Muscles of the Hip Joint: Origin, Insertion, Action

Created by rqueale960 

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Iliacus

Proximal Attachment
This large triangular muscle arises from the upper two-thirds of the concavity of the iliac fossa and the inner lip of the iliac crest, as well as the ventral sacro-iliac and iliolumbar ligaments and the upper surface of the lateral part of the sacrum.

Distal Attachment
The fibers converge as they pass downwards and medially behind the inguinal ligament. The majority of fibers insert onto the lateral side of the tendon of psoas major to form the 'conjoined tendon of psoas major and iliacus'. Some fibers insert onto the lesser trochanter of the femur, below the insertion of the conjoined tendon.

Nerve Supply
Branches of the femoral nerve, derived from L2 and 3, supply iliacus.

Action
Through their conjoined tendon, psoas major and iliacus flex and medially and laterally rotate the hip joint.

Psoas Major

Proximal Attachment
Psoas major arises by a series of slips, each of which arise from the adjacent margins of the vertebral bodies and the intervening discs from the lower border of T12 to the upper border of L5. Some fibers arise from tendinous arches over the lateral side of the bodies of L1 to L4, and from the anterior surface of the lumbar transverse processes. Lumbar arteries, veins and branches of the sympathetic trunk pass around the vertebral bodies deep to the tendinous arches from which the psoas major arises.

Distal Attachment
The muscle descends along the pelvic brim, passing behind the inguinal ligament and in front of the capsule of the hip joint. It ends with a tendinous attachment to the lesser trochanter of the femur. The fibers of the iliacus muscle are inserted into the lateral side of the psoas tendon as this descends along the pelvic brim and for this reason it is referred to as the 'conjoint tendon of psoas major and iliacus'. The tendon is separated from the pubis and the hip joint by a large subtendinous iliac bursa, which may communicate with the hip joint cavity.

Nerve Supply
A muscular branch of the lumbar plexus, derived from ventral rami of L1, 2, and 3 supplies psoas major.

Action
Through their conjoined tendon, psoas major and iliacus, flex and medially and laterally rotate the hip joint.

Rectus Femoris

Proximal Attachments
The straight head (straight tendon) arises from the anterior inferior iliac spine; the reflected head (reflected tendon) arises from a groove on the upper surface of the acetabulum and from the fibrous capsule of the hip joint. The two tendons of origin give rise to muscle fibers, which fuse to form a spindle-shaped muscle.

Distal Attachment
Distally, a thick tendon develops from the muscle and joins the quadriceps femoris tendon, through which it attaches to the upper border of the patella.

Nerve Supply
Usually, a separate branch from the posterior division of the femoral nerve innervates each head of rectus femoris.

Action
Rectus femoris assists to flex the hip joint, and together with the other muscles that make up quadriceps femoris extends the leg

Sartorius

Proximal Attachment
It arises from the anterior superior iliac spine of the hip bone and from the notch immediately below.

Distal Attachment
From this origin it runs infero-medially and attaches by an aponeurosis to the upper part of the medial surface of the tibial shaft in front of the tendons of gracilis and semitendinosus.

Pes anserinus is a commonly used expression (though not one that is officially recognized in anatomical nomenclature) for the partly joined flattened tendons of the insertion of sartorius, gracilis and semitendinosus. These tendons are inserted onto the medial surface of the upper part of the tibia. The fancied resemblance of this arrangement to a goose's foot is the reason for the name! Within this arrangement, the tendons of gracilis and semitendinosus are relatively thick, strong and cord-like, whereas the sartorius tendon is almost fascial in its appearance.

Nerve Supply
The anterior division of the femoral nerve, derived from L2 and 3, innervates sartorius.

Action
Sartorius is a weak flexor, lateral rotator and assists in abduction of the hip joint. It also flexes the knee and medially rotates the leg when the knee is flexed.

Pectineus

Proximal Attachment
Pectineus arises from the pecten pubis, the bone anterior to this and in between the pubic tubercle and iliopubic eminence.

Distal Attachment
The muscle passes downwards, backwards and laterally, to attach along the line in between the lesser trochanter and the linea aspera.

Nerve Supply
The femoral nerve, derived from L2 and L3, and when present the accessory obturator nerve, derived from L3, supplies pectineus.

Action
Pectineus adducts and flexes the hip joint.

Adductor Brevis

Proximal Attachment
Adductor brevis is a triangular muscle, which arises between gracilis inferiorly and obturator externus superiorly, from a linear attachment from the femoral aspect of the body and inferior ramus of the pubic bone.

Distal Attachment
It passes downwards and laterally to insert into the upper half of the linea aspera and to the lower two-thirds of the line between the lesser trochanter and linear aspera, behind pectineus and adductor longus.

Nerve Supply
Adductor brevis is supplied by the anterior division (sometimes the posterior division) of the obturator nerve, derived from the ventral rami of L2, 3 and 4.

Action
Adductor brevis adducts the hip Joint.

Adductor Longus

Adductor longus is a triangular muscle and is the most anterior of the three adductor muscles, lying in the same plane as pectineus.

Proximal Attachment
It arises from a narrow tendon from the femoral surface of the body of the pubis, between the crest and symphysis.

Distal Attachment
The muscle belly expands as it passes downwards and laterally to insert via an aponeurosis into the medial lip of the linear aspera, with adductors brevis and magnus posteriorly and vastus medialis anteriorly. These muscles may merge with each other.

Nerve Supply
Adductor longus is supplied by the anterior division of the obturator nerve, derived from the ventral rami of L2, 3 and 4.

Action
Adductor longus adducts and medially rotates the hip Joint, it also assists to flex the extended hip joint.

Adductor Magnus

Adductor magnus is a large fan-shaped muscle, with short horizontal, oblique and vertical fibers. The horizontal fibers are often known as 'adductor minimus'.

Proximal Attachment
Proximally, adductor magnus has a continuous curvilinear attachment onto the lateral surface of the conjoined ischiopubic ramus and the infero-lateral aspect of the ischial tuberosity.

Distal Attachment
From this origin the muscle fans out to be inserted in continuity to the gluteal tuberosity (medial to the insertion of gluteus maximus) and via a broad aponeurosis to the linea aspera (deep to adductors brevis and longus), and the medial supracondylar line down to and including the adductor tubercle. At intervals along the length of this aponeurotic insertion are a number of tendinous arches. These arches produce openings through which the perforating branches of arteria profundus femoris, the termination of arteria profundus femoris and the femoral artery and veins travel. The upper three or four openings are small, transmitting the terminal and perforating branches of arteria profundus femoris (Slide 1 and Slide 2). The lowest and largest opening, known as the 'adductor hiatus' allows the femoral vessels to pass from the front of the thigh into the popliteal fossa.

Nerve Supply
Adductor magnus has a dual innervation from the posterior branch of the obturator nerve and the tibial component of the sciatic nerve.

Action
Adductor magnus adducts, extends and medially rotates the hip joint.

Gracilis

Proximal Attachment
Gracilis arises from the anterior surface of the body of the pubis and from the adjacent inferior pubic ramus. It descends along the medial aspect of the thigh to reach its distal attachment on the tibia.

Distal Attachment
Its distal attachment is to the upper part of the medial surface of the tibial shaft, posterior to the insertion of sartorius but in front of the tendon of insertion of semitendinosus.

Pes anserinus is a commonly used expression (though not one that is officially recognized in anatomical nomenclature) for the partly joined flattened tendons of the insertion of sartorius, gracilis and semitendinosus. These tendons are inserted onto the medial surface of the upper part of the tibia. The fancied resemblance of this arrangement to a goose's foot is the reason for the name! Within this arrangement, the tendons of gracilis and semitendinosus are relatively thick, strong and cord-like, whereas the sartorius tendon is almost fascial in its appearance.

Nerve Supply
Gracilis occupies the superficial part of the adductor compartment of the thigh, and is innervated by the anterior division of the obturator nerve. This is derived from the ventral rami of L2 and 3.

Action
Gracilis flexes the knee joint, medially rotates the leg when the knee is flexed and is a weak adductor of the thigh.

Semitendinosus

Semitendinosus, as its name suggests, has a long tendon.

Proximal Attachment
Semitendinosus arises from the supero-medial part of the ischial tuberosity of the hip bone, in common with the tendon of origin of the long head of the biceps femoris muscle. From this origin, the semitendinosus muscle runs obliquely, infero-medially behind semimembranosus. Approximately halfway down the thigh, the semitendinosus muscle gives rise to a strong, rounded tendon.

Distal Attachment
In the lower part of the thigh, semitendinosus and semimembranosus together form the upper medial boundary of the popliteal fossa. Distally, semitendinosus is attached to the upper part of the medial surface of the tibial shaft postero-inferior to the insertion of sartorius and gracilis.

Pes anserinus is a commonly used expression (though not one that is officially recognized in anatomical nomenclature) for the partly joined flattened tendons of the insertion of sartorius, gracilis and semitendinosus. These tendons are inserted onto the medial surface of the upper part of the tibia. The fancied resemblance of this arrangement to a goose's foot is the reason for the name! Within this arrangement, the tendons of gracilis and semitendinosus are relatively thick, strong and cord-like, whereas the sartorius tendon is almost fascial in its appearance.

Nerve Supply
Semitendinosus is innervated by the tibial component of the sciatic nerve, derived from L5, S1 and 2.

Action
As it is a hamstring muscle, its action is to assist in flexion of the knee and extension of the hip joint. It also medially rotates the hip joint when the hip is extended and medially rotates the lower leg when the knee is semi-flexed.

Semimembranosus

Semimembranosus is a muscle of the posterior (hamstring) compartment of the thigh, and occupies the postero-medial part of the thigh. Semimembranosus arises from a strong membranous tendon, which gives the muscle its name.

Proximal Attachment
Proximally, semimembranosus arises from the supero-lateral aspect of the ischial tuberosity by a long and flattened tendon. The tendon arises from the upper lateral facet of the ischial tuberosity and continues along the lateral margin of the muscle. The fleshy muscle belly lies medial and deep to the tendon and muscle of semitendinosus and the long head of biceps femoris muscles.

Distal Attachment
It passes downwards and medially, with the semitendinosus tendon grooving its superficial surface. It ends at the back of the knee at a tendon, which inserts into the horizontal groove at the posterior medial corner of the medial tibial condyle. Semimembranosus is attached principally to the posterior surface of the medial tibial condyle. From this insertion several expansions from the tendon pass in different directions. One of the expansions (oblique popliteal ligament) runs supero-laterally behind the knee joint reinforcing the joint capsule. Another prominent expansion passes downwards and laterally to cover the popliteus muscle. This is called the 'popliteus fascia'. A further expansion runs antero-medially along the medial aspect of the knee and partially blends with the capsule of the knee joint.

Nerve Supply
Semimembranosus is innervated by the tibial component of the sciatic nerve, derived from L5, S1 and 2.

Action
In common with the other hamstring muscles, the action of semimembranosus is to flex the knee joint and to assist in extending the hip joint. It also medially rotates the hip joint when the hip is extended and medially rotates the lower leg when the knee is semi-flexed.

Biceps Femoris

Biceps femoris is a muscle of the posterior (hamstring) compartment of the thigh, and lies in the postero-lateral part of the thigh. Biceps femoris arises proximally by two 'heads' - termed the 'long head' and 'short head'.

Proximal Attachment
The long head of biceps femoris arises in common with the tendon of origin of semitendinosus from the supero-medial part of the ischial tuberosity. The short head has a continuous origin from the lateral lip of the linea aspera on the posterior surface of the femoral shaft, the upper half of the lateral supracondylar line and from the lateral intermuscular septum.

Distal Attachment
Distally, the two muscular heads fuse and give rise to a tendon, which inserts principally onto the lateral surface of the fibular head. Extensions from the tendon gain attachment to the lower end of the iliotibial tract and to the lateral tibial condyle.

Nerve Supply
The two heads of biceps femoris are innervated separately by the sciatic nerve; the long head of biceps femoris is supplied by the tibial component, and the short head by the common peroneal component.

Action
In common with the other hamstring muscles, the action of biceps femoris is to flex the knee joint and to assist in extending the hip joint. It also laterally rotates the hip joint when the hip is extended and laterally rotates the lower leg when the knee is semi-flexed.

Gluteus Maximus

Gluteus maximus is a large, coarsely fibered, quadrilateral mass of muscle, which forms the prominence of the buttock and covers the ischial tuberosity.

Proximal Attachment
It arises from the iliac wing behind the posterior gluteal line, including the iliac crest, from the posterior layer of thoracolumbar fascia, the posterior surfaces of the sacrum, coccyx, and sacrotuberous ligament and from the fascia covering gluteus medius (the gluteal aponeurosis).

Distal Attachment
The fibers descend downwards and laterally. The deeper fibers of the lower part of the muscle are inserted into the gluteal tuberosity. The superficial fibers and the upper deep part of the muscle end in a tendinous sheet, which passes lateral to the greater trochanter and is attached to the iliotibial tract of the fascia lata.

The iliotibial tract runs down the anterior lateral side of the thigh. It blends with the capsule of the knee joint to attach to Gerdy's tubercle, the lateral condyle of the tibia and the head of the fibula.

Nerve Supply
The inferior gluteal nerve derived from the ventral rami of L5, S1 and S2, supplies the gluteus maximus muscle.

Action
Gluteus maximus extends (movie 1, movie 2), laterally rotates and assists in abduction of the hip joint. Through its attachment to the iliotibial tract it stabilizes the knee joint when the extensors are relaxed.

Gluteus Medius

Gluteus medius lies between gluteus maximus posteriorly and tensor fasciae latae anteriorly. Much of the muscle is covered by gluteus maximus.

Proximal Attachment
This fan-shaped muscle arises from the outer surface of ilium between the posterior and anterior gluteal lines.

Distal Attachment
The muscle converges to form a tendon, which is attached to the oblique ridge sloping downwards and forwards on the lateral surface of the greater trochanter. There is a bursa between the tendon and the upper lateral surface of the trochanter. The posterior border of gluteus medius may blend with piriformis.

Nerve Supply
By a branch from superior gluteal nerve (L4, 5, S1).

Action
Together with gluteus minimus it abducts and medially rotates the hip joint. Gluteus medius and minimus are fundamental in keeping the trunk in an upright position when the contra-lateral foot is raised during walking.

Gluteus minimus

Gluteus minimus is the smallest of the gluteal muscles and lies antero-inferiorly, deep to gluteus medius.

Proximal Attachment
Gluteus minimus arises from the outer surface of the ilium between the anterior and the inferior gluteal lines.

Distal Attachment
It inserts onto the antero-superior angle of the greater trochanter, from which it may be separated by a bursa.

Nerve Supply
By a branch from the superior gluteal nerve (L4, 5, S1).

Action
Together with gluteus medius, it abducts and medially rotates the hip joint. Gluteus minimus and medius are fundamental in keeping the trunk in an upright position when the contra-lateral foot is raised during walking.

Tensor Fasciae Latae

Proximal Attachment
Tensor fasciae latae arises from the anterior part of the outer lip of the iliac crest, the lateral aspect of the anterior superior iliac spine and the upper part of the anterior border of the iliac wing.

Distal Attachment
It descends between, and is attached to the two layers of the iliotibial tract, generally ending around mid-thigh.

Nerve Supply
By a branch from the superior gluteal nerve (L4, 5).

Action
Tensor fasciae latae acts through the iliotibial tract by pulling it superiorly and anteriorly. It assists in the flexion, abduction and medial rotation of the hip joint and extension of the knee joint. Through these actions, tensor fasciae latae aids in the stabilization of the pelvis on the head of the femur and of the condyles of the femur on the tibial condyles.

Piriformis

Proximal Attachment
Piriformis arises from the anterior aspect of the second to the fourth segments of the sacrum, between and lateral to the sacral foramina. As the muscle leaves the pelvis, some slips arise from the margin of the greater sciatic notch as well as from the pelvic surface of sacrotuberous ligament.

Distal Attachment
The muscle passes out of the pelvis through the greater sciatic foramen. Its rounded tendon is attached to the upper border and medial aspect of the greater trochanter, close to the insertion of the obturator internus and the gemelli, with which it may be partially merged. It may also merge with the gluteus medius.

Nerve Supply
It is supplied by the nerve to piriformis derived from the ventral rami of L5, S1 and S2. If the common peroneal nerve leaves the pelvis separately, it may pierce the piriformis muscle, whose anterior surface is intimately related to the sacral plexus.

The anterior surface of the piriformis is related to the rectum, the sacral plexus and branches of the internal iliac vessels. Outside the pelvis, the anterior surface is in contact with the posterior surface of the ischium and the capsular hip joint. Sciatic, posterior femoral cutaneous and pudendal nerves, inferior gluteal and internal pudendal vessels and muscular branches from the sacral plexus, lie in the interval between piriformis and the superior gemellus/obturator internus.

Action
Piriformis laterally rotates the extended hip joint and abducts the flexed hip joint.

Gemellus Superior

The superior and inferior gemelli arise from the superior and inferior margins of the lesser sciatic notch on either side of the obturator internus tendon with which they blend. The superior gemellus muscle is sometimes absent and is the smaller of the two gemelli.

Proximal Attachment
It arises from the gluteal surface of the ischial spine.

Distal Attachment
It blends with the upper part of the tendon of obturator internus, and is attached to the medial surface of the greater trochanter.

Nerve Supply
The nerve to obturator internus, derived from the ventral rami of L5 and S1, supplies the superior gemellus.

Action
The gemelli together with the tendon of obturator internus laterally rotates the extended hip joint and abducts the flexed hip joint.

Gemellus Inferior

The superior and inferior gemelli arise from the superior and inferior margins of the lesser sciatic notch on either side of the obturator internus tendon. The inferior gemellus muscle is the larger of the two gemelli.

Proximal Attachment
It arises from the upper part of the ischial tuberosity, immediately below the groove for obturator internus tendon.

Distal Attachment
It blends with the lower part of the tendon of obturator internus, and is attached to the medial surface of the greater trochanter.

Nerve Supply
The nerve to quadratus femoris, derived from the ventral rami of L5 and S1, supplies the inferior gemellus.

Action
The gemelli together with the tendon of obturator internus laterally rotates the extended hip joint and abducts the flexed hip joint.

Obturator Internus

Proximal Attachment
Obturator internus arises as a large fan-shaped muscle from the; pelvic margins of the obturator foramen, from the medial two-thirds of the obturator membrane that fills it and from the antero-lateral pelvic surface of the hip bone. The muscle fibers converge, passing backwards, towards a groove on the lesser sciatic foramen. Here its fibers make a right-angled turn, inferior to the ischial spine, to leave the pelvis. The groove is covered by hyaline cartilage, which is separated from the tendon of obturator internus by a bursa termed the 'sciatic bursa of obturator internus'.

Distal Attachment
The tendon of obturator internus then passes horizontally across the posterior aspect of the hip joint capsule to insert, with the gemelli, into an impression on the medial surface of the greater trochanter. Usually a long thin bursa separates the tendon from the hip joint capsule often communicating with the sciatic bursa of obturator internus.

Nerve Supply
Obturator internus is supplied by the nerve to obturator internus, which is derived from the ventral rami of L5, S1 and S2.

Action
Due to the inaccessibility of obturator externus in humans, no direct studies have been carried out on its actions. However, its attachment points suggest that it laterally rotates the extended hip joint and abducts the flexed hip joint.

Obturator Externus

Proximal Attachment
This flat triangular muscle arises from the outer margins of the obturator foramen and from the medial two-thirds of the obturator membrane that fills it. The obturator vessels lie between the muscle and the obturator membrane. The anterior branch of obturator nerve enters the thigh by passing in front of the muscle, with the posterior branch piercing it.

Distal Attachment
The muscle fibers converge, passing backwards, laterally and upwards on the undersurface of the femoral neck and hip joint capsule, to insert into the trochanteric fossa at the medial aspect of the greater trochanter. There may be a bursa lying between the hip joint capsule, femoral neck and the obturator externus tendon. It may communicate with the hip joint.

Nerve Supply
The posterior branch of the obturator nerve, derived from L3 and 4, supplies obturator externus.

Action
Due to the inaccessibility of obturator externus in humans, no direct studies have been carried out on its actions. However, its attachment points suggest that it laterally rotates the extended hip joint and abducts the flexed hip joint.

Quadratus Femoris

Quadratus femoris lies posterior to the hip joint and femoral neck, separated from them by the tendon of obturator externus and the transverse branch of the medial circumflex femoral artery. There is often a bursa between the anterior aspect of the muscle and the lesser trochanter.

Proximal Attachment
Quadratus femoris is a flat quadrilateral muscle, which arises from the superior lateral margin of the ischial tuberosity.

Distal Attachment

It inserts into the quadrate tubercle situated at the mid-point of the intertrochanteric crest of the femur and to the bone immediately below it.

Nerve Supply

The nerve to quadratus femoris, which is derived from L5 and S1, supplies the quadratus femoris muscle.

Action

Quadratus femoris laterally rotates and adducts the hip joint.

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