Musculature

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The hip musculature can be conceptualized as a superficial layer and a deep layer. The fascia lata covers the entire hip region including the three muscles that make up the superficial layer: the tensor fascia lata, sartorius, and gluteus maximus (Figure 6.3). The fascia lata also splits to cover the deep and superficial surface of the tensor fascia lata and gluteus maximus encasing these muscles. The tensor fascia lata and the gluteus maximus insert as a continuation, forming the iliotibial band. The gluteus maximus also partly inserts into the proximal femur at the gluteal tuberos-ity. This fibromuscular sheath was described by Henry8 as the "pelvic deltoid," reflecting the fashion in which it covers the hip much as the deltoid muscle covers the shoulder. Interestingly, the gluteus maximus is the largest muscle in the body, and the sarto-rius, which crosses two joints, although quite weak, is the longest.

The gluteus medius has a transitional relationship between the superficial and deep musculature layers (Figures 6.3, 6.4). Its origin from the iliac crest is relatively superficial and covered by a portion of the

Anatomical Terms For Greater Trochanter
FIGURE 6.1. Palpation requires thorough knowledge of the topographic anatomy.
Greater Tuberos

FIGURE 6.2. The lateral two portals (anterolat-eral and posterolateral) are placed directly over the superior margin of the greater trochanter at its anterior and posterior borders. The anterior portal is positioned at the site of intersection of a sagittal line drawn distally from the anterior superior iliac spine and a transverse line across the tip of the greater trochanter.

FIGURE 6.2. The lateral two portals (anterolat-eral and posterolateral) are placed directly over the superior margin of the greater trochanter at its anterior and posterior borders. The anterior portal is positioned at the site of intersection of a sagittal line drawn distally from the anterior superior iliac spine and a transverse line across the tip of the greater trochanter.

Sartorius

Tensor fascia lata

Iliotibial band

Iliotibial band

Sartorius

Tensor fascia lata

Cubital Tunnel Syndrome

um m

Gluteus medius

Iliotibial Band Layers

Gluteus maximus

Gluteus medius

FIGURE 6.3. Superficial muscular layer of the hip.

Gluteus maximus

FIGURE 6.3. Superficial muscular layer of the hip.

Piriformis Superior gemellus Ischial spine

Obturator internus

Inferior gemellus

Ischial tuberosity

Gluteus medius Gluteus minimus

Greater trochanter

Cut end of gluteus medius

Gluteus medius Gluteus minimus

Greater trochanter

Cut end of gluteus medius

Clavipectoral Fascia

Obturator externus

Quadratus femoris

Gluteus maximus cut end elevated

Ischial tuberosity

Obturator externus

Quadratus femoris

Gluteus maximus cut end elevated

FIGURE 6.4. Deep structures (posterior view).

fascia lata, whereas its insertion into the greater trochanter corresponds with the deep muscles.

Posteriorly, the deep muscle layer includes the piriformis, the obturator internus with a common tendinous insertion including the superior and inferior gemelli, the obturator externus, and the quadratus femoris (see Figure 6.4). Laterally, the gluteus minimus lies on the deep surface of the gluteus medius. Anteriorly, the origin of the rectus femoris, including its direct and reflected heads, covers the anterior capsule (Figure 6.5). Just anterior to this is the iliopsoas tendon, formed from the muscles of the iliacus and psoas major inside the pelvis, coursing on the way to its insertion on the lesser trochanter.

Medially, the hip is bordered by the adductor muscle group including the adductor longus, magnus, and brevis, and the gracilis (see Figure 6.5). These muscles are of limited clinical significance for hip arthroscopy except when considering a medial approach to the joint, which has been described as a technical entity, but has thus far found limited clinical application.9

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