor magnus
  • Adductor minimus
  • Gracilis

17. 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)

18. 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)

19. 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

20. 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
  • Innervation
    • Obturator nerve (L2-4)

21. 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
  • Innervation
    • Obturator nerve (L2-4)

22. 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)

23. Adductor magnus

    • Sidelying with top hip flexed
    • Begin by locating ischial tuberosity
    • Ask pt. to adduct his hip slightly
    • 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

24. Gracilis

  • Action
    • Hip joint:Adduction and flexion
    • Knee joint:Flexion and internal rotation
  • Origin
    • Infrior pubic ramus below the symphysis