Jonathan & Elad

)-,ower limb
/· Bony pelvis. Diameters of the pelvis. (page 2)
/ 2. Joints and ligaments of the pelvic girdle. (page 6)
J-i. Gluteal region. (page 8)
/ Subinguinal hiatus. (page 10)
1
SI'. Femur. (page 11)
~Hip joint. (page 12)
'/. Flexors of the hip joint, and their innervation. (page 15)
/2 Extensors of the hip joint, and their innervation. (page 16)
A. Adductors of the hip joint, and their innervation. (page 17)
}ff. Anterior region of the thigh. (page 18)
y. Posterior region of the thigh. (page 20)
)1. Femoral triangle. (page 21)
~ Femoral canal. Adductor canal. (page 22)
J-4. Popliteal fossa. (page 23)
Joyw
15. Knee joint. (page 24) -) ncrt-
16. Muscles acting on the knee joint, and their innervation. (page 29)
17. Bones of the leg. (page 30)
18. Anterior region of the leg. (page 32)
19. Posterior region of the leg. (page 34)
20. Ankle joint. (page 36)
21. Medial and lateral malleolar regions. (page 39)
22. Muscles acting on the ankle joint, and their innervation. (page 41)
23. Bones of the foot. (page 42)
24. Joints and ligaments of the foot. (page 44)
25. Statics of the pelvis (page 47)
26. Arches of the foot (page 48)
27. Plantar region of the foot. (page 49)
28. Dorsum of the foot. (page 51)
29. Arteries, venous and lymphatic drainage of the lower limb. Pulse
points of the lower limb. (page 52)
30. Sensory innervation of the lower limb (including its segmental
pattern). (page 56)
31. Motor innervation of the lower limb (including its segmental
pattern). (page 58)
32. Neurovascular gateways of the lower limb. (page 59)

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 Jonathan & Elad

1. Bony pelvis. Diameters of the pelvis.

• HIPBONE
• The mature hip bone (L. os coxae) is the
large, flat pelvic bone formed by the fusion
of three primary bones-ilium, ischium, and
pubis-at the end of the teenage years.
• At puberty, the three bones are still
separated by a Y-shaped trlradiate cartilage

•
centered in the acetabulum.
The fusion is complete between 20 and 25
years of age.
-
• ILIUM
• The ilium forms the largest part of the hip
bone and contributes the superior part of
the acetabulum.
• The ilium has thick medial portions (columns) for weight bearing and thin, wing-like, posterolateral
portions, the alae (L. wings), that provide broad surfaces for the fleshy attachment of muscles .
• The body of the ilium joins the pubis and ischium to form the acetabulum .
• Anterior superior and anterior inferior iliac spines.
• The iliac crest
0 Inner lip
0 Outer lip
0 Intermediate zone
0 The tuberculum of the iliac crest
(iliac tubercle), lies 5-6 cm
posterior to the ASIS.
• The posterior inferior iliac spine
marks the superior end of the
greater sciatic notch.
-·-
Aurlculllr.urlaoe

• The lateral surface of the ala of the Poe.lenM •~rior !i&lte 9PM
ilium has three rough curved lines : ,..""'l~J~~-Po.twlotW•not'diao•,,.._
0 The posterior, anterior, and
a,
inferior gluteal lines.
• Medially, each ala has a large,
smooth depression, the iliac fossa.
• Posteriorly, the medial aspect of
the ilium Obtuntot" foram.n

0 The auricular surface

0 The iliac tuberosity
0 They form the sacropelvic surface. ,....., """''°"'"
0 They form synovial and .. . .
syndesmotic articulation with the reciprocal surfaces of the sacrum at the sacroiliac Joint.
::_:::::----...,,,.,

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 Jonathan & Elad

ISCHIUM
•The ischium forms the posteroinferior part of the hip bone.
•The superior part of the body of the ischium fuses with the pubis and ilium, form ing the
posteroinferior aspect of the acetabulum.
• The ramus of the ischium joins the inferior ram us of the
pubis to form a bar of bone, the ischiopubic ram us
(which constitutes the inferomedial boundary of the
obturator foramen).
• The posterior border of the ischium forms the inferior
margin of the greater sciatic notch.
• The ischial spine (at the inferior margin of greater sciatic
notch).
• The lesser sciatic notch (inferior to ischial spine).
• The ischial tuberoslty
o A rough bony projection at the junction of the inferior
ei.d of the body of the ischium and its ramus).
o The body's weight rests on this tuberosity when sitting,
and it provides the proximal, tendinous attachment of
posterior thigh muscles.
•
•The pubis forms the anteromedial part of the hip bone, contributing the anterior part of the
acetabulum.
• The pubis is divided into a flattened medially placed body and superior and inferior rami that
project laterally from the body.
• Medially, the symphysial surface (which forms the pubic symphysis with contralateral pubic bone).
• The pubic crest (The anterosuperior border of the
united bodies and symphysis).
• · The pubic tubercles
o Small projections at the lateral ends of this crest).
o The tubercles provide attachment for the main
part of the inguinal ligament.
• The pecten pubis (The posterior margin of the
superior ram us of the pubis).
• OBTURATORFORAMEN
• The obturator fora men is a large oval or irregularly
triangular opening in the hip bone.
• It is bounded by the pubis and ischium and their
rami.
• Except for a small passageway for the obturator
nerve and vessels (the obturator canal), the
obturator fora men is closed by the thin, strong obturator membrane.
• ACETABULUM
■ The acetabulum (L., shallow vinegar cup) is the large cup-shaped cavity or socket on the lateral
aspect of the hip bone that articulates with the head of the femur to form the hip joint.
• All three primary bones forming the hip bone contribute to the formation of the acetabulum.
• The acetabular notch.
• The acetabular fossa
• The lunate surface of the acetabulum (the articular surface receiving the head of the femur).

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 Jo nathan & Elad

• Sacrum:

Five fused sacral vertebrae in adults after 20 years .

Forms the roof and posterosuperior wall of the
posterior pelvic cavity.
Provides strength and stability to the pelvis,
transmits the weight of the body to the pelvic
girdle.
Sacral canal: continuation of the vertebral canal,
contains spinal nerve roots inferior to the Ll
vertebra (cauda equina) .
Posterior are 4 pairs of sacral foramina exit of posterior and
anterior rami of spinal nerves. Anterior foramina (connected
by transverse lines) larger than posterior ones.
Base of sacrum: formed by superior surface of Sl . sacral
promontory on the anterior.
• Apex of sacrum: oval facet for articulation with the coccyx .
• Pelvic surface (anterior) : smooth and concave .
• Dorsal surface: rough convex and marked by 5 prominent
longitudinal ridges.
0 Median sacral crest (spinous processes)
0 Intermediate sacral crest (articular processes)
0 Lateral sacral crest (transverse processes)
0 U shaped hiatus: absence of the laminae and spinous processes
of SS, leads into the sacral canal.
0 Sacral cornu: inferior articular processes of S5 project on each
side of hiatus.
• Auricular surface on lateral surface. synovial part of sacroiliac
joint between Sacrum and ilium.

• Coccyx:

fusion of the 3-5 rudimentary coccygeal vertebrae.

Remanent of embryonic tail in embryos from the end of 4•
week until beginning of 8• week.
• Pelvic surface: smooth and concave .
Posterior surface: articular processes.
Articular processes from Col form the coccygeal cornua

-
.,............. 0..,1.alpa,I
which articulate with the sacral cornua .
• Provides attachments for parts of gluteus maxim us,
coccygeus
muscles and
anococcygeal
Coccygool cornu

:Ii
•
-
~k
~ ~ · • l ,r I
Pc»t-.ot aac:r• fouwnino
·1
• Pn,mor,to,y

ligament. I•'
,
Coceyg<1:1I var 11
Sacral h&:ltu$

Coccyoeal var\Obl

- -7'- Coccygeol v~rlobiao 111-V

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 Jonathan & Elad

• DIAMETERS OF PELVIS:
-~---.-
..._____
----
...._,. .......
.._,...1,,~
• Conjugate diameter (conjugata vera) usually 11 cm
from the promontary to the posterior margin of pubic
..c.
, _.,-....-~--
---
e.,....,..,._ ,, _"-_

•
symphysis.
Diagonal diameter, 12.5 cm.
from the promontary to the inferior margin of pubic
--- .....
...,~_,,,_.,.._
_,. -... "'

symphysis.
• Anatomical diameter (conjugata) 11.5 cm
from the promontary to the superior margin of pubic
symphysis.
--
--

Linea hlUTIIIA'4
4.6 -r,u.,OO'Mllt<• l AA•~os\-·) 4.7
True conjugate symphysis 11 cm or greater.
from the promontary to the posterosuperior margin of pubic symphysis.
Transverse diameter- largest
diameter, 13.5 M..UU Tnunrw ObUq••
most laterally points on linea dlamfltr On cml dlamfltrll■ cml dlamfltr (la cml
terminalis. a■aromkal conJu&■lf
• lnterspinous diameter- shortest (promontory - superior
surface of sympbysis:
diameter 10 cm
•-bl: 11.5
between ischial spines. t
Oblique diameter, 12.5 cm. £
•I.:-
.. :a•
tru• (obst,trlt) <ODJU&■ I•
(promontory - most
betwttn the most co11Dects the intersection of
the terminal line and the
:E .. distont. but identical
prominent poiot of the points of the terminol S:lcroiliac joint with the
l:E syruphysis; a-c): 11
ta liuc:
I3. S
iliopubic eminence on the
opposite side:

Ill
i lnl.roal dl ■&ooal
12.5

coojugalf
(promontory- iofttior
surface of symphysis;
a-d): U .5

l:·
,: body of the 3,. sacral !!JeSler scioric notch -
•.... ,·ertebm - middle pan of between the middle of
the two ocetobuli:
obrunuor groove on rhe
syruphysis: opposite sue:
I 12 - 12.5 12
.13. S
....
:Ei
t.s,:-
highest point of the pubic
arch (•IJlferior surface of
between the two ischial
~ t ,! syrupbysis) - apex of
'C D g coccygtal bone: ruberosities: N'A
:: 't II
D • IO ,. I~
- Ii'

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 Jonathan & Elad

2. Joints and ligaments of the pelvic girdle.

JOINTS AND LIGAMENTS OF PELVIC GIRDLE

The primary joints of the pelvic girdle are the sacroiliac joints and the pubic symphysis.
The sacroiliac joints link the axial skeleton (skeleton of the trunk, composed of the vertebral column
at this level) and the inferior appendicular skeleton (skeleton of the lower limb) .
The lumbosacral and socrococcygeal joints, although joints of the axial skeleton, are directly related
to the pelvic girdle.

❖ SACROILIAC JOINTS 11 I iWa

• TYPE AND THE ARTICULATIONS

• The sacroiliac joints consist of an _..,_. _
anterior synovial joint (between the
ear-shaped auricular surfaces of the
sacrum and ilium, covered with
-- . -, ,_
,....

-
articular cartilage) and a posterior
syndesmosis (between the l,
• LIGAMENTS
•
o
tuberosities of the same bones) .

The anterior sacroiliac ligaments

Are the anterior part of the fibrous capsule of
-J
... '
the synovial part of the joint
•
o
The interosseous sacroiliac ligaments
Lying deep between the tuberosities of the
sacrum and ilium.
[~
o Are the primary structures involved in
transferring the weight of the upper body
from the axial skeleton to the two ilia of the
[1
appendicular skeleton.
•
•
The posterior sacroiliac ligaments
The iliolumbar ligaments are accessory
ligaments.
-- :-1
The sacrotuberous ligament
0 Inferiorly, the posterior sacroiliac ligaments
are joined by fibers extending from the
posterior margin of the ilium (between the
C1
posterior superior and posterior inferior iliac
spines) and the base of the coccyx to form this
ligament.
The sacrospinous ligament, passing from
E1
lateral sacrum and coccyx to the ischial spine.
• Most of the time, movement at the sacroiliac
joint is limited by interlocking of the
articulating bones and the sacroiliac ligaments
to sl ight gliding and rotary movements.

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❖ PUBIC SYMPHYSIS
• TYPE
• Secondary cartilaginous joint.
• ARTICULATION
• Symphysial surfces of pubic bones.
• Consists of a fibrocartilaginous lnterpublc disc

r~ and surrounding ligaments uniting the bodies of

~~
the pubic bones in the median plane.
o The interpubic disc is wider in women.
---
~r
• LIGAMENTS
• The supe r pubic ligament connects the
superior aspects of the pubic bodies and
interpubic disc, extending as far laterally as the
pubic tubercles .

r.-=i • The inferior (arcuate) pubic ligament is a thick

arch of fibers that connects the inferior aspects of the joint compone
nts.

❖ LUMBOSACRAL JOINTS

[ • TYPE AND ARTICULATIONS

• LS and S1 vertebrae articulate at the anterior
intervertebral (IV) joint formed by the LS/S1 IV disc 5th lumbar vertebra (LS)
between their bodies and at two posterior
Lumbosacral joint ' ,
zygapophysial joints (facet joints) between the
articular processes of these vertebrae. Ilium ( 1
• The facets on the S1 vertebra face posteromedially, Sacro-lllac joint" ~ \ •
interlocking with the anterolaterally facing inferior
Sacrum ~; ,
articular facets of the LS vertebra, preventing the
Sacro-<:occygeal Lio -,
lumbar vertebra from sliding anteriorly down the joint D~ ,
incline of the sacrum.
• LIGAMENTS (figure 3.6 in the previous page)
=ulum ~
• These joints are further strengthened by fan-like
iliolumbar ligaments radiating from the transverse
processes of the LS vertebra to the ilia.
1'
Head of femur
Femur - - - Pubic
symphysl s
• The anterior and posterior longitudinal ligaments
could be mentioned as well.
• MOVEMENTS
• Flexion and extension.
• Some lateral flexion is allowed as well.
❖ SACROCOCCYGEAL JOINT

• TYPE
• The sacrococcygeal joint is a secondary cartilaginous joint with an
IV disc.
• ARTICULATIONS
Fibrocartilage and ligaments join the apex of the sacrum to the base of
the coccyx.
• LIGAMENTS
• The anterior and posterior sacrococcygeal ligaments.

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 Jon ath an & Elad

3. Gluteal region .
The gluteal region is the
prominent area posterio
(the buttocks) and extend r to the pelvis an d inferi
or to the level of the ilia
ing laterally to the poste
rior margin of the gre c creSt s
• Gluteal ligaments: ate r tro ch an ter •
• The sac rot ub ero us
ligament extends across
into a fora men tha t is the sciatic notch of the
further subdivided by hip bo ne, converting
the sacrosplnous ligam the no tch
gre ate r and lesser sciati
c foramlna. ent an d ischial spine, cre ati
• The gre ate r sciatic ng the
foramen ls the passagew
sciatic nerve). wh ere as ay for str uct ure s en ter
the lesser sciatic foram ing or leaving the the
en is the passageway for pelvis (e.g.,
the perineum (pudenda! str uc tur es en ter ing or
neNe,lntemal pudenda leaving
• Since the piriform ! vessels,obturator intern
is muscle passes throu
gh the
us muscle).
for am en and infraplrlf gre ate r sciatic for am en, for
orm foramen. ms the suprapiriform
• gluteal vessels and
neNes, everything else
• Muscles of gluteal reg passes through infrap
ion iriform for am en .

---. . . ----Iln-nlo- --gkMal-

TABLl S 6 . MUSCLlS
OFG LUl cAL REGION , ABDUCTORS
AN D ROT ATO RSO FllU
Mus e.. GH
Prol llma l

--
Glut eus milX lmuS
lbum postenor to pos\
\Fog 534 A&C ) eflO (
gluteal i.ne. doru l su1a
ce of -lll igl l(n po da
sacn .tm and coc cyx (UI, 11, 11:z) ly
.~ -r: an dj loo l-;
tub ero us ~ flom - polillon) and
-lnbl
... a--

-
gk M al ~ -N;lland

-"'-
Glu1eus med1us
External sur1ace ot wm lnrl ling ll'C m~p ooll -
(Fog 5 34"- C. & E) Ll llo rll -ol gr -. lofl
betw een ante oor and
posteno, gluteal 11\H

---_""-_'-'--- -........"_
Gluteus manamus Ab clu cta ndm odi dy-
External sur1ace ot IWff
(f,g 5 34A -0)
betw een ante nor and
glute al lines
l
S'lten or -- " '. .. - Suporlorgklloll
111M1 (1.5, S1)
thigh: MOP pelvis leve
-lps ilal e<a llim bls
weig
__ hl-b
_tarin
_.,. (11
g and11-
l

Tensor of laso a
•ac:ant
lata (Fog 5 34JI
Anteno, wpe no,
anleno< part ol uc
apww;
ID -co nd jle ol-
~-during
ilS Mk ,g~ .....
-_,~_ '-
Pwdormas Antenor sur1ace of uau
' (Fog 534 F &G) m; Su po rlo r_ ol. ,_
saa o.-O US l,gamenl
Obturator l'ltemus
IF,g 5 34H)
PeM csw tace ol - . -
memtxane and IUITourd
"'.,_ rami o1 . ,. 52

ng

--"'-- - -
boo es lnlamus(U5, S1)
ta ou )o l-
I Supenor and Superior'. lsc'1ial spno ta.aly--
infe no,g emell1
lnlenoctsehoal - - - lh lg ha nd --
(Fig 5.34H) Suporlor gomoluo:

..... __... ...~

-- al lll )ly •

... -
lhlgh : •-,
lolU )ol .... ... t u dY l·
n--
_ glff lllu o,

----
=-
OuaCYatus remons
-- al lll )ly •

----In
(Fig 5.341)
Late<olborderol -
CuD IIIU lord lon
tube rosil y
..,
... .oc1. . .1c Mii l ol ~
- ( 1 . . 5. S 1) ta. aly -lN gh ";

• Aterles of gluteal and po

sterior thigh regions (ta
.......,.
TA.B l.£ S .9 ART ERIE SOF G
UlftALA
N D ~'l' ltlG H
RIE GIO NS
ble 5.9)
Supe r,o,, glute al

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Jonathan & Elad

• Veins of gluteal region: R1gh1 common lilac veil

• They Run with the arteries of the gouteal region : and 1ympll nodo

-Gluteal veins (superior & inferior) Rlghtlnlemal

illac vetnand
-Internal pudenda! veins lymph nodo
These veins drain into internal iliac vein . Supeno, gluteal ...,
• Lymphatic drainage of gluteal region: ond ly~node

• Lymph from the deep tissues of the buttocks follows the gluteal vessels
to the superior and Inferior gluteal lymph nodes and from them to the
internal, external, and common iliac lymph nodes and from them to ......._ lnlenoJ gluteal Win
the lateral lumbar (aortic/caval) lymph nodes. Femoral vein •nd lymph node
Internal r,udenclal
vt, vein

• Neurovascular Structures of Gluteal ReRion

J Nme

Clurial
Origin Couna Distribution
l
5ll>er101 As lateral cutaneous Pass Wlferolaterally across lac crest Suppl'; si<in of super« buttock as far as
blanches of posteoor tube<cle of lllaC Cles1

I _j
rami of LH.3 spinal
neM!S

J
Midde As lateral cutaneous
branches of posteoor
ram, of S1-s3 spilal
EX4 ttvoogh posterior sacral forami\a and
pass laterally IO gluteal leg,o!l
Suppl'; slon OYer sacrum and adjacent
area of buttock
--
--__ , ..,. ....._
....._
lnlerior
neM!S

Posteoor cwneous Eme!ges born lllerior bonler of gkrteos Supples s~n of ilferior hall of buttock as -- ' C-

- \:::_--· --·
---
neM! of thgh (Wlilr maxrnus and ascends~ lo d fa, as greater ~ochanler .;_-__,_/
ramiof~spilal ,.,
neM!Sl
Saabc Sacral plexus (antenor Enters git.tell leglDI\,.. gruier sciabc Soppl,es no muscles in guteal region; sup-
and posterio, cmslons ol ~ n lnfemr 10 pinlOrms and deep to pbes al musdes ol posleno< compallmonl
anterlo! rami ol L4-S3 gltAeus rnaxrnus,descends In posterior of !high (!illal dMslon supples all but short
spr,aJ """"'1) thgh deep 10 biceps lemons: bllllCales anto head ol bc:eps. WhichI s ~ by com•
thal and common fiWar nerves at apex of mon fibulal<fMslon)
popllealfossa

Posteno< Sacral plexus (antenor Enters gklell ,eg,on via greater scialic: Supples skin ol inlenor hatt of but1ocl<
cutaneous ne,ve and poster<lf ov1sms of 1cnmen infeno, 10 ponlorm,s and deep to (llvough infenot durial neM!S), si<ln OYer
of lhlgh anterior raml of S1-83 gluteus maxmn. erne~ lrnm inlenoi posteriot ~ and poplteal Iossa, and
spinal neives) bo<de< of latter. descends II posteroor thgh si<in of laleraJ pe11ne11n and upper medial
deep lo lasaa lata lhigl (via ks per'neal blanch)

Supenorll'Jleal Saaal plexus (posleriot Enters gkJlell reglDI\ '11 grealer sdatlc lnnet'lates gluteus rnedius. gluteus m•
dlYislons ol anteriol' rami loramen 51.1)efior 10 pnoms;auses Imus, and tensor lasdae latae muscles
ot L...St sponal 081'/eS) lalerllybe1-ghJleusrneciutand
rmmus as tar as tenso< lasaae latae

lnleriorgluteal Saaa1 plexus (posterior Enters gl!Aeal region,.. greaJer sciabc &rpploes gluteus rnaxm.is

j dMsions ot anteno< ram/

ot LS-S2 spinal nerves)
1cnmen inlenor lo pr,lonnrs and deep to
rtleriot pan ot gluteus rnaxaws. <!Mong
1110 several branches

Nerve to "'adra· Saclal plexus (anleroor Enters gluteal region >Aa grealer sciatrc inne<valos !-,p )oi\L lnlenor gemellus. and
Ills lemons dMSIOIIS ot anteriot ram loramen lnleri« lo p,rrlomis. deep (anleflol) "'adratus lemoris

J Pudenda!
ot L4-St spinal 081'/es)

Sacral plexus (antenor

tosaabcOet'IO

EllllS peMs..., greater saabc foramen SUppl,. no structLres in gluteal region 0<
dMsions ot anteriot ramf nterior 10 pinfolmis; descends poslenor to postenol t1igh (prirq,al Oet'le lo pemeun)
- of S2-s4 sp,nal neives) S8CfOSf)n)US lgamenl. enters pelinelln
tlvough lesser saallc loramen

1 Nerve lo oblUlBtor
lnlernus
Saaal plexus (posteriot
dMSIOOS ot anteriot nimi
ol ~2 Spllal neries)
Exra peMs v,a greater sdatoc lotarnen In-
tenor to prilormis: descends posterior 10
sacrospirous igamenL enters pelinelln
Supplies supenor gemelus and oblurat0<
11temus

tlvough lesser scialrc loramen

t'1
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Jonathan & Elad

4 . Subinguinal hiatus.
(Subinguinal space)
• Located deep to inguinal ligament,as Inguinal ligament passes from ASIS to pubic tubercle .
• Borders:
• Anteriorly by the inguinal ligament.
• Posteriorly by the hip bone (ASIS,AIIS,superlor margin of acetabulum,lliopubic eminence,superior
pubic ramus up to pubic tubercle).
• Laterally by a perpendicular line to the ASIS.
• Medially by the pubic t ubercle and medial edge of the thigh.
• Subinguinal hiatus is divided into 2 (3) major compartments as the lllopectlneal arch (thickening of fascia
of psoas major muscle) which passes between the deep surface of the Inguinal ligament and the illopubic
eminence:
• Muscular compartment (lacuna musculonervosa) that contains:
o The iliopsoas muscle.
o The femoral nerve.
o The lateral cutaneous nerve of thigh.
• Vascular compartment (lacuna vascorum) that contains:
o The femoral artery and vein (here is where the external iliac vessels change their name to femoral
artery and vein).
o The femoral branch of genltofemoral nerve (anterolateral to femoral artery).
• The femoral ring (lacuna lymphatlca) Is counted as the 3rd compartment by the department,it can be
counted as a subdivision of the vascular compartment.
• Borders:
o Laterally, t he vertical septum between the femoral canal and femoral vein.
o Posteriorly, the superior ramus of the pubis covered by the pectineus muscle and its fascia.
o Medially, the lacunar ligament.
o Anteriorly, t he medial part of the inguinal ligament.
• Contains a group of deep Inguinal lymph nodes, the Rosenmilller lymph nodes.
• Femoral ring is clinically Important since it's a potential space for passage of the hernial sac.
■ This opening is closed by femoral septum.

Ln1erol c11t,11W101A nen,e of th

(.
£:
10
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 Jonathan & Elad

5. Femur.
• longest and heaviest bone In the body
• Additional material which possible to be asked from:
The angle of inclination:
o The proximal femur is "bent" (l-shaped) so that the long axis
of
the head and neck projects superomediolly at on angle to that of
the obliquely oriented shaft.
o This obtuse angle of inclination is greatest (most nearly straight)
at birth and gradually diminishes (becomes more acute) until the
adult angle is reached (115-140', averaging 126").
o The angle of inclination is less in females because of the increase
d
width between the acetabula (a consequence of a wider lesser
pelvis) and the greater obliquity of the femoral shaft. Shlftott.«U
o The angle of inclination allows greater mobility of the femur
at
the hip joint.
o The angle of inclination also allows the obliquity of the femur
within the thigh, which permits the knees to be adjacent and
inferior to the trunk.
• The torsion angle, or angle of declination:
o When the femur is viewed superiorly (so that one is looking
along
the long axis of the shaft), it is apparent that the two axes lie at
an
angle (the torsion angle).
o Its it's the angle between the axis of femoral head and neck
and
the Transverse axis of femoral condyles.
o The mean of which Is 7'in males and 12'in females .
o The torsion angle, combined with the angle of inclination, allows
rotatory movements of the femoral head within the acetabulum
to '-" _,.,_
convert into flexion and extension, abduction and adduction, and
rotational movements of the thigh.
• The Q angle:
o The two condyles are on the same horizontal level when the bone
is in
its anatomical position, so that if an isolated femur is placed upright
with both condyles contacting the floor or tabletop, the femoral
shaft
will assume the same oblique position it occupies in the living body
(about 9'from vertical in males and slightly greater in females).
o It's the angle between the long axis of the shaft and weight-bearing
line
(line of gravity).
o same oblique position it occupies in the living body (about 9'from
vertical in males and slightly greater in females).

AlOSol
flmO!al

(-~ ~
Torllanan g!e--,_,,. ..,_-
ollemur

Greater
-....
·-
...,.,.,

(D) (E) Uachlnlal

Ang,• al lncinallOn Mtddlle,o,q,tt Lot.tnil~ -
""'i•a f- ~a1ncw1 1on (F) S~v,ewcfen'<lnstn111>g
In 3-yea,-dd ct,ild

J
tnld~I Ill old 1119 ~ ...... .-. W.--0,W --
torslOll angle of lemur

J • 11

J
1
 Jonathan & Elad

6. Hip joint.
• TYPE
• It is a strong and stable multiaxial ball and socket type
of synovial joint.
• ARTICULAR SURFACES OF HIP JOINT
The round head of the femur articulates with the cup-like
acetabulum of the hip bone.
Except for the pit or fovea for the
ligament of the femoral head, all of the
head is covered with articular cartilage.
The heavy, prominent acetabular rim of
the acetabulum consists of a semilunar
articular part covered with articular
cartilage, the lunate surface of the
--
acetabulum.
The acetabular rim and lunate surface
form approximately three quarters of a
circle; the missing inferior segment of the
circle is the acetabular notch.
The lip-shaped acetabular labrum (L.
labrum, lip) is a fibrocartilaginous rim
attached to the margin of the
acetabulum, increasing the acetabular
articular area.
• The transverse acetabular ligament, a
continuation of the acetabular lab rum,
bridges the acetabular notch.
• Centrally a deep non-articular part, called the acetabu
lar fossa, is formed mainly by the ischium .
• JOINT CAPSULE OF HIP JOINT
The hip joints are enclosed within strong joint capsules, formed
of a loose external fibrous layer
(fibrous capsule) and an internal synovial membrane.
Proximally, the fibrous layer attaches to the
acetabulum, just peripheral to the rim to which the Anglo olWib ofv~
1

labrum is attached, and to the transverse acetabular Acetabular rm 11

""'" '-

ligament. Acellbular tlbnlm , : •: ~

Distally, the fibrous layer attaches to the femoral Orb1Cul1rzone--....., _

neck only anteriorly at the intertrochanteric line. R1Una cul1-~-/.

r ", ',,:--'~, \ -IU~aceancarlla9e ol lunate
dheadolle m..
....:....:.'~.
Some deep fibers pass circularly around the neck, Greatet - , -
troc:hanler ✓.
--P '
•,
Epe,hys,o o1 head

Acttabular tossa
forming the orbicular zone. Fibrous ,A/ . ~ ,t ~~, ~
1
Ugament Of hied of femur
leyer ol
Thick parts of the fibrous layer form the ligaments of , Epphyllal plate o1 hood
jolnl
capsule , \
the hip joint, which pass in a spiral fashion from the L Transverse acetabuw lgamenl

pelvis to the femur.

tightened fibrous layer increases the stability of the
•• Synovlll
membrane
(""""""'-- w,lh acetabulat labn,n)

joint, but restricts extension of the joint to 10-

200beyond the vertical position.
\
I Venlcal
Planeolace labullrnm

The synovial membrane of the hip joint

o Reflects proximally along the femoral neck to the edge
of the femoral head.
o Longitudinal synovial folds (retinacula) occur in the synovia
l membrane covering the femoral
neck.
o Subsynovial retinacular arteries (branches of the medial,
and a few of the lateral, circumflex
femoral artery) that supply the femoral head and neck course
within the synovial folds.

12
J

J
] Jonathan & Elad

LIGAMENTS OF HIP JOINT

J lliofemoral ligament
o Anteriorly and superiorly is the strong, Y-shaped iliofemoral ligament, which attaches to the
anterior inferior iliac spine and the acetabular rim proximally and the intertrochanteric line
distally.
o The iliofemoral ligament specifically prevents hyperextension of the hip joint during standing.
Pubofemoral ligament
o Anteriorly and inferiorly is the pubofemoral ligament, which arises from the obturator crest of the
pubic bone and passes laterally and inferiorly to merge with the fibrous layer of the joint capsule.

l o

o
This ligament blends with the medial part of the iliofemoral ligament and tightens during both
extension and abduction of the hip joint.
The pubofemoral ligament prevents overabduction of the hip joint.
• lschiofemoral ligament
o Posteriorly is the ischiofemoral ligament, which arises from the ischial part of the acetabular rim.
• The ligament of the head of the femur
o Primarily a synovial fold conducting a blood vessel, is weak and of little importance in
strengthening the hip joint.
o Usually, the ligament contains a small artery to the head of the femur.

---... - - }- -
11.of~•~t
lwhof.,..,...~1

• MOVEMENTS OF HIP JOINT

Hip movements are flexion-extension, abduction-adduction, medial-lateral rotation, and
circumduction.
The main muscles producing movements of the hip joint:
o The iliopsoas is the strongest flexor of the hip.
o In addition to its function as an adductor, the adductor magnus also serves as a flexor (anterior or
aponeurotic part) and an extensor (posterior or hamstrings part).
o Several muscles participate in both flexion and adduction (pectineus and gracilis as well all three
"adductor" muscles).
o In addition to serving as abductors, the anterior portions of the gluteus medius and minim us are
also medial rotators.
o The gluteus maxi mus serves as the primary extensor from the flexed to the straight (standing)
position.

J-
13
 Jonathan & Elad

BLOOD SUPPLY OF HIP JOINT

Arteries supplying the hip joint include the following:
o The medial and lateral circumflex femoral arteries (by retinacular arteries).
o The artery to the head of the femur, which is a branch of the obturator artery of variable size; it
traverses the ligament of the head.
NERVE SUPPLY OF HIP JOINT
Hilton's law states that the nerves supplying the muscles extending directly across and acting at a
given joint also innervate the joint.

o Flexors innervated by the femoral nerve pass anterior to the hip joint; the anterior aspect of
the hip joint is innervated by the femoral nerve (directly and via articular rami of the
muscular branches to the pectineus and rectus femoris).
o Lateral rotators pass inferior and posterior to the hip joint; the inferior aspect of the joint is
innervated by the obturator nerve (directly and via articular rami of the muscular branch to
the obturator externus), and the posterior aspect is innervated by the nerve to the quadratus
femoris.
o Abductors innervated by the superior gluteal nerve pass superior to the hip joint; the
superior aspect of the joint is innervated by the superior gluteal nerve.
o Pain percieved
L
as coming from
the joint may be
misleading (
because pain
can be referred
from the
vertebral
[
column.

[
u,
,_-
A
\ r
u

14
 Jonathan & Elad

7. Flexors of the hip join t, and thei r inne rvat

ion.
Muscle
01,111 Al11chmen1 lnn,rva11on• Main Acllon(s)
Pecllneus Supe11or romus of pubis
(fig. S 21A & B) Pecllneal Me of femur, lull hmo11I nervt (l2. l3) Adducl1 and flexes th,gh ;
1nfe11or lo lesur uochan1er may retetve a branch asslS1S wdh medial rotation
from oblUlalor nervt ol fhlQh
lllopsoas
(fig 5 21A & C)
Psoas major S1du of T12-LS venebru Lnser uoch1n1u of femur Anltnor r,m1 of lumbar
ano discs between 1h1m.
n,rves lll, U, L3)
lllnsverse processes ol all
lumbar vertebrae
--- --+ --- --- --+ --- --- --- -+ Acl con,o,nl
ly In nu,ng
Psou minor Sides ol l12-LI ,enebrae Pect,nul ifne, 111opec1,neal eml•
--- --- -7 lh1Qh al h,p JOIOI and ,n
An11nor raml of lumbar slabliz,ng lhlS )olnl·
and ln1trverteb111 discs ntnct via ltopetbnnl arch nerves (LI. L2)
llfacus Iliac cresl. 11t1c Iossa, ala Tendon of psoas maior, lesnr Femoral nervt (L2. L3)
of smum. and antenor Uoch1n1tr, and femur dislil 10 I
Slcro•illlc 1,01men1s
Sartorius Anler1or superior lbc spine
(Flg 5.21A & D)
Sup111or pan ol media\ surtatt Femo11I nme (l2, L3) Flues. abdum, and laltr•
and supenor pan of notch of11bl1
lnfenor lo tt .ay rolales lh,oh al h,p Jo1n1.
nexes teo al knn io,nl
(med,afty ro1a~ng leg when
knee 15 lltudl'
lnnerVJlion• llaln Action -~Ir:-- -- -- -
Adductor longus Body of pubis lnlenor lo
(FIO S 23E & G) Middle lhlrd of inu aspm Addutts Uugh
pubic aes1 oflemur
Oblurolor ner,e, branch of.
Adductor brevfs Body and lnlerior ramus of anlenorOMs,on (L2. L3, l4)
(Ag S.23f & 6) Ptthntal line and prolllmaf Adducts th,oh.10
pubis pan of nnea aspm of femur some uteot nuts rt
Adductor magnus Adduc1or part lnfenor ramus
(FiQ S 23C. 0, & G) Adductor pan gluleal Adductor part. obturator Adducts th,gh
ol pubrs, 11mus of ischlum 1ub11osi1y, ~•ea upera,
Hamsuings part: lschlaf ntrve (U. L3, L◄). branches Adductor part.
m1d11f ,upracondrlar bne of postenor dlvtslon
tuberosrty nexuthlQh
Ham,tnng pan. adductor Hamstring part. ltblaf pal\ of Hamstrings part
1ubercfe of lemur sclallc nerve (L◄) extends !high
Gracllls (F,o.S.23H) Body and lnlenor ramus of Supertor part of medial Obluralor nme (L2. L3)
pub,s sunace of bbla. Adducts lh,gh; flexes
leg: helps ro1ate leo
med,aly
Muscle
Innervation• 111111 Action
Quadriceps femoris
(fig 5.21E-H)

Rettus femorls Anllnor Inferior iiac sp,ne and Via common tendinous femoral nerve Extlnd leg at tntt 101n1.
--- --- -~~ilium supenor to acetabulum
--- --- (quadnceps tendon) and
--- -< lndepen dant a1tachm1nts to
(L2, L3, L4) rectus lemons also steadies
hip Joint and helps 1,opsoas
bne of pateUa; indirectly Yta
patenar igament lo t,blal tuber• ftn lhiQh
osrty; medraf end lateral vasb
also aruch to bbla and palela
via aponeuroses (mediif and
lateral pat1hr 11bnacufa)

Abduct nd m1d~t,
101111 thloh: liup pelvis
Sup1riol gflltell ltwtl 1rht111plbt111I

T1n1or fastiae
lalH (flO 5.34J)
Anlenar IUPIIIOI lilt 1pln1;
anttrlor part of lat crut
llio:JJlal ~act. "11!th aaathn
ner,e !LS, S1) limb lneiQh t·bnnn o
and 1dnnt1 oppo\ltt
(UhSUppontdl Sidi dunno
lls t'IIIIIQPbllt
-
--
to literal condytt of ~bll

J
15

J
 r
' '
\
Jonat han & Elad

8. Extensors of the hip joint, and

their innervatio
LI
n.
Muscle•

Semhendlnosus
Dl1lal Attachment
Medial surface of superior part
Innervation•
-- -- -~---,
Main AcUon
- -- 1 - - - - - - - '
C
of ubfa Extend thigh; flex leg
1--- --- --- --- -1 l lblal dlvlston of and rotate 11 medially

'1
Semlmembranosus 1schIa1 tuberosity when knee Is flexed .
Posterior pan of medial condyle
sciatic nerve pan of when thloh and leg ate
ol tibia: reflected attachment
fIbla (L5, St, S2) flexed . these muscles
forms oblique popliteal llgament
(lo lateral femoral condyle) can extend trunk
Bl eeps femorfs

G
Lono head lschlal tuberoslty Lateral side of head of fibula ,
Shon head llnea aspera and Long head: tibial Flexes leo and rotates
tendon Is split at this srte by fibu•
faleral supracondyfar line ol division of sciatic It laterally when knee
la, collateral ligament of knee
lemur nerve (LS. St . S2) ls flexed : etlends thloh
Shon head: common (e.g.. accelerauno mass
lIbular division ol during firs! step of oalt).

Adductor magnus
(Fig. S.23C , D. & G)
Adductor part. tnlenor ramus
of pubis. ramus of Isch1um
Adductor part oiuteal
tuberoslty. hnea aspera .
sclallc nerve
(LS. St, S2)

Adductor part: obturator Adducts fhloh

L
Hamstrinos pan Ischlal nerve (L2. L3, L4), branches Adduc1or part
medial supracondylar line

C
tuberosny of posterior division flexes !high
Hamsumo part adductor Hamstrlno part. tibial pan of
tubercle of femur Hamstnnos pan
sciatic nerve (L4) extends thigh
Gluteus maximus

----- [
lhum posterior to postenor
(Flo 5.34A & C) 01u1eat hne: dorsal surface of
sacrum and coccyx: saccotu•
berous ltoament
Most fibers end In MtObblal
tract. which lnsens Into
l1terat condyte of llbla.
some fibers Insert on
lnlenor oluteal nerve
(LS. St , S2)
Extends thigh (especially
trom llexed posrtlon) and
uslsts in 11s lateral rotalion:
steadies thigh and assists In
l or,iM'd }8-.. [
otuteal tuberosity
rlslno from si11lno position

16
 Jonathan & Elad

9. Adductors of the hip joint, and their innervation.

Innervation• --
Main Action
Adducts !high
Middle lhlrd of llnea aspera
Adductor long us Body or pubis Inferior to 0bturalor nerve . branch of,
of lemur an1enor division (L2 , L3, L4) Adducts thigh: to
(Fig. 5.23E & G) pubic crest
some extent flexes II
Peclineal line and proximal
Body and inferior ram us of pan of line a asp era of femur
Adduclor brevls Adducts thigh
(Fig. 5.23f & G) pubis Adductor par1 obturator Adductor part
Adductor part. gluteal nerve (L2 . L3, L4). branches
Adductor part inlenor ram us flexes thigh
Adductor mag nus tuberoslty, hnea aspera . of posterior division
ol pubis, ramus ot ischlum Hamstrings part
(Fig. 5.23C. D. & G) media! supracondylar line Hamstring part Ublal pan ol
Hamst1ings part: ischial Hamstring part· adductor extends thigh
tuberosfly scla!JC nerve (L4)
tubercle offemur Adducts thigh: flexes
0 bturator nerve (L2, L3) leg. helps rotate leg
Superior part of medial
Gracllls (Fig. 5.23H) Body and Inferior ramus of medially
surface of libla.
pubis
Laterally rotates thigh:
0bturator nerve (L3 . L4) steadies head ot
Trochanteric Iossa of femur
Obturator ex!emus Margins of obturator roramen femur in acetabufum
and obturator membrane

] Pectrneus Supenor ramus of pubis

Pectlneal line or femur, Just
inferior to lesser troclunter
Femoral nerve (L2. L3):
may receive a branch
from obturalor nerve
Adducts and flexes thigh;
assists with medial rotalion
of thigh
(Fig. 5.21A & B)

j
J

4.123b

4.118

17
 L
Jonathan & Elad

10. Anterior region of the thigh.

TABLES.J.L MUSClESOFAN

Muaci.

Pectineus
TERIORTHIGH: FlEXORS OFH

l~J
IPJOINT

SuperlO< r&n.1s ol pub,s

Dtalll Al..chmt nl
tnner -ntlon •
Main Actio n(•)
L
(F,g S21A &B) Petbn ell loneol lemur, IUSI
Fe moral nerve tl2, l.3);

C
l\fenor 10 lesser trochantor M<!Ucts and he,es lh,gh,
may r -v• a branch ISSISl S Vr1th medlll rotation
trom obt1.1ra\or nMVe
U,opsoas of !high
(F',g. 5 21,l.& C)
Psoasma)OI Sodes ofl12-l.S 11enobrao
lesser Uochanter ol 1emur
and chcs boi..een lhc!m. M10ft0f raml o1 lumbar
llansverse processes ol all nerves \l 1, l2. l.3)
lumbar vertebrae
t-- -- -+ -- - - -- --- <r
Psoas manor Side$ol --- --- --- +-
T12-L1 Yl!f1ebree P0c:1,nea1 11\e 1hopoct,neaJ --- --- --1 Act conjolnUy In lle,ong
cl-.gl\alhp jofllandln
and illcNGrtebral d>SCS Anler.. ran-o of lumbar
eminence via ,llopoct,neal asch SleW1Z1ng lh,s jo<nt'
ner.os (L1, l2)

C
lbacus lhac crest. 1\lac Iossa. ala
ofsocrurn. and ante« •
Tendon ol psoas ma,or lesser
lrOchanter, and lemur clslal IO It Femoral nerve \L2, l.3)
sacroi11ac llgasnents
Sartora,s Antenor superior iliac spine
IFlg 5 2t A & D) SIJ!>Oror pan of medoal IUfiace
and superior part of nofch Femor.J ner,e tl2. L3)
of bllia Ae)(es, abducts, and later·
r,feno, 10 ft
ally rolalff ltigh at hop
jolnl. nexes log ll lcnee
jolOI, \modially rotalJng log
v.t,en lcnee Is llexed)'
C
TABLE S.3,11 MUSQ.ES OF ANTE
RIORTI-IIGH: EXTENSORS OF
KNEE
Muldo

Quadriceps lemons
(Fig. 521E -I{)
DI.-~
Innervation• Main Action C
C
Rectus lemons Anlerior lnferor lfiac spine and
Via common lendinous
ilium superior lo acelabufum Femoral nerve Extend leg al knee joint,
(~le ndo n)a nd
(l2, l.3, l4) rOC1us fernoris also studies
Vasl\JS lalerllrs G~a101 lrochanle< and lateral ndependent atlachmenls lo
base of palela; lndnclly via h,p joint and helps k,opsoas
lop of linea ospera of IC!IOUr nex !high
paleUar llgament 10 tiblal
Vasilis mediais luberoslly: med'ial and 1a101al
lr4ertrochanlelic lone and
medial ~Pol mea aspera vasll also attach lo tibia and
palola Ilia aponeuroses
l - - -- -- - 1 - - - of'"""'
- - - - - - - ; (medi al and lal01al pale!lar
Vasilis illennedous Ante<1or and relu1aCUla)
lalend surfaces
of shaft ol femur

-
TABLE 5.4. MUSCLES OF MEDI

Adduo1or longus
\Ag 5-23E&G)
ALTHIGH: ADDUCTORS OFTHIG
H

- lnn1rv1tlon•

--
Adducts thigh

--
Obturalornerve, branch of.
Mdudor br1Y11 Body and Inferior ramus of
\F,g. 5.23F & G) Pecuneol lone and proxfmal anlerb- dMsion (l2. L3, L4)
puli1 pan ol ionea aspera ol lem,. Adducts !high; IO
some extent fiexes i1
Adduc:IOr part. Inferior ramus Addudor part. gluteal
(Fig 5 23C. D. & GI of pubes. rornus ol lsc:hlum Adduclor part. abU.ralor
lubet051ty, lllea aspera, Adductalhigh
HatnSl/ings part 1s<hlll nerve (L2. L3. l4), bronches Addue1orp1111:
rned<al sopraconcfylar I"• ol posterior dMslon
IUberosily Hams1nng part. adductor l\exaslhlflh
HomslmQ pan: blliaf part of Hamstmgs pan
tuberd• ol femur sciatJcner,o (LA)
Grlcas(F,g.5.23HI exleodl lhigh
Body and inlerlo< ramus of Super<>r par1 ol medial
pubis Obluraior nerve tl2. L3) Adduclslhlgh; lle,es
wrlace ol Iba.
log: helps rota!eleg
Dbu m e>1ern1, ITl<Jd,aiy
IAarg,ns ol obluniior foramen Trocl\anleric Iossa of 1.,,..
and oblurllDr membrane Oblu,a.. nerve (l.3, l4)
laleroly rotaies thogll:
llt!ldlcs head ol
lenu W\ acetabuk.lm

18
J
J Jonathan & Elad

J Generally, the anterior group is innervate

Ntf't't
or1o1n ceonlltHdiii
...... ...... .1
d by the

COUTJI
femoral nerve, the medial group by the
I
0111rtbullon In LOilrtr Limb
obtu rator nerve

Subcor lll T12 1n111101 ramus

I
Co,irHI alOno UlltrlOf '°'dll ot 1211'1 n,. L11111le11tan1011s bf1ntl'I 11,ppt,11 •••n Lalerol cutaneous , FomoraJ bninciil

4
OI Gonnotemora1
1111111 (11111\I0UI branc.11 dHUnd 1
l~c:crnl
°'" 11,p 11,.0• '111,110, to 11111rtor pan of au branch of alJbcoslal
Genilal l>nlnc!!J nerve
Cflil •ltd al'lll!IOI 10 QIUltr IIOthan nerve (T12)
lllet-lngulnal Lwmbu plo11, (l 1. OCU• -
Pt1HI II\IOIIQh ln9111ntl UIIII, drodH ftntOIII tlfltlCh 141ppttt1 ,wt ovtr
tu
j,
liOftlly 1121 1n10 t1monl ano 1ott011I or Labtll branch m1d,1I
o ltl'IJOIII 1n1not1 Laleral cutaneous lho-mgu,nal nerve
Gtnltoft moral l11rnb11 pltr.u• ll 1-L?)
Ouctnd s 11'1Hm1r "•'11(1 °' PIOU
m111tt. d1~idH kilo QIMII 11111 ltffiDfll
ftl!IOfl l -.,nlh ,11ppl!H sl,n 0"1'11
p1rt ol ftltlOtll 1J1i11nol1 Olflfll bu nth
bltlll
nerve of thigh
(anlenor branches)
branch u suppliu an\111011c1cih.1ffl 011011
Llltf&I
c u11n10111 nl fVI
lllmba, plnus tl2 ..l3)
Pauu dHp 10 N'IQllltlll i.;1m1nt. 2-3
CCl'I n,1ditil lo 1nt1nc» 111p1nor lac 5p,n1
S11pplill SklA Ofl
m1;or1

.ntenor 1rad llltrll

- Antenor cutaneous
CUlaneous branch
ot obturator nerve
ol thfgh HPtttso 1thl;h
branches of
Anlttlor cul.In• L11tntar pluus Via hmou1I femoral nerve
OUI branch u Ann III ltmonl oonglt. p11ru lasci1 Supplf' 1\an OI 1nlt110f lfld medul aspttll
nuntL 2-U) (laieral QIOUP)
1all illonQ oau, ol Uf10flUS fflll1dl ot Uugh
C11t1n1 ou1 Lumbar plo.u1 VII Oblut•·
branch ot fOIO•t ~ tts dt1ttlll b11wcu ldduc· Sl111 ol ffildlllC part
10,nu,. ,. 1nttr\or bf1ntb
to11 lono111 ,no DrtVtl., Httnot Or'l'ls.ton ot fflldiillhlOh
oblur11or ntrvt \l2-L4l ot obhirllOI "'"'' pitlCH luCia 1111 lo

J
fllCll 1\ln of ll'IIOh

-
_
TABL£S.S. ARTERIESOFAN'TERK
......, >RANDMEDlAL THIGH

.....
,_..

--· - - - - - °"""'
..____ _ -
Canln .a~of- .ltfnli

---·--·---
llac.art e,ydiuS to ....... COJn M!hn) ygh~c ana.
Bra.nchN ~.. ...,, . , , . . W'ld ~

- -
IOrmN • Mllnw l'MI adductor
MM.
o..o....., .. ~IIW;'t➔ an
WheNI . . NIM btc:OffiN ~

Pasa s~~p ,tdrie ul,an d

- lfW)'
....... ......
- ··-----
Wenot lO....,_ llnt IOk:vpn:JIMftQ a,1'f',f fpul
adductDf lor9,lt;. dll«:onO lng - - -
lt!wO'l medi.l! Mitd'-" ""' - to
WOlswd...,,.. to--ff l!.lldt l"'.,... .,.

-
_--_--. ____
ClOIWIOf, and laiiltll Pltl o4 ltUf*

] -... .-. Passes mdally .-.d pc»ltnol ty betWMn

'"""" pldral s andllep loal. - - - .
~ 1"1$0 lblo0d tohtlk llndr.c :II
ollorru; lrlt'll'Y. . . tntchlak .Np,a,1
°""......,.. ..,., .--
reglon and~n MIOp cllWI
Of'N~ a'IOl,lill~ol~
.rl
tnrdl )l)N WtcW l,fulNf .,_, . ~
..,..
afM IM:b n~b y~lr

... ...., iO
,._.,.....,_ l'Nllfar. . lromlilin'lof'II hnPW Nllnd ...-on Q~
,_ .. p.._
...., _,.. ,._. ,~.. ,,__
I a......
__
tn\lm#a .ic.,-.ry ot(W'I

..............
.....,....
20'\Ma nace:a aoty

.-,ttof flhlnit nor

...
P-...ltw oughob lunuQf lotwnen .
rndl l~ol ltlrg hwi d~
WIIDM edotW l)CIIIW W)ttnr
~

ct..~
-----"""'
..,....r,, olOn.n n&vtnt brat'dlv .fldl

genaM t plrilnia, Uf' MUIOl'l 'IOllt

~tnn dla,p pie~ •uar
rul. ~~• olN ;h.a nd
~palW IOttn nc:h~ mt.dC
>
--
J
passo n~lid elofl ldct,t le,
tat~ t.UCN dto'9 chill~

19
 Llj
LI
Jonathan & Elad
C,
11. Posterior region of the thigh.
C
TABLE SJ. MUSCLES OFPOSTERIORTHIGH: EXTENSORS OFHIPAND FLEXORS OF KNEE

lluscle' Distal Allachment lnnervatlon1 llllnActlon

l~i1Q
Sem1tend100sus Medial surlace of superior part
of llbia Extend lhigh; flex leg
~
C
t--- - - - - - - l Tibial d1viSlon ol and rolale 11 medially
Semimembranosus lschial tuberos1ly Poslerior part of medial condyle scialic nerve part of when knee Is flexed;
when !high and leg aie
~
of libia; reflected attachmenl C1

-
tibia (LS,s1,s21
forms oblique poplrteal ligamenl flexed, lhese muscles f
·'

Biceps lemoris
(lo laleral femoral condyle)

Long head:ischlal luberosily Laleral side ol head of llbula;

can extend trunk
ti
Long head:tibial Flexeslegand rotates It
Short head: hnea aspera tendon ~ splrt al lhlssite by division of sciauc lalerallywhen knee is
and laleral supracondy1ar fibular collaleral ligamenl of nerve (LS, S1, S2J flexed; extends thigh
line of lemur knee Short head: convnon (e.g., accelerating mass
fibulai diviskln of dunng first slep of gart).
sciati; nerve (LS,
s1,s21

Nerve Origin Course

- Distribution
Sciatic Saaal plexus (antena Em~ glUleal region via greater sciallc
and postenor dMSlons Supplies no muscles in gluteal 'OQIOll; sup-
foramen Inferior 1" plrdormts and deep to plies aN roosdes of postenor compartmenl
or anteno, l'Oll1I o/ L4-S3 gluteus maxrnus: descends in posterior
spinal nerves) o/ thigh (bbial dlvisloo supplies all bUl shO!I
lhlgh deep to biceps remorts: lill-'tates Into head o/ biceps, which Is supplied by com-
tibial and common fibular nerves at apex o/ mon filular division)
popfiteal rosso

Posterior Saaal plelllJS (antenor Enters gluteal reg,on via grea1er sciatic
cutaneous nerve Supplies skin or inferior hair o/ buttocl<s
end posterio, d'rvisions or l0<amen rnferior to plnlormis and deep to
of thigh (through ,rienor cJu,ial ne,ves). sktn over
anterior rami o/ S1-S3 gluteus rna,umus. emerging from 1nferior poslenor tligh and popi,teal rosso. and skin
spinal nerves) border o/ latter. descends m poslcrior lhig, o/ lateral pemeum and ewer medial thigh
deep to fascia lata (via rts per,neal brnn:h)

The sciatic nerve, the most important structure inferior to the piriformis, is
represented by a line that extends from a point midway between the
greater trochanter and ischial tuberosity down the middle of the posterior
aspect of the thigh. The level of the bifurcation of the sciatic nerve into the
tibial and common fibular nerves varies.
-
The tibial nerve is the medial, larger terminal branch of
the sciatic nerve derived from anterior (preaxial) divisions of
the anterior rami of the L4-S3 spinal nerves.

Perforating Enters~- companment by perlo,aung aponemlC.ic: pon1011 or edwcto, Stw'es majonty (cenral ponrons)
magnus attaclvnent and medial r11ermusruar septum; after providmg mus- cj hamstmg musdes, lhen con-
cular branches to hamstmgs, con11nues to anteno, compartment by p;ercing titues 1" supply vastus laterai,s In
lateral ntermuscuar sepiun ....... ccmpanment

Perforating Arteries. There are usually four perforating arteries of the

profunda femoris artery, three arising in the anterior compartment and the
fourth being the terminal branch of the profunda femoris artery itself. The
perforating arteries are large vessels, unusual in the limbs for their
transverse, intercompartmental course.

Perforating veins accompany the arteries of the same name

to drain blood from the posterior compartment of the thigh
into the profunda femoris vein.

20
 Jonathan & Elad

12. Femoral triangle.

• The femoral triangle is bounded:
• Superiorly by the Inguinal ligament that forms the base of the femoral triangle.
• Medially by the lateral border of the adductor longus.
• Laterally by the sartorius.
• The apex of the femoral triangle is where the medial border of the sartorius crosses the lateral
border of the adductor longus.
• The muscular floor of the femoral triangle is formed by the iliopsoas laterally and the pectineus
medially.
• The roof of the femoral triangle Is formed by the fascia lata and cribriform fascia, subcutaneous
tissue, and skin,
The contents of the femoral triangle, from lateral to medial, are:
Femoral nerve and its (terminal) branches.

J Femoral sheath and its contents:

o Femoral artery and several of its branches.
o Femoral vein and its proximal tributaries (e.g., the great saphenous and deep femoral veins).
o Deep inguinal lymph nodes and associated lymphatic vessels. (femoral canal)

J Lateral cutaneous nerve of the thigh passes supercially and laterally,the best way to find it is to
find the ASIS and right beside it you are able to find it.

J Femoral nerve

J lliacus
muscle }
. lliopsoas
Psoas maJO<
tendon (ASIS).L
-laclpnl......

:::::::a:;~ .-·.,,,,
/ _/' Psoas minor tendon
Llllral

'] lllacus fascia

Ci=
[ , .,
~ / ~
lngulnal - - --i---;,--->..., inside femoral sheath
ligament
Femoral artery
Femoral vein
{ \

l -\ ~-. ~ \
"-

1
',. ._ <!'..' / r ::::
Femoral canal
1
gament
ng
Deep
ioclltoy----:--t--,
Deetilflery
llldal......,_
•'-lard""

1'-,,,><==:::::::::a:~
o,,p..,-ani...,
Fascia lata+ \\ ow;
Fafcl!orm -- --'-___Ja. --:T '
••h"'
. Ftmnl "11,y
Oillrg-cnl
margin , -;c--- - Deep inguinal s,p.,..,...
\\ ,' lymph node
- Saphenous , --"---
nerve \ \, -- - saphenousopenlng
] " - -- -i- Great saphenous
(B) Anterior view ' vein
,-- - - - (8J
- - - OuUine of femoral
triangle

21
 Jonathan & Elad

13. Femoral canal. Adductor canal.

Femoral canal
• Is the smallest of the three compartments of the femoral sheath .
It is conical and short (approximately 1.25 cm) and lies between the medial edge of
the femoral sheath and the femoral vein.
Extends distally to the level of the proximal edge of the sophenous opening.
• Allows the femoral vein to expand when venous return from the lower limb is
increased.
• Contains loose connective tissue, fat, a few lymphatic vessels, and sometimes a
deep inguinal lymph node (lacunar node).
Borders:
Anterosuperlorly by inguinal ligament
Posteriorly by pectin ea I ligament lying anterior to superior pubic ram us and
pectineus muscle.
Medially by lacunar ligament.
[

Adductor canal
The adductor canal (subsartorial canal; Hunter canal) is a long
(approximately 15 cm), narrow passageway in the middle third of the
thigh.
It extends from the apex of the femoral triangle, to the adductor
hiatus in the tendon of the adductor magnus.
• The adductor canal provides an intermuscular passage for the
femoral artery and vein, the saphenous nerve, and the slightly larger
nerve to vastus medialis, delivering the femoral vessels to the
=:... . _,. .,___""',_. ,. -_"_...,__. . . ,__
-·•··"""--"·,....-... . . . _,. . . . . ~-
.....
popliteal fossa where they become popliteal vessels.
• The adductor canal is bounded: _ I
• Anteriorly and laterally by the vast us medialis.
• Posteriorly by the adductors longus and magnus. al
• Medially by the sartorius.
■ In the inferior third to half of the canal the anterior wall is formed by
the subsartorial or vastoadductor fascia spans between the adductor
Inguinal ligamenl
[
■r
longus and the vastus medialis muscles.
• ADDUCTOR HIATUS I
■ is an opening or gap between the aponeurotic distal attachment of
the adductor part of the adductor magnus and the ten di nous distal
Adductor magnus muscle
[
attachment of the hamstring part.
■ The adductor hiatus transmits the femoral artery and vein from the
adductor canal in the thigh to the popliteal fossa posterior to the
knee.
[
j

~(,N Adduclor canal [

22
C

[
,
i1 Jonathan & El ad

r-1 14. Popliteal fossa .

rJ •
•
Is a mostly fat filled compartment, diamond shaped region located posterior to the knee .
The popliteal fossa Is bounded superficially:
Superolaterally by the biceps femorls (superolateral border) .
Superomedially by the semlmembranosus, lateral to which is the semitendinosus (superomedial
border).
• lnferolaterally and inferomedially by the lateral and medial heads of the gastrocnemlus,
respectively (inferolateral and inferomedial borders).
• Posteriorly by skin and popliteal fascia (roof).
The popliteal fossa is bounded deeply:
Superior boundaries are formed by medial and lateral supracondylar lines of femur.
Inferior bounderies are formed by the soleal llne ofTlbla.
• The floor is formed by the popllteal surface of the femur superiorly, the posterior aspect of the
joint capsule of the knee joint centrally, and the investing popllteus fascia covering the popliteus
muscle inferiorly.
•
•
The contents of the popliteal fossa include the:
Termination of the small saphenous vein.
Popliteal arteries and veins and their branches and
- --
tributaries.
• Tibial and common fibular nerves are direved from the
sciatic nerve (ending in the superior angle of popliteal
fossa).
o While in the fossa, the tibial nerve gives branches to
the soleus, gastrocnemius, plantaris, and popliteus
muscles.
o The medial sural cutaneous nerve is also derived from
the tibial nerve in the popliteal fossa .
o It is joined by the sural communicating branch of the
-4191:t
common fibular nerve at a highly variable level to form the sural nerve.
• Posterior cutaneous nerve of thigh

-........
• Popliteal lymph nodes and lymphatic vessels.
o Superficial and deep popliteal lymph nodes.

v.ntton~chat coffitct,,ng tplwn

••-----+-- am.1..............
f ■------,-- DonobM,.,cchcbng apt.m
4 191

Flbubr&Nry

23
 Jonathan & Elad

15. Knee join~

The knee joint is our largest and most superficial joint.
• TYPE
It is primarily a hinge type of synovial joint, allowing flexion and extension; however, the hinge
movements are combined with gliding and rolling and with rotation about a vertical axis.
Again would be good to know its HINGE-PIVOT TYPE.

• ARTICULATIONS, ARTICULAR SURFACES, AND STABILITY OF KNEE JOINT Femoropalelfar

artlculatlon
The knee joint consists of three articulations: Patella
AdductO< tubercle
o Two femorotibial articulations (lateral and medial) between the ► Medal epicondyf•
Laleral epicondyte - MedlallemoraJ
lateral and the medial femoral and tibial condyles. condyle
Lateral femoral condyJe
Medial temorollblal
o One intermediate femoropatellar articulation between the patella Lateral temorollblal - ' artlculaUon
artlcuraUon
and the femur. Apex of ~ Medlalandlaterar
head A t~ •·, UbJal condyles
o The fibula is not involved in the knee joint.
Held~ TLberos!ty
• The stability of the knee joint depends on (1) the strength and actions Ned< AXIi Of llbla
RJUla - - Tlbla
of the surrounding muscles and their tendons and (2) the ligaments
(A) Anterior View
that connect the femur and tibia.
o Of these supports, the muscles are most important.
Femoraf condyles
o The most important muscle in stabilizing the knee joint is the large
lnt•~~-of Lateral ltmorotlblll
fem.. 8
quadriceps femoris, particularly the inferior fibers of the vastus artJcUlafJon
Madill temorollblal
medialis and lateralis. artlcuJallon Tibial cond)'les
o The erect, extended position is the most stable position of the knee. (B) Postertor vtew Head and necl< ol fi>ula
• JOINT CAPSULE OF KNEE JOINT
• The joint capsule of the knee joint is typical in consisting of an external fibrous layer of the capsule
(fibrous capsule) and an internal synovial membrane that lines all internal surfaces of the articular
cavity not covered with articular cartilage.
• The fibrous layer attaches to the femur superiorly, just proximal to the articular margins of the
condyles.
The fibrous layer has an opening posterior to the lateral tibial condyle to allow the tendon of the
popliteus to pass out of the joint capsule to attach to the tibia.
Inferiorly, the fibrous layer attaches to the margin of the superior articular surface (tibial plateau)
of the tibia, except where the tendon of the popliteus crosses the bone.
• The quadriceps tendon, patella, and patellar ligament replace the fibrous layer anteriorly.
• The extensive synovial membrane of the capsule
o It lines the internal surface of the fibrous layer laterally and medially, but centrally it becomes
separated from the fibrous layer.
o From the posterior aspect of the joint, the synovial membrane reflects anteriorly into the
intercondylar region, covering the cruciate ligaments and the infrapatellar fat pad, so that they
are excluded from the articular cavity.
0 This creates a median infrapatellar synovial fold (Thus it almost subdivides the articular cavity
into right and left femorotibial articular cavities).
0 Fat-filled lateral and medial alar folds cover the inner surface of fat pads that occupy the space
on each side of the patellar ligament internal to the fibrous layer.
• EXTRACAPSULAR LIGAMENTS OF KNEE JOINT
The joint capsule is strengthened by five extracapsular or capsular (intrinsic) ligaments: patellar
ligament, fibular collateral ligament, tibial collateral ligament, oblique popliteal ligament, and
arcuate popliteal ligament.
The patellar ligament, the distal part of the quadriceps tendon, is a strong, thick fibrous band
passing from the apex and adjoining margins of the patella to the tibial tuberosity.
■ The collateral ligaments of the knee are taut when the knee is fully extended, contributing to
stability while standing.

24

I
I
 Jonathan & Elad

• The fibular collateral ligament (FCL; lateral co llateral

ligame nt):
o It extend s inferiorly from the lateral epicondyle of the
femur to the lateral surface of t he fibular
head.
o The tendon of the popllteus passes deep to th e FCL,
separating it from the lateral meniscus.
The tibial collateral ligament (TCL; medial collateral ligame

1~ '
nt):
o Extends from the medial epicondyle of the femur
to the medial condyle and the superior part of
the medial surface of the tibia .
/ r,
o The deep fibers of the TCL are firmly
attached to the medial meniscus.
o When damaged as a result, the TCL and ·
; .
medial meniscus are commonly torn
1 ,
during contact sports such as football and
ice hockey.
,iJ: ; !
• The oblique popliteal ligament: I f , 1,J I \I
_....,,_ ft I 4.i
o A recurrent expansion of the tendon of
the semimembranosus that reinforces
l" . I )V,
the joint capsule poster iorly as it spans Obl,qu, pop1,i.o1 ig,mont ., ,._.:.1
ec:.c,v.,,
"'"'
:Y•
the intracondylar fossa .
ll>UII , ...1,,11t,g1mtllf - -
o The ligament arises posterior to the
medial tibial condyle and passes
superolaterally toward the lateral femoral
condyle.
The arcuate popliteal ligament also
strengthens the joint capsule
posterolaterally.
o It arises from the posterior aspect of the
fibular head, passes superomedially over
the tendon of the popliteus, and spreads
over the poster ior surface of the knee
joint.
465
• INTRA-ARTICULAR LIGAMENTS OF KNEE JOINT
• The intra-articular ligaments within the knee joint
consist of the cruciate ligaments and menisci .
• The tendon of the popliteus is also intra-articula
r during part of its course .
• The cruciate ligaments (L. crux, a cross) :
o Crisscross within the joint capsule of the joint but
outside the synovial cavity.
o The cruciate ligaments are located in the center
of the joint and cross each other obliquely, like
the letter X.
o During medial rotation of the tibia on the femur,
the cruciate ligaments wind around each other;
thus the amount of medial rotation possible is limited
to about 10'.
o Because they become unwound during lateral rotatio
n, nearly 60'of lateral rotation is possible
when the knee is flexed approximately 90°, the movem
ent being ultimately limited by the TCL.
o The chiasm (point of crossing) of the cruciate ligame
nts serves as the pivot for rotatory
movements at the knee.
• The anterior cruciate ligament (ACL):
o Arises from the anterior intercondylar area of the
tibia, just poster ior to the attachment of the
medial meniscus.
o It extends superiorly, posteriorly, and laterally
to attach to the posterior part of t he medial side
of the lateral condyle of the femur .
o It limits posterior rolling (turning and traveling)
of the femoral condyles on the tibial plateau
during flexion .
o It also prevents posterior displacement of the femur
on the tibia and hyperextension of the knee
joint.

25