Gluteus maximus
insert?
supply nerve roots
actions
EXAM
insert -> gluteal tuberosity of femur
nerve supply L5 S1 S2
inferior gluteal nerve
action: external rotation and extension of hip
what nerve supplies tensor fascia lata
superior gluteal nerve
Gluteus medius insert
action
clinical sign
type of gait
EXAM
insert: lateral surface of the greater trochanter. Gluteus minimus inserts deep to that
Action: during standing - hip abductor
during gait with gluteus minimus it supports the body whilst one leg is in the air preventing pelvis dropping to the opposite side
trendelenberg gait
superior gluteal nerve
causes of trendelenberg gait EXAM
weak abductor muscles
avulsion of tendon
L5 radiculopathy
DDH congential coxa vara coxa valga
superior gluteal nerve injury
myopathy
iliopsoas muscle
origin - iliacus and psoas major
insertion: lesser trochaneter
main flexor of the hip
Where does the psoas major originate?
The deep part of psoas major originates from the transverse processes of L1-L4. The superficial part originates from the
lateral surfaces of T12-L4 and the intervening vertebral discs.
What is the action of psoas major?
Psoas major flexes and externally rotates the hip
Quadratus femoris
origin lateral border of the upper part of ischial tuberosity
insertion quadrate line of femus
quadratus femoris L5-S1
which muscle in pubic tunercle
ligament
nerve entrapped
adductor magnus
inguinal ligament
lateral cutansoue nerve of
meralgia paraesthetica
muscles attached to greater trochanter
P GOGP
Piriformis
Gluteus medius and minumus
Obtruator internus
Gemeli
Obtruator internus
where does the iliotibial tract attach
what muscles insert onto it
Clinical significance
The Iliotibial tract is attached to the anterolateral iliac tubercle of the iliac crest proximally and the lateral condyle of the
tibia distally.
What muscles insert onto it?
* Gluteus maximus
* Tensor fasciae lata
What is its clinical significance?
* The iliotibial tract stabilizes the knee in extension and in partial flexion. It is important in walking and
running
* During standing: pelvic stabilisation & posture control especially during asymmetrical standing by
performing knee hyperextension & locking & converting the limb into a rigid supportive pillar
* Hip flexion, extension, abduction, lateral rotation, medial rotation (through the actions of gluteus
maximus and tensor fasciae latae).
sciatic nerve
What is the variation
Surface marking
which vessles exit the greater sciatic foramen from above
L4-S3
In the majority of cases the sciatic nerve exits beneath the piriformis. Alternatively, either the whole nerve may pass
through piriformis, or it may divide high with one division passing through or around the piriformis
curved line drawn from 2 points: halfway between the posterior superior iliac
spine to the ischial tuberosity to halfway between the ischial tuberosity and the greater trochanter.
The superior gluteal vessels and nerve exit above piriformis.
bloody supply to the head of the femur
The majority of the blood supply to the
head of the femur is from retinacular
arteries, which arise as ascending cervical
branches from the extracapsular arterial
anastomosis. This is formed posteriorly by
the medial femoral circumflex artery and
anteriorly from branches of the lateral
femoral circumflex artery with minor
contributions from the superior and
inferior gluteal arteries from iliac.
There is also supply from the artery of the
ligamentum teres, also known as the artery
of the round ligament of
the femoral head (a branch of the
obturator artery).
Quadriceps job
Hamstrings
biceps short head peroneal
origin of biceps short head is lateral linea aspera
hamstrings actions of all 3
biceps actions
semitendinosus and semimebransaus
All three muscles:
Flexion of the leg at the knee joint.
Extension of thigh at the hip.
Biceps
Lateral rotation of the hip and knee
Semitendinosus and Semimembranosus
Medially rotates the thigh at the hip joint
and the leg at the knee joint.
Structures at risk in supracondylar fracture of the femur
superfiical to deep
most superficial is tibial nerve
* Popliteal vein
* Popliteal artery
lateral to medial
common peroneal
tibial nerve
* Popliteal vein
* Popliteal artery
boudnaries of the popliteal fossa
Laterally Biceps femoris above, lateral head of gastrocnemius and plantaris below
Medially Semimembranosus and semitendinosus above, medial head of gastrocnemius below
Floor Popliteal surface of the femur, posterior ligament of knee joint and popliteus muscle
Roof Superficial and deep fascia
Differential diagnosis of lump from popliteal fossa?
- Backer’s cyst
- Popliteal artery aneurysm
- Lipoma
- Schwannoma
- Popliteal vein varicosities
Boundaries of femoral triangle
contents
Superiorly - nguinal ligament
Laterally- Sartorius
Medially - Adductor longus
Floor - Iliopsoas, pectineus and adductor longus
Roof * Fascia lata and Superficial fascia
- Superficial inguinal lymph nodes (palpable below the inguinal ligament)
- Long saphenous vein
Contents
* Femoral vein (medial to lateral)
* Femoral artery-pulse palpated at the mid
inguinal point
* Femoral nerve
* Deep and superficial inguinal lymph nodes
* Lateral cutaneous nerve
* Great saphenous vein
* Femoral branch of the genitofemoral nerve
femoral artery surface landmark
mid inguinal point
adductor canal
boundaries
contents
Hunter’s canal, also known as the subsartorial or adductor canal, runs from the apex of the femoral triangle to the
popliteal fossa.
Laterally Vastus medialis muscle
Posteriorly Adductor longus, adductor magnus
Roof Sartorius
CONTENTS
Saphenous nerve
Superficial femoral artery
Superficial femoral vein
(posterior to the artery in the upper part then posterolateral)
Nerve to vastus medialis
location of femoral head
located 2–4 cm above the midpoint of
the greater trochanter to pubic tubercle line;
What is the surface marking of the adductor hiatus?
The adductor hiatus lies 2⁄3 along the line between the ASIS and the adductor tubercle of the femur.
Contents of lacuna vasorum?
(order from medial part)
* Deep inguinal lymph nodes
* Femoral vein,
* Femoral artery
* Femoral branch of the
genitofemoral nerve
Posterior compartment of leg nerve supply and muscles
The tibial nerve supplies the posterior compartments of the leg (deep and superficial)
- Superficial (GPS): Gastrocnemius, plantaris, soleus
- Deep (Pfft): Popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
