The iliopsoas refers to the joined psoas and the iliacus muscles. The two muscles are separate in the abdomen, but merge in the thigh; as such, they are given the common name iliopsoas. The iliopsoas muscle joins to the femur at the lesser trochanter, acts as the strongest flexor of the hip; the iliopsoas muscle is supplied by parts of the femoral nerve. The iliopsoas muscle is a composite muscle formed from the psoas major muscle, the iliacus muscle; the psoas major originates along the outer surfaces of the vertebral bodies of T12 and L1-L3 and their associated intervertebral discs. The iliacus originates in the iliac fossa of the pelvis; the psoas major unites with the iliacus at the level of the inguinal ligament and crosses the hip joint to insert on the lesser trochanter of the femur. The iliopsoas is classified as an "anterior hip muscle" or "inner hip muscle"; the psoas minor does contribute to the iliopsoas muscle. The inferior portion below the inguinal ligament forms part of the floor of the femoral triangle.
The psoas major is innervated by direct branches of the anterior rami off the lumbar plexus at the levels of L1-L3, while the iliacus is innervated by the femoral nerve. The iliopsoas is the prime mover of hip flexion, is the strongest of the hip flexors; the iliopsoas is important for standing and running. The iliacus and psoas major perform different actions; the iliopsoas muscle is covered by the iliac fascia, which begins as a strong tube-shaped psoas fascia, which surround the psoas major muscle as it passes under the medial arcuate ligament. Together with the iliac fascia, it continues down to the inguinal ligament where it forms the iliopectineal arch which separates the muscular and vascular lacunae, it is a typical posture muscle dominated by slow-twitch red type 1 fibers. Since it originates from the lumbar vertebrae and discs and inserts onto the femur, any structure from the lumbar spine to the femur can be affected directly. A short and tight iliopsoas presents as externally rotated legs and feet.
It can cause pain in the low or mid back, SI joint, groin, knee, or any combination. The iliopsoas gets innervation from the L2-4 nerve roots of the lumbar plexus which send branches to the superficial lumbar muscles; the femoral nerve passes through the muscle and innervates the quadriceps and sartorius muscles. It comprises the intermediate femoral cutaneous and medial femoral cutaneous nerves which are responsible for sensation over the anterior and medial aspects of the thigh, medial shin, arch of the foot nerves; the obturator nerve passes through the muscle, responsible for the sensory innervation of the skin of the medial aspect of the thigh and motor innervation of the adductor muscles of the lower extremity and sometimes the pectineus. Any of these innervated structures can be affected. Psoas abscess Iliopsoas tendonitis Muscles of the hip Muscles/Iliopsoas at exrx.net Cross section image: pelvis/pelvis-e12-15—Plastination Laboratory at the Medical University of Vienna
Gray's Anatomy is an English language textbook of human anatomy written by Henry Gray and illustrated by Henry Vandyke Carter. Earlier editions were called Anatomy: Descriptive and Surgical, Anatomy of the Human Body and Gray's Anatomy: Descriptive and Applied, but the book's name is shortened to, editions are titled, Gray's Anatomy; the book is regarded as an influential work on the subject, has continued to be revised and republished from its initial publication in 1858 to the present day. The latest edition of the book, the 41st, was published in September 2015; the English anatomist Henry Gray was born in 1827. He studied the development of the endocrine glands and spleen and in 1853 was appointed Lecturer on Anatomy at St George's Hospital Medical School in London. In 1855, he approached his colleague Henry Vandyke Carter with his idea to produce an inexpensive and accessible anatomy textbook for medical students. Dissecting unclaimed bodies from workhouse and hospital mortuaries through the Anatomy Act of 1832, the two worked for 18 months on what would form the basis of the book.
Their work was first published in 1858 by John William Parker in London. It was dedicated by Gray to 1st Baronet. An imprint of this English first edition was published in the United States in 1859, with slight alterations. Gray prepared a second, revised edition, published in the United Kingdom in 1860 by J. W. Parker. However, Gray died the following year, at the age of 34, having contracted smallpox while treating his nephew, his death had come just three years after the initial publication of his Anatomy Descriptive and Surgical. So, the work on his much-praised book was continued by others. Longman's publication began in 1863, after their acquisition of the J. W. Parker publishing business; this coincided with the publication date of the third British edition of Gray's Anatomy. Successive British editions of Gray's Anatomy continued to be published under the Longman, more Churchill Livingstone/Elsevier imprints, reflecting further changes in ownership of the publishing companies over the years.
The full American rights were purchased by Blanchard and Lea, who published the first of twenty-five distinct American editions of Gray's Anatomy in 1862, whose company became Lea & Febiger in 1908. Lea & Febiger continued publishing the American editions until the company was sold in 1990; the first American publication was edited by Richard James Dunglison, whose father Robley Dunglison was physician to Thomas Jefferson. Dunglison edited the next four editions; these were: the Second American Edition. W. W. Keen edited the next two editions, namely: the New American from the Eleventh English Edition. In September 1896, reference to the English edition was dropped and it was published as the Fourteenth Edition, edited by Bern B. Gallaudet, F. J. Brockway, J. P. McMurrich, who edited the Fifteenth Edition. There is an edition dated 1896 which does still reference the English edition stating it is "A New Edition, Thoroughly Revised by American Authorities, from the thirteenth English Edition" and edited by T. Pickering Pick, F.
R. C. S. and published by Lea Brothers & Co. Philadelphia and New York; the Sixteenth Edition was edited by J. C. DaCosta, the Seventeenth by DaCosta and E. A. Spitzka. Spitzka edited the Eighteenth and Nineteenth editions, in October 1913, R. Howden edited the New American from the Eighteenth English Edition; the "American" editions continued with consecutive numbering from the Twentieth onwards, with W. H. Lewis editing the 20th, 21st, 22nd, 23rd, 24th. C. M. Gross edited the 25th, 26th, 27th, 28th, 29th. Carmine D. Clemente extensively revised the 30th edition. With the sale of Lea & Febiger in 1990, the 30th edition was the last American Edition. Sometimes separate editing efforts with mismatches between British and American edition numbering led to the existence, for many years, of two main "flavours" or "branches" of Gray's Anatomy: the U. S. and the British one. This can cause misunderstandings and confusion when quoting from or trying to purchase a certain edition. For example, a comparison of publishing histories shows that the American numbering kept apace with the British up until the 16th editions in 1905, with the American editions either acknowledging the English edition, or matching the numbering in the 14th, 15th and 16th editions.
The American numbering crept ahead, with the 17th American edition published in 1908, while the 17th British edition was published in 1909. This increased to a three-year gap for the 18th and 19th editions, leading to the 1913 publication of the New American from the Eighteenth English, which brought the numbering back into line. Both 20th editions were published in the same year. Thereafter, it was the British numbering that pushed ahead, with the 21st British edition in 1920, the 21st American edition in 1924; this discrepancy continued to increase, so that the 30th British edition was published in 1949, while the 30th and last American edition was published in 1984. The newest, 41st edition of Gray's Anatomy was published on 25 September 2015 by Elsevier in both print and online versions, and
The piriformis is a muscle in the gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group, it was first named by Adriaan van den Spiegel, a professor from the University of Padua in the 16th century. The piriformis muscle originates from the anterior part of the sacrum, the part of the spine in the gluteal region, from the superior margin of the greater sciatic notch, it exits the pelvis through the greater sciatic foramen to insert on the greater trochanter of the femur. Its tendon joins with the tendons of the superior gemellus, inferior gemellus, obturator internus muscles prior to insertion; the piriformis is a flat muscle, pyramidal in shape, lying parallel with the posterior margin of the gluteus medius. It is situated within the pelvis against its posterior wall, at the back of the hip-joint, it arises from the front of the sacrum by three fleshy digitations, attached to the portions of bone between the first, second and fourth anterior sacral foramina, to the grooves leading from the foramina: a few fibers arise from the margin of the greater sciatic foramen, from the anterior surface of the sacrotuberous ligament.
The muscle passes out of the pelvis through the greater sciatic foramen, the upper part of which it fills, is inserted by a rounded tendon into the upper border of the greater trochanter behind, but partly blended with, the common tendon of the obturator internus and superior and inferior gemellus muscles. In 17 % of people, the piriformis muscle is pierced by all of the sciatic nerve. Several variations occur, but the most common type of anomaly is the Beaton's type B, when the common peroneal nerve pierces the piriformis muscle, it may be united with the gluteus medius, send fibers to the gluteus minimus, or receive fibers from the superior gemellus. It may have two sacral attachments; the piriformis muscle is part of the lateral rotators of the hip, along with the quadratus femoris, gemellus inferior, gemellus superior, obturator externus, obturator internus. The piriformis laterally rotates the femur with hip extension and abducts the femur with hip flexion. Abduction of the flexed thigh is important in the action of walking because it shifts the body weight to the opposite side of the foot being lifted, which prevents falling.
The action of the lateral rotators can be understood by crossing the legs to rest an ankle on the knee of the other leg. This causes the femur to point the knee laterally; the lateral rotators oppose medial rotation by the gluteus medius and gluteus minimus. When the hip is flexed to 90 degrees, piriformis abducts the femur at the hip and reverses primary function, internally rotating the hip when the hip is flexed at 90 degrees or more. Piriformis syndrome occurs when the piriformis irritates the sciatic nerve, which comes into the gluteal region beneath the muscle, causing pain in the buttocks and referred pain along the sciatic nerve; this referred. Seventeen percent of the population has their sciatic nerve coursing through the piriformis muscle; this subgroup of the population is predisposed to developing sciatica. Sciatica can be described by pain, tingling, or numbness deep in the buttocks and along the sciatic nerve. Sitting down, climbing stairs, performing squats increases pain. Diagnosing the syndrome is based on symptoms and on the physical exam.
More testing, including MRIs, X-rays, nerve conduction tests can be administered to exclude other possible diseases. If diagnosed with piriformis syndrome, the first treatment involves progressive stretching exercises, massage therapy and physical treatment. Corticosteroids can be injected into the piriformis muscle. Findings suggest the possibility that Botulinum toxin type B may be of potential benefit in the treatment of pain attributed to piriformis syndrome. A more invasive, but sometimes necessary treatment involves surgical exploration. Surgery should always be a last resort; the piriformis is a important landmark in the gluteal region. As it travels through the greater sciatic foramen, it divides it into an inferior and superior part; this determines the name of the vessels and nerves in this region – the nerve and vessels that emerge superior to the piriformis are the superior gluteal nerve and superior gluteal vessels. Inferiorly, it is the same, the sciatic nerve travels inferiorly to the piriformis.
This article incorporates text in the public domain from page 476 of the 20th edition of Gray's Anatomy "Piriformis" University of Washington Anatomy photo:13:st-0408 at the SUNY Downstate Medical Center - "Gluteal Region: Muscles" Anatomy photo:43:15-0101 at the SUNY Downstate Medical Center - "The Female Pelvis: The Posterolateral Pelvic Wall"
Quadratus femoris muscle
The quadratus femoris is a flat, quadrilateral skeletal muscle. Located on the posterior side of the hip joint, it is a strong external rotator and adductor of the thigh, but acts to stabilize the femoral head in the acetabulum, it originates on the lateral border of the ischial tuberosity of the ischium of the pelvis. From there, it passes laterally to its insertion on the posterior side of the head of the femur: the quadrate tubercle on the intertrochanteric crest and along the quadrate line, the vertical line which runs downward to bisect the lesser trochanter on the medial side of the femur. Along its course, quadratus is aligned edge to edge with the inferior gemellus above and the adductor magnus below, so that its upper and lower borders run horizontal and parallel. At its origin, the upper margin of the adductor magnus is separated from it by the terminal branches of the medial femoral circumflex vessels. A bursa is found between the front of this muscle and the lesser trochanter. Sometimes absent.
Groin pain can be a disabling ailment with many potential root causes: one such cause overlooked, is quadratus femoris tendinitis. Magnetic resonance imaging can show abnormal signal intensity at the insertion of the right quadratus femoris tendon, which suggests inflammation of the area. Since the muscle works to laterally rotate and adduct the femur, actions involving the lower body can strain the muscle. In addition, patients present with hip pain and an increased signal intensity of the MRI of the quadratus femoris have been shown to have a narrower ischiofemoral space compared to the general populace; the ischiofemoral impingement may be a cause of the hip pain associated with quadratus femoris tendinitis. This article incorporates text in the public domain from page 477 of the 20th edition of Gray's Anatomy Mcminn, R. M. H.. Last's Applied. Elsevier Australia. ISBN 0-7295-3752-8. Platzer, Werner. Color Atlas of Human Anatomy, Vol 1: Locomotor system. Thieme. ISBN 3-13-533305-1. Thieme Atlas of Anatomy.
Thieme. 2006. ISBN 978-1-60406-062-1. PTCentral Anatomy photo:13:st-0409 at the SUNY Downstate Medical Center
Tensor fasciae latae muscle
The tensor fasciae latae is a muscle of the thigh. It is related to the gluteus maximus in function and structure and is continuous with the iliotibial tract, which attaches to the tibia; the muscle assists in walking, or running. It arises from the anterior part of the outer lip of the iliac crest, it is inserted between the two layers of the iliotibial tract of the fascia lata about the junction of the middle and upper thirds of the thigh. The tensor fasciae latae tautens the iliotibial tract and braces the knee when the opposite foot is lifted; the terminal insertion point lies on the lateral condyle of the tibia. Tensor fasciae latae is innervated by the superior gluteal nerve, L5 and S1. At its origins of the anterior rami of L4, L5, S1 nerves, the superior gluteal nerve exits the pelvis via greater sciatic foramen superior to the piriformis; the nerve courses between the gluteus medius and minimus. The superior gluteal artery supplies the tensor fasciae latae; the superior gluteal nerve arises from the sacral plexus and only has muscular innervation associated with it.
There is no cutaneous innervation for sensation. The tensor fasciae latae is a tensor of the fascia lata; the fascia lata is a fibrous sheath that encircles the thigh like a subcutaneous stocking and binds its muscles. On the lateral surface, it combines with the tendons of the gluteus maximus and tensor fasciae latae to form the iliotibial tract, which extends from the iliac crest to the lateral condyle of the tibia. In the erect posture, acting from below, it will serve to steady the pelvis upon the head of the femur; the basic functional movement of tensor fasciae latae is walking. The tensor fasciae latae is utilized in horse riding and water skiing; some problems that arise when this muscle is tight or shortened are pelvic imbalances that lead to pain in hips, as well as pain in the lower back and lateral area of knees. Because of its insertion point on the lateral condyle of the tibia, it aids in the lateral rotation of the tibia; this lateral rotation may be initiated in conjunction with hip abduction and medial rotation of the femur while kicking a soccer ball.
The tensor fasciae latae works in synergy with the gluteus medius and gluteus minimus muscles to abduct and medially rotate the femur. The TFL is a hip abductor muscle. To stretch the tensor fasciae latae, the knee may be brought medially across the body. If one leans against a wall with crossed legs and pushes the pelvis away from the wall sidebending the lumbar spine should be avoided as it stretches the lumbar region rather than the tensor fasciae latae and other muscles which cross the hip rather than the spine; because it is used for so many movements and is in a shortened position when seated, the TFL becomes tight easily. TFL stretches lengthen this important muscle. A small case notes that “it seems possible that a sloped or banked surface could predispose an individual to a TFL strain.” In such a case, “treatment consists of rest and flexibility exercises”, such as lliotibial band stretching. "Tensor fasciae latae" translates from Latin to English as "stretcher of the side band". "Tensor" is an agent noun that comes from the past participle stem "tens-" of the Latin verb "tendere", meaning "to stretch".
"Fasciae" is in the singular genitive case. "Latae" is the respective singular, feminine form of the Latin adjective "latus" meaning "side". This article incorporates text in the public domain from page 476 of the 20th edition of Gray's Anatomy Cross section image: pelvis/pelvis-e12-15—Plastination Laboratory at the Medical University of Vienna Muscles/TensorFasciaeLatae at exrx.net Coachr
The sartorius muscle is the longest muscle in the human body. It is a long, superficial muscle that runs down the length of the thigh in the anterior compartment; the sartorius muscle originates from the anterior superior iliac spine and part of the notch between the anterior superior iliac spine and anterior inferior iliac spine. It runs obliquely across the anterior part of the thigh in an inferomedial direction, it passes behind the medial condyle of the femur to end in a tendon. This tendon curves anteriorly to join the tendons of the gracilis and semitendinosus muscles in the pes anserinus, where it inserts into the superomedial surface of the tibia, its upper portion forms the lateral border of the femoral triangle, the point where it crosses adductor longus marks the apex of the triangle. Deep to sartorius and its fascia is the adductor canal, through which the saphenous nerve, femoral artery and vein, nerve to vastus medialis pass. Like the other muscles in the anterior compartment of the thigh, sartorius is innervated by the femoral nerve.
It may originate from the outer end of the inguinal ligament, the notch of the ilium, the ilio-pectineal line or the pubis. The muscle may be split into two parts, one part may be inserted into the fascia lata, the femur, the ligament of the patella or the tendon of the semitendinosus; the tendon of insertion may end in the fascia lata, the capsule of the knee-joint, or the fascia of the leg. The muscle may be absent in some people; the sartorius muscle can move the hip joint and the knee joint, but all of its actions are weak, making it a synergist muscle. At the hip, it can flex, weakly abduct, laterally rotate the thigh. At the knee, it can flex the leg. Turning the foot to look at the sole or sitting cross-legged demonstrates all four actions of the sartorius. One of the many conditions that can disrupt the use of the sartorius is pes anserine bursitis, an inflammatory condition of the medial portion of the knee; this condition occurs in athletes from overuse and is characterized by pain and tenderness.
The pes anserinus is made up from the tendons of the gracilis and sartorius muscles. When inflammation of the bursa underlying the tendons occurs they separate from the head of the tibia. Sartorius comes from the Latin word sartor, meaning tailor, it is sometimes called the tailor's muscle; this name was chosen in reference to the cross-legged position. In French, the muscle name itself "couturier" comes from this specific position, referred to as "sitting as a tailor". There are other hypotheses as to the genesis of the name. One is that it refers to the location of the inferior portion of the muscle being the "inseam" or area of the inner thigh that tailors measure when fitting trousers. Another is that the muscle resembles a tailor's ribbon. Additionally, antique sewing machines required continuous cross body pedaling; this combination of lateral rotation and flexion of the hip and flexion of the knee gave tailors enlarged sartorius muscles. The sartorius is called the honeymoon muscle; this article incorporates text in the public domain from page 470 of the 20th edition of Gray's Anatomy Anatomy photo:14:st-0407 at the SUNY Downstate Medical Center Cross section image: pembody/body15a—Plastination Laboratory at the Medical University of Vienna Cross section image: pelvis/pelvis-e12-15—Plastination Laboratory at the Medical University of Vienna
The gluteus medius one of the three gluteal muscles, is a broad, radiating muscle, situated on the outer surface of the pelvis. Its posterior third is covered by the gluteus maximus, its anterior two-thirds by the gluteal aponeurosis, which separates it from the superficial fascia and integument; the gluteus medius muscle starts, or "originates," on the outer surface of the ilium between the iliac crest and the posterior gluteal line above, the anterior gluteal line below. The fibers of the muscle converge into a strong flattened tendon that inserts on the lateral surface of the greater trochanter. More the muscle's tendon inserts into an oblique ridge that runs downward and forward on the lateral surface of the greater trochanter. A bursa separates the tendon of the muscle from the surface of the trochanter; the posterior border may be more or less united to the piriformis, or some of the fibers end on its tendon. The posterior fibres of gluteus medius contract to produce hip extension, lateral rotation and abduction.
During gait, the posterior fibres help to decelerate internal rotation of the femur at the end of swing phase. • The anterior part acting alone helps to flex and internally rotate the hip. • The posterior part acting alone helps to extend and externally rotate the hip. • The anterior and posterior parts working together abduct the hip and stabilize the pelvis in the coronal plane. Dysfunction of the gluteus medius or the superior gluteal nerve can be indicated by a positive Trendelenburg's sign. Trendelenburg gait This article incorporates text in the public domain from page 474 of the 20th edition of Gray's Anatomy Anatomy photo:13:st-0404 at the SUNY Downstate Medical Center Cross section image: pelvis/pelvis-e12-15—Plastination Laboratory at the Medical University of Vienna