Muscles of Hip Thigh and Knee Pain

Tensor Fasciae Latae Muscle (Fig. 19.106) Origin

Iliac crest between the iliac tubercle and the ASiS (outside)

Insertion

Through the iliotibial tract to the front side of the lateral condyle of the tibia

Action

Abduction in the hip joint

• Stabilizing the knee in extension

Innervation

Superior gluteal nerve (L4-S1) Trigger Point Location

At the front edge of the muscle in the proximal third

Referred Pain

Anterolateral thigh, possibly all the way to the knee

Associated Internal Organs

None

Sartorius Muscle (Figs. 19.107,19.108) Origin

Slightly below the ASIS Insertion

Tibial tuberosity, medial edge Action

• Flexion in the hipjoint Abduction in the hip joint

• Outward rotation in the hipjoint

• Flexion in the knee joint

• Inward rotation in the knee joint

Nerve Pain

Fig. 19.106

Innervation

Femoral nerve (L3-L4)

Trigger Point Location

TP1-3 lie in the course of the muscle from proximal to distal.

Referred Pain

Ventral and medial thigh (in the course of the muscle)

Associated Internal Organs

Vastus lateralis

Patellar ligament

TP of the tensor fasciae latae

Sartorius

Rectus femoris lliotibial tract

Iliac -crest lliacus

TP of the sartorius

Sartorius Psoas Image

- Vastus medialis

Psoas major

Patella

Superficial pesanserinus

Attachment tendon of the quadriceps femoris lliacus

Sartorius

TPs vastus lateralis

Tensor fasciae la

Rectus -femoris

Iliopsoas

Innervationsgebiete Adduktoren

Psoas major LVB5

Piriformis Sacro

Pecti neus

TP of the adductor longus Adductor longus

-TP of the gracilis

Gracilis

Adductor magnus

Biceps femoris Head -of fibula tract

Patella

Sartorius

- Patellar ligament

Piriformis Sacrum

Sacrospinous ligament

Iliopsoas Pectineus

Adductor longus

|- Gracilis

- TP of the pectineus

Vastus lateralis

- Vastus medialis

Psoas major

Patella

Patellar ligament

Superficial pesanserinus

TP of the tensor fasciae latae

Tensor fasciae latae

Sartorius

TP of the rectus femoris

Rectus femoris lliotibial tract lliacus

Sartorius

TPs vastus lateralis

Biceps femoris Head -of fibula

Iliac -crest lliacus

TP of the sartorius

Attachment tendon of the quadriceps femoris

Tensor fasciae la

Rectus -femoris

Iliopsoas tract

Vastus intermedius Vastus medialis Vastus lateralis Rectus .femoris

Patella

Psoas major LVB5

TP2 of the vastus medialis

Piriformis Sacro spinous lig. Sacro-lig.

Pecti neus

TP1 of the vastus medialis

Sartorius

- Patellar ligament

TP of the adductor longus Adductor longus

-TP of the gracilis

Gracilis

Adductor magnus

Fig. 19.107

■ Pectineus Muscle

Origin

• Superior pubic ramus

Insertion

Pectineal line below the greater trochanter Action

• Flexion in the hipjoint

• Adduction in the hipjoint

• Inward rotation in the hipjoint

Innervation

• Occasionally also obturator nerve (L2-L3)

Trigger Point Location

Distal of the superior pubic ramus (see Fig. 19.108) Referred Pain

Deep inguinal pain immediately below the inguinal ligament

Associated Internal Organs

• Urinary bladder

• Uterus, adnexa, prostate

Inguinal Ligament PainQuadriceps Muscle Origin

■ Quadriceps Femoris Muscle (Figs. 19.109,

Rectus Femoris Muscle Origin

• Anterior inferior iliac spine (AIIS)

• Ilium, cranial to the acetabulum

Vastus Lateralis Muscle Origin

• Upper section of the intertrochanteric line

• Greater trochanter

• Lateral lip of the linea aspera

• Lateral supracondylar ridge

• Lateral intermuscular septum of the femur

Vastus Medialis Muscle Origin

• Lower section of the intertrochanteric line

• Medial lip of the linea aspera

• Medial intermuscular septum of the femur

Vastus Intermedius Muscle Origin

Frontal and exterior side of the femur (up to about one hand-width above the condyles)

Trigger Point Location

TP of a therectii'. ^ femoris

Trigger point of the rectus femoris: Slightly caudal of the AIIS

Trigger point of the vastus medialis: You find this at the medial rim of the muscle. TP1 lies further distal, slightly above the patella, and TP2 almost exactly in the middle of the thigh

Trigger point of the vastus intermedins: Trigger points are difficult to palpate because a digital examination is difficult due to the deep-lying position of this muscle. The trigger points lie proximal in the muscle belly, but more distal than the trigger points of the rectus femoris. Access to these trigger points is obtained by proximal palpation of the lateral rim of the rectus femoris and from there palpating deeply into the thigh

Trigger point of the vastus lateralis: Due to its deep position in the thigh, palpation of its trigger points is very difficult. They are distributed throughout the entire muscle belly and manifest with typical referred pain only when the muscle is compressed onto the femur. (See also Fig. 19.107)

Fig. 19.109

Rectus Femoris, Vastus Lateralis, Vastus Medialis, and Vastus Intermedius Muscles

Insertion

• Through the quadriceps tendon to the patella

• Through the patellar ligament to the tuberosity of the tibia

Referred Pain

Trigger point of the rectus femoris:

• Around the patella

Trigger point of the vastus medialis: ventromedial knee (TP1) and thigh (TP2) area.

Trigger point of the vastus intermedius: in the entire ventral thigh, concentrated in the middle of the thigh.

Trigger points of the vastus lateralis: lateral thigh and knee area.

Action

- Extension at the knee joint ■ Rectus femoris also hip bend

Associated Internal Organs

None

Innervation

Femoral nerve (L3-L4)

Innervation
Fig. 19.1 lOa-c
Gracilis Muscle Action

■ Gracilis and Adductor Longus, Brevis, and Magnus Muscles

Gracilis Muscle (Fig. 19.112) Origin

Inferior pubic ramus (outside) Insertion

Front side of the tibia (below the sartorius) Action

• Adduction in the hip joint

• Flexion in the knee joint

• Inward rotation in the knee joint (when knee flexed)

Innervation

Obturator nerve (L2-L3)

Trigger Point Location

In the middle third of the muscle belly

Referred Pain

Inside of the thigh

Thigh Chains

Associated Internal Organs

• Urinary bladder

Adductor Longus Muscle Origin

• Shaft of the pubic bone

• Pubic tubercle (underneath and medial)

is Insertion

Medial lip of the linea aspera (distal two-thirds)

Action

• Adduction in the hip joint

• Inward rotation in the hip joint

Innervation

Obturator nerve (L2-L3)

Adductor Brevis Muscle (Fig. 19.113) Origin

Inferior ramus and shaft of the pubic bone Insertion

Linea aspera (proximal third) Action

Adduction in the hip joint Innervation Obturator nerve (L2-L3) Trigger Point Location

You can palpate the trigger points well when you pretense the muscles by flexing and abducting the hip. For this purpose, the patient lies in supine position. The trigger points lied in the proximal half of the muscles.

Referred Pain

• Ventromedial thigh

• Suprapatellar

• Along the rim of the tibia

Associated Internal Organs

• Urinary bladder

Muscles of Hip, Thigh, and Knee Pain 197

TPs of the" adductor • longus '.''X and brevis * .

TPs of the" adductor • longus '.''X and brevis * .

Knee Refer Pain Hip
TP of the adductor magnus

Adductor Magnus Muscle (Fig. 19.114) Origin

• Ramus of the ischium

• Inferior ramus of the pubis

• Ischiadic tuber

Insertion

• Linea aspera up to the gluteal tuberosity

• Adductor tubercle of the femur

Action

• Extension in the hip joint

• Adduction in the hip joint

• Inward rotation in the hip joint

Innervation

Trigger Point Location

TP1 In the middle of the muscle, near the insertion of the linea aspera TP2 Near the origin at the ischium and pubis (see Fig. 19.113)

Referred Pain

Fig. 19.113

TP1 Groin and ventromedial thigh, not all the way down to the knee TP2 Pubic bone, vagina, rectum, bladder, or other diffuse pain in the small pelvis

Associated Internal Organs

• Urinary bladder

Gluteus

TP2 of the adductor magnus

Sacro-tuberous ligament Obturator internus

Biceps femoris (long head) andsemi-tendinosus

Tensor fasciae latae Sartorius Rectus femoris

Piriformis

Gemelli muscles

Gluteus medius and minimus muscles

Gluteus

TP2 of the adductor magnus

Tensor fasciae latae Sartorius Rectus femoris

Piriformis

Gemelli muscles

Sacro-tuberous ligament Obturator internus

Biceps femoris (long head) andsemi-tendinosus

Rectus Femoris And Biceps Femoris

Biceps femoris (short head)

Vastus medialis Plantaris Gastrocnemius (lateral head)

Biceps femoris

Biceps femoris (short head)

Vastus medialis Plantaris Gastrocnemius (lateral head)

Biceps femoris lliotibial tract

Semitendinosus Image

femoris tendinosus

Quadriceps femoris lliotibial tract femoris tendinosus

Quadriceps femoris

Fig. 19.114

■ Biceps Femoris, Semitendinosus, and Semimembranosus Muscles

Biceps Femoris Muscle (Fig. 19.115) Origin

• Ischiadic tuber (backside)

• Lateral lip of the linea aspera (middle third)

Insertion

• Lateral supracondylar line of the femur

• Lateral collateral ligament

• Lateral condyle of the tibia

Action

• Extension in the hipjoint

• Flexion in the knee joint

• Outward rotation in the knee joint

Innervation

Tibial and fibular nerve (L4-S3) Trigger Point Location

Several trigger points are found in the middle third of the posterolateral thigh.

Referred Pain

• Proximal posterolateral lower leg

• Posterolateral thigh, not up to the gluteal fold

Semitendinosus Muscle (Fig. 19.116) Origin

Ischiadic tuber (backside) Insertion

Medial surface of the tibia (below the gracilis) Action

• Extension in the hipjoint

• Flexion in the knee joint

• Inward rotation in the knee joint

Innervation

Tibial nerve (L5-S1)

Semimembranosus Muscle (Fig. 19.116)

Origin

Ischiadic tuber (backside) Insertion

• Medial condyle of the tibia

• Oblique popliteal ligament

• Fascia of the popliteus

Action

• Extension in the hipjoint

• Flexion in the knee joint

• Inward rotation in the knee joint

Innervation

Tibial nerve (L5-S1)

Trigger Point Location

Several trigger points are found in the middle third of the posteromedial thigh.

Calves Trigger Point Pictures

Fig. 19.115

Referred Pain

• Caudal end of the buttocks and gluteal fold (primary pain)

• Posteromedial thigh

• Medial half of the back of the knee and of the calf

Fig. 19.116

Iliac crest

Tensor

Iliac crest

Tensor

Tensor Vaginae Femoris Muscle

- Biceps femoris (long head)

TPs of the biceps femoris (example)

Gastrocnemius

- Biceps femoris (long head)

TPs of the biceps femoris (example)

Gastrocnemius

■ Popliteus Muscle (Figs. 19.117, 19.118) Origin

Posterior side of the tibia (above the line for the soleus muscle and below the tibial condyles)

Insertion

• Lateral epicondyle of the femur

• Radiating into the knee joint capsule

• Connection to the lateral meniscus (posterior horn)

Action

• Inward rotation in the knee joint

• Pulls the lateral meniscus backward

Innervation

Tibial nerve (L5-S1)

Trigger Point Location

In the proximal half of the origin of the muscle, near the tibia

Referred Pain

Knee joint

Associated Internal Organs

Gracilis-

membranosus

tendinosus

Gastrocnemius Lateral Head

Flexor digitorum longus

Biceps femoris

Plantaris

membranosus lateral head of the gastrocnemius

Soleus

Achilles tendon

Peroneus brevis

Crural chiasm

Peroneus longus

Calcaneal tuber

Tibialis posterior

Tibialis -anterior

Peroneus Longus And Tibialis Posterior

TP of the popliteus

— Tendon of the peroneus longus

Gracilis-

membranosus

tendinosus

Medial-

head of the gastrocnemius

TPs of the gastrocnemius:

TP4-

Flexor — digitorum longus

Tibialis — posterior

Plantar — chiasm

Tibialis — anterior

hallucis longus

Biceps femoris

Plantaris

membranosus lateral head of the gastrocnemius

-Medial head of the gastrocnemius

- Lateral head of the gastrocnemius

- Popliteus

- Biceps femoris

- Peroneus longus

TP of theplantaris TP2 of the soleus

TP of the popliteus

TP3 of the soleus

TP! of the soleus

- Peroneus longus

- Peroneus brevis

— Lateral malleolus

— Tendon of the peroneus longus

Soleus

Flexor digitorum longus

Achilles tendon

Peroneus brevis

Crural chiasm

Peroneus longus

Calcaneal tuber

Tibialis posterior

Tibialis -anterior

Fig. 19.117

Peroneus Brevis Pain

Fig. 19.118

31 Days To Bigger Arms

31 Days To Bigger Arms

You can have significantly bigger arms in only 31 days. How much bigger? That depends on a lot of factors. You werent able to select your parents so youre stuck with your genetic potential to build muscles. You may have a good potential or you may be like may of the rest of us who have averages Potential. Download this great free ebook and start learns how to build your muscles up.

Get My Free Ebook


Responses

  • Amina Tesmi
    Where is the biceps femoris long and short head?
    5 years ago
  • Panu Laurila
    What muscles are around the iliac crest?
    5 years ago
  • iines
    What internal organs are above hips?
    5 years ago
  • martin
    How to palpate the short head of the biceps?
    5 years ago
  • lioba trevisani
    Where is the inguinal ligament?
    5 years ago
  • rosa
    When the hip is in the medial position, where is its innervation point?
    5 years ago
  • DANIELA
    Which muscles referred pain pattern is to the lateral calf and around the lateral malleo?
    5 years ago
  • Josefiina
    Where is the posterolateral thigh?
    4 years ago
  • Semira
    What internal organs are located in the thigh area?
    4 years ago

Post a comment