54 



APPLIED ANATOMY. 



sartorius cross both the hip-joint and knee-joint, as does practically the tensor fasciae 

 femoris through its prolongation, the iliotibial band. The movements of the hip are 

 flexion, extension, adduction, abduction, and rotation. Circumduction is a combin- 

 ation of the first four movements. 



Flexion is mainly the result of the action of the sartorius, iliacus, psoas, rectus 

 femoris, and pectineus. 



Extension is mainly due to the gluteus maximus, medius, and minimus, biceps, 

 semitendinosus, and semimembranosus. 



Adduction is accomplished by the pectineus, adductor longus, brevis, and 

 magnus, and to a less extent by the gracilis, quadratus femoris, and lower part of the 

 gluteus maximus. 



Abduction in the extended position is due to the tensor fascia? femoris, sarto- 

 rius, gluteus medius, and gluteus minimus. When flexed the short rotators also aid. 



Internal rotation is produced mainly by the tensor fasciae femoris and the 

 anterior portion of the gluteus medius and minimus; three muscles only. The ilio- 

 psoas acts as a weak internal rotator if the femur is in a position of extreme external 

 rotation. 



External rotation is mainly due to the short external rotators pyriformis, 

 gemelli, obturators, quadratus femoris, the adductors, and the posterior portion of 

 the three gluteals. To a slight extent the sartorius, iliopsoas, pectineus, and biceps 

 may also aid at times. 



SURFACE ANATOMY. 



The crest of the ilium, can be palpated in its entire length. In very thin people 

 it causes an elevation of the surface, but usually it is marked by a depression. Its 

 anterior third is subcutaneous and is more easily seen and felt than the posterior two 

 thirds. A line joining the highest point of the crests passes through the fourth 

 lumbar spine. A line joining the 

 anterior superior spines in front 

 passes below the promontory of 

 the sacrum. The anterior superior 

 spine can be readily felt. It lies 

 downward and outward from the 

 umbilicus: as has been said, meas- 

 urements are best taken by press- 

 ing the tape against its lower 

 surface rather than its subcuta- 

 neous one. 



The posterior superior spine, 

 marked by a dimple, is best recog- 

 nized by following the crest of the 

 ilium to its posterior extremity. It 

 is opposite the middle of the sacro- 

 iliac joint and the second sacral 

 spine. 



The posterior inferior spine is 

 4 to 5 cm. ( i Y?, to 2 in. ) directly 

 below the posterior superior spine. 

 The spine of the ischium, which 

 marks the position of the pudic 

 and sciatic arteries, is 8 to locm. 

 (3 to 4 in.) below the posterior 

 superior spine and the tuberosity 

 of the ischium is 1 2 to 1 5 cm. ( 5 to 



6 in. ). Running forward from the posterior inferior spine for a distance of 4 to 5 cm. 

 (i Y 2 to 2 in.) is the great sciatic notch; through it pass the pyriformis muscle, gluteal 

 artery and nerves, and sciatic nerve. A line joining the posterior superior spine and 

 the tip of the greater trochanter may be named the posterior iliotrochanteric line 



Crest of ilium 

 Nelaton's line 



Anterior superior spine 

 Tip of trochanter 



Tuberosity of ischium 

 Gluteofemoral fold 



FIG. 506. Surface anatomy of the region of the hip. 



