The iliac fascia is a fascia in the region of the ilium of the pelvis. It has the following connections: laterally, to the whole length of the inner lip of the iliac crest. Medially, to the linea terminalis of the lesser pelvis, where it is continuous with the periosteum. At the iliopectineal eminence it receives the tendon of insertion of the Psoas minor, when that muscle exists. Lateral to the femoral vessels it is intimately connected to the posterior margin of the inguinal ligament, is continuous with the transversalis fascia. Lateral to the femoral vessels the iliac fascia is prolonged backward and medialward from the inguinal ligament as a band, the iliopectineal fascia, attached to the iliopectineal eminence; this fascia divides the space between the inguinal ligament and the hip bone into two lacunæ or compartments: the medial vascular lacuna transmits the femoral vessels. The lateral muscular lacuna transmits Iliacus and the femoral nerve. Medial to the vessels the iliac fascia is attached to the pectineal line behind the conjoint tendon, where it is again continuous with the transversalis fascia.
Fascia iliaca block This article incorporates text in the public domain from page 466 of the 20th edition of Gray's Anatomy
The vertebral column known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord found in all chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs; the vertebral column houses a cavity that encloses and protects the spinal cord. There are about 50,000 species of animals; the human vertebral column is one of the most-studied examples. In a human's vertebral column there are thirty-three vertebrae; the articulating vertebrae are named according to their region of the spine. There are twelve thoracic vertebrae and five lumbar vertebrae; the number of vertebrae in a region overall the number remains the same. The number of those in the cervical region however is only changed. There are ligaments extending the length of the column at the front and the back, in between the vertebrae joining the spinous processes, the transverse processes and the vertebral laminae.
The vertebrae in the human vertebral column are divided into different regions, which correspond to the curves of the spinal column. The articulating vertebrae are named according to their region of the spine. Vertebrae in these regions are alike, with minor variation; these regions are called the cervical spine, thoracic spine, lumbar spine and coccyx. There are twelve thoracic vertebrae and five lumbar vertebrae; the number of vertebrae in a region overall the number remains the same. The number of those in the cervical region however is only changed; the vertebrae of the cervical and lumbar spines are independent bones, quite similar. The vertebrae of the sacrum and coccyx are fused and unable to move independently. Two special vertebrae are the axis, on which the head rests. A typical vertebra consists of two parts: the vertebral arch; the vertebral arch is posterior. Together, these enclose the vertebral foramen; because the spinal cord ends in the lumbar spine, the sacrum and coccyx are fused, they do not contain a central foramen.
The vertebral arch is formed by a pair of pedicles and a pair of laminae, supports seven processes, four articular, two transverse, one spinous, the latter being known as the neural spine. Two transverse processes and one spinous process are posterior to the vertebral body; the spinous process comes out the back, one transverse process comes out the left, one on the right. The spinous processes of the cervical and lumbar regions can be felt through the skin. Above and below each vertebra are joints called facet joints; these restrict the range of movement possible, are joined by a thin portion of the neural arch called the pars interarticularis. In between each pair of vertebrae are two small holes called intervertebral foramina; the spinal nerves leave the spinal cord through these holes. Individual vertebrae are named according to their position. From top to bottom, the vertebrae are: Cervical spine: 7 vertebrae Thoracic spine: 12 vertebrae Lumbar spine: 5 vertebrae Sacrum: 5 vertebrae Coccyx: 4 vertebrae The upper cervical spine has a curve, convex forward, that begins at the axis at the apex of the odontoid process or dens, ends at the middle of the second thoracic vertebra.
This inward curve is known as a lordotic curve. The thoracic curve, concave forward, begins at the middle of the second and ends at the middle of the twelfth thoracic vertebra, its most prominent point behind corresponds to the spinous process of the seventh thoracic vertebra. This curve is known as a kyphotic curve; the lumbar curve is more marked in the female than in the male. It is convex anteriorly, the convexity of the lower three vertebrae being much greater than that of the upper two; this curve is described as a lordotic curve. The sacral curve begins at the sacrovertebral articulation, ends at the point of the coccyx; the thoracic and sacral kyphotic curves are termed primary curves, because they are present in the fetus. The cervical and lumbar curves are compensatory or secondary, are developed after birth; the cervical curve forms when the infant is able to sit upright. The lumbar curve forms from twelve to eighteen months, when the child begins to walk. Anterior surfaceWhen viewed from in front, the width of the bodies of the vertebrae is seen to increase from the second cervical to the first thoracic.
From this point there is a rapid diminution, to the apex of the coccyx. Posterior surfaceFrom behind, the vertebral column presents in the median line the spinous processes. In the cervical region these are short and bifid. In the upper part of the thoracic region they are directed obliquely downward.
The iliolumbar artery is the first branch of the posterior trunk of the internal iliac artery. The iliolumbar artery turns upward behind the obturator nerve and the external iliac artery and vein, to the medial border of the psoas major, behind which it divides into: Lumbar branch of iliolumbar artery Iliac branch of iliolumbar artery 1. Last lumbar→iliolumbar 2. Lateral sacral↔lateral sacral 3. Middle sacral→lateral sacral 4. Superior hemorrhoidal→middle hemorrhoidal 5. Medial femoral circumflex→inferior gluteal 6. Medial femoral circumflex↔obturator 7. Lateral femoral circumflex→superior gluteal 8. Deep iliac circumflex→superior gluteal 9. Deep iliac circumflex→external iliac 10. Last lumbar→superior gluteal 11. Last lumbar→deep iliac circumflex 12. Iliolumbar→deep iliac circumflex; this article incorporates text in the public domain from page 621 of the 20th edition of Gray's Anatomy Anatomy photo:44:10-0100 at the SUNY Downstate Medical Center Radiology image: Pelvis:15PelArt from Radiology Atlas at SUNY Downstate Medical Center Anatomy figure: 43:07-02 at Human Anatomy Online, SUNY Downstate Medical Center pelvis at The Anatomy Lesson by Wesley Norman Illustration at mrcog-wiseowl.com
Lateral rotator group
The lateral rotator group is a group of six small muscles of the hip which all externally rotate the femur in the hip joint. It consists of the following muscles: Piriformis, gemellus superior, obturator internus, gemellus inferior, quadratus femoris and the obturator externus. All muscles in the lateral rotator group originate from the hip bone and insert on to the upper extremity of the femur; the muscles are innervated by the sacral plexus, except the obturator externus muscle, innervated by the lumbar plexus. This group does not include all muscles which aid in lateral rotation of the hip joint: rather it is a collection of ones which are known for performing this action. Other muscles that contribute to lateral rotation of the hip include: Gluteus maximus muscle Gluteus medius muscle and gluteus minimus muscle when the hip is extended Psoas major muscle Psoas minor muscle Sartorius muscle Hip anatomy Glutealregion at The Anatomy Lesson by Wesley Norman
Inferior gemellus muscle
The inferior gemellus muscle is a muscle of the human body. The Gemelli are two small muscular fasciculi, accessories to the tendon of the Obturator internus, received into a groove between them; the Gemellus inferior arises from the upper part of the tuberosity of the ischium below the groove for the Obturator internus tendon. It blends with the lower part of the tendon of the Obturator internus, is inserted with it into the medial surface of the greater trochanter. Absent. Like the obturator internus muscle, the gemellus superior and gemellus inferior help to steady the femoral head in the acetabulum. Both muscles help to laterally rotate the extended thigh and abduct the flexed thigh at the hip Superior gemellus muscle This article incorporates text in the public domain from page 477 of the 20th edition of Gray's Anatomy PTCentral Anatomy photo:13:st-0401 at the SUNY Downstate Medical Center
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
The gluteus minimus, the smallest of the three gluteal muscles, is situated beneath the gluteus medius. It is fan-shaped, arising from the outer surface of the ilium, between the anterior and inferior gluteal lines, behind, from the margin of the greater sciatic notch; the fibers converge to the deep surface of a radiated aponeurosis, this ends in a tendon, inserted into an impression on the anterior border of the greater trochanter, gives an expansion to the capsule of the hip joint. It is a local stabilizer for the hip. A bursa is interposed between the greater trochanter. Between the gluteus medius and gluteus minimus are the deep branches of the superior gluteal vessels and the superior gluteal nerve; the deep surface of the gluteus minimus is in relation with the reflected tendon of the rectus femoris and the capsule of the hip joint. The gluteus medius and gluteus minimus abduct the thigh, when the limb is extended, are principally called into action in supporting the body on one limb, in conjunction with the tensor fasciæ latæ.
Their anterior fibers flex the hip, by drawing the greater trochanter forward, rotate the thigh inward, in which action they are assisted by the Tensor fasciæ latæ. Additionally, with the hip flexed, the gluteus minimus internally rotate the thigh. With the hip extended, the gluteus gluteus minimus externally rotate the thigh; the attachment to the superior capsule of the hip may serve to retract the capsule away from the joint during motion. This mechanism may prevent capsular impingement similar to the role of the articularis genus in the knee; the muscle may be divided into an anterior and a posterior part, or it may send slips to the piriformis, the superior gemellus or the outer part of the origin of the vastus lateralis. Paralysis of this muscle or gluteus medius, such as may be caused by the superior gluteal nerve palsy, can lead to difficulty abducting the leg. Patients will compensate for their difficulty walking by adopting a Trendelenburg gait; this article incorporates text in the public domain from page 475 of the 20th edition of Gray's Anatomy PTCentral Anatomy photo:13:st-0406 at the SUNY Downstate Medical Center