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 Anatomy and Metabolism of Bone

Cysts and Bursae of Hip  !!navigator!!

  1. Iliopsoas bursa
    Location: surrounds iliopsoas tendon
    • largest bursa in body
    • communication with hip in 15%
  2. Greater trochanteric bursae
    1. Trochanteric bursa
      Location: covers posterior facet, beneath gluteus maximus muscle + iliotibial tract
    2. Subgluteus medius bursa





















      Innervation of Pelvis & Thigh Muscles

      Supplying NerveMuscles Innervated
      Sacral plexuspiriformis, inferior gemellus, superior gemellus, obturator internus, quadratus femoris
      Femoral nerveiliopsoas, pectineus, quadriceps (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius), sartorius
      Obturator nerveadductor brevis, adductor longus, anterior head of adductor magnus (also supplied by sciatic nerve), obturator externus, gracilis
      Sciatic nerve
      › tibial divisionlong head of biceps femoris, semitendinosus, semimembranosus, adductor magnus
      › peroneal divisionshort head of biceps femoris
      Superior gluteal n.gluteus medius, gluteus minimus, tensor fasciae latae
      Inferior gluteal n.gluteus maximus



      Location: covers superior portion of lateral facet, beneath lateral portion of gluteus medius m.
    3. Subgluteus minimus bursa
      Location: covers superomedial portion of anterior facet, beneath + medial to gluteus minimus m.
  3. Ischiotrochanteric bursa
  4. Obturator externus bursa
    Location: posteroinferior communication of hip joint capsule
  5. Ischial bursa (= weaver's bottom)
  6. Paralabral cyst

Iliotibial Tract  !!navigator!!

Function: primary stabilizing structure of anterolateral knee together with lateral capsular ligaments

Consists of:

  1. Distal extension of superficial + deep layers of fascia lata
  2. Tensor fasciae latae
  3. Gluteus maximus m.
  4. Gluteus medius m.

Insertion:

  1. supracondylar tubercle of lateral femoral condyle
  2. intermuscular septum of distal femur (deep component)
  3. Gerdy tubercle (main site of superficial component) = anterolateral tubercle of tibia
    [Pierre Nicolas Gerdy (1797–1856), surgeon in Paris]
  4. patella + patellar ligament

Hamstring Muscle Complex  !!navigator!!

  • Most frequently injured muscle!
  1. medial hamstring
    Function: flexion + medial rotation of knee joint as thigh is swung forward and hip extended
    1. Semimembranosus m.
      Origin: superolateral aspect of ischial tuberosity (beneath semitendinosus m.)
      Course: medial + anterior to other hamstring muscles with connections to tendons of adductor magnus m. + long head of biceps m.
      Insertion: via 5 tendinous arms on
      • medial tibial condyle (anterior1 + direct2 + inferior3 arm) deep to tibial collateral ligament
      • posterior oblique lig. (capsular4 arm)
      • arcuate lig. (oblique popliteal lig.5)

      Innervation: single branch off tibial division of sciatic n.
    2. Semitendinosus m.
      Origin: inferomedial impression of upper portion of ischial tuberosity conjoined with long head of biceps femoris m.
      Insertion: Gerdy tubercle conjoined with gracilis m.
      Innervation: tibial n. (2 separate branches)
  2. lateral hamstring
    Function: flexion + lateral rotation of knee joint
    1. Biceps femoris m.
      Insertion: head of fibula, lateral condyle of tibia, fascia of leg
      1. long head
        Origin: medial facet of ischial tuberosity
        Innervation: tibial portion of sciatic n.
      2. short head (does not cross 2 joints, may be absent)
        Origin: lateral linea aspera + lateral supracondylar line + intermuscular septum
        Used as: landmark to distinguish between proximal and distal hamstring injuries
        Innervation: peroneal division of sciatic n.

 Outline