PT 1011: Osteology and Gluteal Region

OSTEOLOGY OF THE LOWER EXTREMITY Posterior inferior iliac spine (PIIS)

BONES OF THE GLUTEAL REGION • located below the posterior superior iliac
spine
HIP BONES (Os Coxae)
Greater sciatic notch
• Not the hip
joint • Above and behind the acetabulum
• Ilium, ischium, • Shared by the ilium and ischial
and pubis form the • L4 - Where anesthesia is given; landmark
hip bone below cord
o Equivalent of o if given above L1, it will cause
clavicle and scapula; paralysis
forms lower limb
girdle; form
anterolateral wall of
pelvis
• Acetabulum – meeting point of the three
bones
o Hip joint: acetabulum and head of
femur
o Triradiate cartilage (Y-shaped)
▪ iliofemoral
• Articulates with the sacrum, posteriorly at
the sacroiliac joint and anteriorly, at the
symphysis pubis
o Pelvis is formed by the sacrum and 2
hip bones
ILIUM

• Largest bone in the hip

Iliac crest
• Gluteal lines at the ala
• upper flattened portion of the ilium
• highest point Ala
• located approximately at L4
• it ends in front at the anterior superior iliac
spine (ASIS)
• and behind at the posterior superior iliac
spine (PSIS)
o at the level S2
o seen as dimple (for ectomorphs)
Iliac tubercle

• lies 2 inches behind ASIS (portion felt

anteriorly)
Anterior inferior iliac spine (AIIS)

• below the anterior superior iliac spine; level

of L4
PT 1011: Osteology and Gluteal Region

Gluteal lines Ischial ramus

• For origins of gluteal muscles • point of connection with inferior ramus of

• Inferior pubis
• Anterior • connects the tuberosity of the ischium to the
• Posterior ramus
• lower thinner part
ISCHIUM
Ischial tuberosity

• Forms the posterior aspect of the lower part

of the body of the bone
Greater and lesser sciatic notches are converted
into greater and lesser sciatic foramina by the
presence of the sacrospinous and sacrotuberous
ligaments

• The ligaments are from the ischial spine

• Greater notch at the level of ilium
• Becomes a foramen when there are
ligaments attached to it
PUBIS

Ischial tuberosity

• site for attachment of hamstring muscles

• Felt during sitting tall
o sit bone
• Large, roughened area that forms the
posterior aspect of the lower part of the body
of the bone.
Ischial spine

• Projects from the posterior border and

intervenes between the greater and lesser
sciatic notches
• Site for ligament attachment, used for
measurement site for pelvic opening.
• too pointed, narrow opening for delivery of
baby • The pubis can be divided into a body, a
• divides the two notches in the hip: greater superior ramus and an inferior ramus
and lesser sciatic notch • Bodies of the two pubic bones articulate with
Obturator foramen each other in the midline anteriorly at the
symphysis pubis
• “hole” or opening for nerves/blood vessels o Cartilaginous joint
o Obturator nerve, artery and vein
Superior ramus
• Formed by ischium and pubis
• joins the ilium and ischium at the acetabulum
PT 1011: Osteology and Gluteal Region

Inferior ramus o < 2/5 is the ilium (upper boundary)

o and the rest is pubis (1/5; midline)
• joins the ischial ramus below the obturator
• this is where the head of the femur articulates
foramen
Acetabular notch
Obturator foramen
• inferior margin
• filled in by obturator membrane
• circular non-articular depression of the
Pubic crest acetabular fossa
• covered by a ligament and artery pass
• forms the upper border of the body of the through
pubis
• ends laterally at the pubic tubercle Acetabular fossa

• Horseshoe shaped
• articulation of femoral head
SACRUM

ACETABULUM

• The sacrum consists of five rudimentary

vertebrae fused together
• The upper border or base of the bone
articulates with the fifth lumbar vertebra and
inferior border with the first coccyx
• Laterally articulates with the two iliac bones
at the sacroiliac joints
o plane joint; gliding
o Symphysis pubis
▪ Cartilaginous; between pubis
Sacral promontory

• S1
• Outer surface, deep depression • anterior and upper margins of the first sacral
• where the three hip bones come together vertebra that forward (becomes the posterior
• Contributing a little margin of the pelvic inlet)
o > 2/5 is the ischium (lower and side)
PT 1011: Osteology and Gluteal Region

Sacral canal • tail bone

• Consists of four vertebrae fused together
• formed by the vertebral foramina together
to form a small triangular bone, which
• contains the following:
articulates at its base with the lower end of
o anterior and posterior roots of the
the sacrum
lumbar, sacral, coccygeal spinal
• The coccygeal vertebrae consist of bodies
nerves
only, but the first vertebra possesses a
o filum terminale
rudimentary transverse process and
o fibrofatty material and subarachnoid
cornua.
space reach up to lower border of 2nd
• The cornua are the remains of the pedicles
sacral vertebra
and superior articular processes and
Sacral hiatus project upward to articulate with the sacral
cornua
• part in which it is not entirely closed
• laminae of the 5th sacral vertebra, and
sometimes those of the 4th, fail to meet in the
midline

BONES OF THE THIGH AND LEG REGION

FEMUR

• Longest and strongest bone of the body

PROXIMAL THIRD

• The upper end of the femur has a head, a

neck, and greater and lesser trochanters
• Anterior: rough
• Posterior: there is a cleft

COCCYX
PT 1011: Osteology and Gluteal Region

Head

• forms about two thirds of a sphere and COXA VARA COXA VALGA
articulates with the acetabulum A deformity of hip A deformity of the hip
where angle of where the angle of
Fovea capitis inclination is less than inclination is usually
120 degrees above 135 degrees
• small depression at the center of the head for
Causes: Causes:
attachment of ligamentum teres Fracture Normal at birth
o contains blood supply to the head of Fibrous dysplasia Underlying
femur coming from obturator artery Rickets Neuromuscular
• flat and depressed Traumatic proximal diseases (cerebral
femoral epiphyseal palsy, spinal muscular
Neck plate closure atrophy, polio etc.)
• which connects the head to the shaft, passes Osteomyelitis Skeletal diseases (hip
Osteogenesis dislocation, arthritis)
downward, backward, and laterally and
Imperfecta
makes an angle of about 125° known as
Paget’s disease
angle of inclination (slightly less in the Presentation: Presentation:
female) with the long axis of the shaft. Limb length Limb length
• Normally 120-130 degrees discrepancy (shorter leg) discrepancy (longer leg)
Prominent greater Impaired ambulation
ANGLE OF INCLINATION
trochanter and sitting balance
• Starts to bend when baby starts to stand and Limitation of abduction secondary to bilateral
walk because of the weight put and internal rotation of adduction contractures
o When born, the angle is about 180 the hip
Angle of inclination Angle of inclination
degrees
decreases increases

Greater and lesser trochanters

• large eminences at the junction of the neck

and the shaft
Intertrochanteric line

• Connects the two trochanters; where

iliofemoral ligament is attached; anterior
Quadrate tubercle

• Intertrochanteric crest found posteriorly

• Attachment of quadratus femoris
PT 1011: Osteology and Gluteal Region

MIDDLE THIRD
Shaft

• smooth and rounded on its anterior surface

but posteriorly has a ridge and hollow portion
Linea aspera

• where muscles and intermuscular septa are

attached
• posterior
Medial supracondylar ridge to the adductor tubercle

• above and below the medial margin

continues to the medial condyle
• where the head is
Lateral supracondylar ridge

• continuous below with the lateral condyle

Gluteal tuberosity

• found in the posterior surface below greater

trochanter; for the attachment of the gluteus
maximus muscle

PATELLA

• Largest sesamoid bone

LOWER THIRD o help elongate tendon
Lateral condyle o to make it more functional
• Kneecap
Medial condyle • Develops with in the tendon of quadriceps
Intercondylar notch • Triangular with the apex inferiorly
• Apex: connected to the tibial tuberosity via
• it separates the lateral and medial condyles patellar ligament or ligamentum patella
posteriorly • Posterior articulates with condyles of femur
o have a cartilage
Adductor tubercle
o should be smooth because it will be
• part on the medial part of the distal femur sliding on the femur
continuous with the medial epicondyle. • Smooth in front and at the back it is attached
• For attachment of adductor magnus muscle to the medial and lateral condyles
PT 1011: Osteology and Gluteal Region

o Medial facet for the medial condyle o between anterior and posterior
o Lateral facet for the lateral condyle intercondylar areas
• Upper, lateral, and medial margins of patella o important because this is where the
are for attachment of different quadriceps anterior and posterior cruciate
muscles ligament are attached
• Lateral proximal part is a facet for head of
fibula
• Tibia tuberosity
o Found between the two condyles
o The quadriceps tendon make dikit
here after the patella

TIBIA MIDDLE THIRD

PROXIMAL THIRD

• Large weight bearing medial bone of leg

o if fractured, hard to walk again
o every time you stand, the weight
goes: hip → knee → tibia
o wala masyado weight in the fibula so
you are still able to walk even if it’s
fractured
• Articulates with condyle of femur proximally
and head of fibula (above) and distal fibula
below)
Parts:

• Lateral and medial condyles (plateau above)

• Intercondylar eminence
PT 1011: Osteology and Gluteal Region

Parts: FIBULA

• Shaft is triangular • Slender lateral bone

o Anterior is triangular (patusok) • No part in articulation at the knee but
o Posterior is somehow rounded participates in ankle joint below
• Shin subcutaneous anterior border • For attachment of muscles
o slightly protruding • Has an Expanded upper end, a shaft and a
• Tuberosity lower end
o Junction of anterior border for • forms the lateral malleolus of the ankle
attachment of ligamentum
patella/quadricep tendon UPPER THIRD
• Interosseous border (lateral) Parts:
o for attachment of interosseous
membrane • The upper end, or head, is surmounted by a
styloid process.
DISTAL THIRD o It possesses an articular surface for
Parts: articulation with the lateral condyle of
the tibia.
• Distal of the medial aspect of the tibia forms o It also have a neck
the medial malleolus • Common peroneal or fibular nerve passes in
o Most prominent part at the distal end the head
• Lateral interosseous border o superficial in the head
o gives attachment to the interosseous o supplies the muscles on the anterior
membrane. and lateral compartment of the leg
• Soleal line o cross leg for a long period of time can
o oblique line at the posterior aspect of compress this
the tibia, for the attachment of the ▪ can result to foot drop
soleus muscle. o Muscles attached to this is
responsible for dorsiflexion
▪ if peroneal nerve is
compressed, it will be hard to
do this action
• Shaft of the fibula is long and slender
• The medial or interosseous border gives
attachment to the interosseous membrane
LOWER THIRD
Parts:

• Lower end of the fibula

o forms the triangular lateral malleolus
• Malleolar fossa
o depression found below and behind
the articular facet
• Triangular facet
o for articulation of talus
• Ankle joint
o The important muscles and ligaments
attached to the fibula
PT 1011: Osteology and Gluteal Region
16. Middle phalanx of second
toe
17. Distal phalanx of second toe

THE TARSAL BONES

Calcaneum

• The calcaneum is the largest bone of the

foot
• Heel bone
• Forms prominence of the heel articulates
above with the talus and in front with the
Cuboid
• It has six surfaces.
o The anterior surface is small and
articulates with the cuboid bone.
o The posterior surface forms the
prominence of the heel; gives
attachment to the Achilles tendon
o The superior surface is dominated
by two articular facets for the talus,
separated by a roughened groove,
the sulcus calcanei.
o The inferior surface has an anterior
tubercle in the midline and a large
medial and a smaller lateral tubercle
at the junction of the inferior and
posterior surfaces for the attachment
of peroneal muscles

BONES OF THE FOOT AND ANKLE REGION

1. Calcaneus
2. Talus
3. Navicular
4. Medial cuneiform
5. Intermediate cuneiform
6. Lateral cuneiform Talus
7. Cuboid
8. First metatarsal • The talus articulates above at the ankle
9. Second metatarsal joint with the tibia and fibula, below with the
10. Third metatarsal calcaneum, and in front with the navicular
11. Fourth metatarsal bone
12. Fifth metatarsal
• Ankle joint → plantarflex and dorsiflex →
13. Proximal phalanx of great
toe distal tibia – talus – distal fibula
14. Distal phalanx of great toe • It possesses a head, a neck, and a body
15. Proximal phalanx of second o Head of the talus is directed distally
toe articulates with navicular bone.
PT 1011: Osteology and Gluteal Region

o neck of the talus lies posterior to the

head and is slightly narrowed
o body of the talus is cuboidal.
• Its superior surface articulates with the
distal end of the tibia; it is convex from
before backward and slightly concave from
side to side.

METATARSAL AND PHALANGES

• Resemble that of the hands

o Metatarsal: each has a head, shaft
and body
o Phalanges: each has proximal,
middle and distal phalanges (except
for the big toe because it only has
proximal and distal phalanges)
• First metatarsal is large and strong and plays
an important role in supporting the weight of
Navicular
the body
• tuberosity of navicular can be seen and felt o has sesamoid bone in the tendon
in front and below the medial malleolus o abduct and adduct
• medial side o Not Condyloid
• Metatarsal phalangeal joint: condyloid
Cuboid

• lateral side
Cuneiform

• 3 wedge shaped cuneiform bones that

articulate with navicular and 3 metatarsals
• Medial, intermediate, and lateral
PT 1011: Osteology and Gluteal Region

THE GLUTEAL REGION Deep fascia

• Also known as buttock • Continuous with deep fascia of thigh or

• Composed mainly of the gluteal muscle and fascia lata
thick fascia • Splits to enclose the gluteus maximus
• Boundaries: • On lateral surface it thickens to form a strong
o Superior – iliac crest wide band, iliotibial tract (from tubercle of
o Inferior – gluteal fold of the buttock iliac crest to the lateral condyle of tibia)
• Prominence of buttocks: gluteus medius • Iliotibial tract forms the sheath for tensor
and fat fasciae latae muscle
SKIN OF THE BUTTOCK LUMBAR PLEXUS

• Cross section: line in the middle is the • Purely lumbar

gluteal cleft • From spinal nerves L1-L4
• Divide one side into 4 quadrants • Each nerve then divides into anterior and
posterior nerve fibers

Upper outer lateral branch of iliohypogastric

quadrant nerve (L1 and T12 - anterior rami)
Lower outer lateral cutaneous nerve of thigh
quadrant (L2 and L3)
Upper inner posterior rami of first 3 lumbar and
quadrant first 3 sacral nerve (L1-3 & S1-3)
Lower inner posterior cutaneous nerve of thigh
quadrant (S1-3) BRANCHES
L1 Iliohypogastric
• upper outer quadrant and
• Coccyx area and cleft of buttocks – supplied muscles in abdomen
by small branches of sacral and coccygeal Ilioinguinal
nerves • passes inguinal area
• innervates perineal area
FASCIA (scrotum, penis, etc.)
Superficial fascia L1 – L2 Genitofemoral
• innervates cremaster
• Thick muscle which is attached to
o Large quantity of fat testicles → cremasteric
• Responsible for prominence of buttock reflex
• sensory sensation on the
inner thigh
L2 – L3 lateral femoral cutaneous
PT 1011: Osteology and Gluteal Region

• sensory only on the anterior

and lateral of the thigh
• lower outer quadrant
L2, L3, L4 obturator nerve
L2, L3, L4 femoral nerve
• largest branch

LUMBOSACRAL PLEXUS

• Mixture of lumbar and sacral

• Found in front of the piriformis in the
posterior pelvic wall
• Formed by anterior rami of L4-5, S1-4

JOINTS IN THE GLUTEAL REGION

HIP JOINT

• Multiaxial Ball and socket joint

BRANCHES • Formed by the articulation of the round
L4 – S3 Sciatic nerve head of femur and acetabulum
• Largest branch • Femoral head comprises 2/3 of a sphere
• Largest nerve of the body inserting deep into the acetabulum
L4, L5, S1 Superior gluteal n. o This makes it more stable than the
L5, S1, S2 Inferior gluteal n. shoulder
L4, L5, S1 N. to quadratus femoris • Articular surface is horseshoe shape and
L5, S1, S2 N. to obturator internus deficient at the acetabular notch; cavity is
S1, S2, S3 Posterior cutaneous n. of thigh deepened by the acetabular labrum
S2, S3, S4 Pudendal n. • Strong, fibrous capsule permits free
S1 – S2 N. to piriformis movement of hip joint, stable joint
• Capsule
o Attached to intertrochanteric line of
femur to halfway along posterior of
neck
PT 1011: Osteology and Gluteal Region

o Retinacula – attachment to • Y ligament of Bigelow

intertrochanteric lines accompanied • Y Shape / inverted Y
by blood vessels to the head and • Attachment:
neck of femur; where blood supply o from AIIS
passes through o to upper and lower parts of
intertrochanteric line
• Function:
o prevents hyperextension when
standing & lateral rotation or external
rotation
o prevent hip from hyperextending
• strongest ligament in the body
• found anterior
Pubofemoral ligament

• Triangular
• Attachment:
o Base is from superior ramus of pubis
and goes to the intertrochanteric line
o Apex – lower intertrochanteric line
• Function: Limits extension and abduction
Ischiofemoral ligament
LIGAMENTS
Iliofemoral ligament

• Spiral shape
• Attachment:
o to body of ischium
o to greater trochanter of femur
PT 1011: Osteology and Gluteal Region

• Function: Limits extension and internal • bridges gap between the acetabulum
rotation • The ligament bridges the acetabular notch
converting it to a tunnel where blood
Ligament of head of femur (Ligamentum teres)
vessels and nerves enter the hip joint

• flat and triangular

• is weak and of little importance in THE MOVEMENTS OF THE HIP JOINT
strengthening the hip joint
Flexion Iliopsoas (strongest flexor)
• Attachment: attached to the acetabular sartorius, rectus femoris,
notch & transverse ligament and pit of pectineus, adductor longus,
femoral head (fovea capitis) adductor brevis, adductor
• Function: It limits adduction and provides a magnus and gracilis
pathway for blood vessels to enter the head Extension hamstring, adductor magnus
of femur. (because it has two parts and the
o Obturator artery one in the back extends), gluteus
maximus
Transverse Acetabular ligament Abduction gluteus medius and minimus,
assisted by sartorius, tensor
fasciae latae and piriformis
Adduction adductor longus, brevis,
magnus, assisted by gracilis &
pectineus
Medial g. medius and minimus, tensor
rotation fascia lata
Lateral Obturator externus & internus,
rotation gemelli, piriformis, quadratus
femoris and is assisted by g.
maximus

SACROILIAC JOINT

• Attachment: between the sacrum and iliac

bones
• Attachment: attached to bony rim of • Type: plane joint (gliding)
acetabulum • Function: shock absorber for the spine
• it deepens the acetabular fossa and grasps above and converts torque from the lower
the femoral head beyond its equator extremities into the rest of the body
PT 1011: Osteology and Gluteal Region

• Ligaments:
o Anterior sacroiliac
o Posterior sacroiliac ligament
o Interosseous ligament
o Sacrospinous and sacroiliac
ligament
• Nerve supply: branches of sacral spinal
nerves (snell)
o Superior gluteal

SYMPHYSIS PUBIS JOINT

• Cartilaginous joint between the two pubic

bones
• Ligaments:
o Anterior pubic ligament
SACROCOCCYGEAL JOINT
o Posterior pubic ligament
• Cartilaginous joint between the last sacral o Superior pubic ligament
vertebrae and first coccygeal vertebrae o Arcuate pubic ligament
• Ligament: • Nerve: branches from the iliohypogastric,
o Anterior Sacrococcygeal Ligament ilioinguinal and pudendal nerves.
o Posterior Sacrococcygeal Ligament • No movement is possible (snell) but during
o Lateral Sacrococcygeal Ligament birth, The possible movements at this joint
o Interarticular Ligaments wo bones include angulation, rotation and
• Nerve: pudendal nerve displacement. These movements are very
• Movement: Forward and backward slight because of the nature of joint
movement o During delivery of a baby
PT 1011: Osteology and Gluteal Region

MUSCLES IN THE GLUTEAL REGION Gluteus medius

Gluteus maximus

Origin Outer surface of ilium

Insertion Greater trochanter
• Largest muscle in the body Nerve Superior gluteal nerve
• lies superficial in the gluteal region Action Abducts thigh and medial rotation
responsible for the prominence of the Steady the pelvis on the lower limb
buttock. when foot of opposite side is taken
off ground (trendelenburg’s test)
Origin Outer surface of ilium, posterior
surface of sacrum & coccyx
Insertion Iliotibial tract; inserts in greater Trendelenburg’s test or Trendelenburg gait
trochanter • Weakness of gluteus medius and minimus
Nerve Inferior gluteal nerve • Pelvis sinks down on the opposite
Action Extends and laterally rotates hip unsupported side
Maintains knee in extension
(iliotibial tract) and extensor of trunk

Gluteus Maximus Gait or Lurching gait

• weakness of this affects walking
o gluteaus maximus helps
straightening the body when
walking for balance
o if weak: extended back or lurching
when walking
o if both are weak, there will be
lurching on both sides
o more obvious when both gluteus
muscles are affected
Waddling gait
• Bilateral muscles are affected
• Walking like a duck
PT 1011: Osteology and Gluteal Region

Gluteus minimus Piriformis

• The piriformis lies partly within the pelvis at

its origin.
• Its position serves to separate the superior
gluteal vessels and nerves from the
inferior gluteal vessels and nerves
o All at the top of it are superior and
the same goes on the opposite
• The sciatic nerve is just under it that’s why it
is important
o Hypertrophied or too much use of
piriformis → impinge sciatic nerve

Origin Outer surface of ilium

Insertion Anterior surface of greater trochanter
Nerve Superior gluteal nerve (L4-S1)
Action Abducts thigh
anterior fibers medially rotate the
thigh

Tensor fasciae latae

Origin Anterior surface of S2, 3 and 4

vertebrae
Insertion Upper border of greater trochanter
Nerve Anterior rami of first and second
sacral nerves (S1-S2; nerve to
piriformis)
Action Lateral rotator of thigh

Gemellus superior

• The tensor fasciae latae runs downward and

backward to its insertion in the iliotibial tract
assists the gluteus maximus muscle in
maintaining the knee in the extended
position

Origin Iliac crest (between ASIS and iliac

tubercle)
Insertion Iliotibial tract
Nerve Superior gluteal nerve (L4-S1)
Action Maintains knee in extension
PT 1011: Osteology and Gluteal Region

Origin Ischial spine Quadratus femoris

Insertion Upper border of greater trochanter
Nerve Nerve to obturator internus (L5-S2)
Action Lateral rotator of thigh at hip joint

Gemellus inferior

Origin From lateral border of ischial

tuberosity
Insertion Quadrat tubercle
Nerve Sacral plexus (L4-S1; n. to quadratus
femoris)
Action Lateral rotator of thigh
Origin Ischial tuberosity
Insertion Upper border of greater trochanter
Nerve Sacral plexus (nerve to quadratus
femoris) L4-S1
Action Lateral rotator of thigh

Obturator internus

• Fan shape muscle

Origin Obturator membrane

Insertion Upper border of greater trochanter
Nerve Nerve to quadratus internus
Action Lateral rotator of thigh