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A Summary of Abduction at the Hip Joint

Author: Kevin B. Rosenbloom, C.Ped, Sports Biomechanist

 

Hip abduction is the lateral, superior raise of the thigh and leg at the hip joint, away from the body’s sagittal plane. The range of motion has been estimated at 40-45° (Washington State DSHS 2014, Quinn 2019), with more flexible individuals reaching up to 55° (Roaas & Andersson 1982). The sartorius, gluteal group (maximus, medius, minimus), piriformis, superior gemellus, obturator internus and tensor fascia lata are the most significant contributors to hip abduction (Visible Body 2019). It is important to note that other sources have suggested some contribution by the tensor fascia lata, but these sources do not provide adequate research examples to include in this summary.

The Buttock

The gluteus maximus is a thick and broad, quadrilaterally-shaped muscle that occupies the majority of the superficial, posterior iliac wing of the pelvis. The g. maximus muscles borders’ originate at the posterior gluteal iliac line to the lower sacrum, the base of the spine and the side of the coccyx. The upper portion of the muscle, being the larger of the two, passes across the femoral greater trochanter and inserts into the iliotibial band of the tensor fascia lata. The lower portion of the muscle inserts into the gluteal tuberosity, between the adductor magnus and vastus lateralis muscles. The gluteus maximus is considered to be one of the strongest muscles in the body (Weil 2017, Barclay 2018).

Another thick muscle, the gluteus medius, originates between the iliac crest, the posterior gluteal iliac line above and the anterior gluteal iliac line below. Approximately 30% of its posterior half is enclosed by the gluteus maximus. The g. medius inserts into a strong and flat tendon attached at the lateral surface of the greater femoral trochanter. The weakening of the gluteus medius (and/or g. minimus) can have a patient display a Trendelenburg gait. This could be a sign of severe hip dysfunction like congenital hip dislocation or arthritis (Hardcastle & Nade 1985, Macinicol & Makris 1991).

Originating from the posterior gluteal iliac line above and the anterior gluteal iliac line below (along the greater sciatic notch), the gluteus minimus is covered almost entirely by the g. medius. Its insertion is the anterior surface of the greater femoral trochanter. Variations of the muscle show it may be divided into two parts or it may have fibers attaching to the piriformis, the superior gemellus or the outer vastus lateralis (Gray 1918).

Deep Posterior Compartment

The obturator internus’ origins surround the posterior obturator foramen in the inner pelvis. From the foramen, the muscle’s fibers concentrate into a bottle-neck at the lesser sciatic foramen and continue posteriorly along the inner pelvic ischium before it wraps around to the outer posterior ischium, between the ischial spine and tuberosity. It then proceeds to traverse along the outer ischium, bordering with the fibers from both gemelli, until it inserts onto the medial great femoral trochanter, just superior to the trochanteric fossa. A few decades ago, an abscess in the obturator internus was not a thoroughly examined causation to hip pain. Since then, more research on the topic has been processed and evaluated with case studies reporting that antibiotics indeed help combat the ailment (Birkbeck & Watson 1995, Viani et al. 1998, Papadopoulos et al. 2000, Gajraj 2005).

Tensor Fascia Lata

The tensor fascia lata arises from the outer surfaces of the anterior superior iliac spine, just between the g. medius and the sartorius muscles. Its insertion attaches to the two bands of the iiotibial tract approximately at the greater femoral trochanter in the upper thigh, with the iliotibial tract inserting onto the lateral tibial condyle. Preliminary research has shown that patients with hip pathology, did not show signs of asymmetry in the structure or functional output of the tensor fascia lata when compared to healthy individuals (Grimaldi et al. 2009). The tensor fascia lata muscle is used often for reconstruction surgery (Koshima et al. 2001).

For more information about the sartorius, please visit the hip flexion summary. For a summary on the piriformis and the gemelli muscles, please visit the hip extension summary.

drawing/sketch posterior hip abductors gluteus maximus medius minimus sartorius piriformis superior inferior gemellus obturator internus femur tibia fibula

Figure 1. Sketch of Hip Abductors (Right), Posterior View.

Muscle Overview – Hip Abductors

Sartorius [1]

Origin: Anterior superior iliac spine

Insertion: Medial superior tibial shaft, distal to condyle, via pes anserinus

Additional Actions: Flexion and lateral rotation at hip joint; flexion and medial rotation at knee joint

Gluteus maximus [2]

Origin: Posterior gluteal iliac line to the lower sacrum of the pelvis, base of the spine and the side of the coccyx

Insertion: Upper fibers at the iliotibial tract of the tensor fascia lata and lower fibers at the gluteal tuberosity

Additional Actions: Medial and lateral rotation at the hip joint

Gluteus medius [3]

Origin: Beneath the gluteus maximus and between the iliac crest, posterior gluteal iliac line above and the anterior gluteal iliac line below

Insertion: Lateral surface of the greater femoral trochanter

Additional Actions: Medial and lateral rotation at the hip joint

Gluteus minimus [4]

Origin: Inferior to and beneath the gluteus medius on the gluteal iliac surface of the pelvis

Insertion: Anterior surface of the greater femoral trochanter

Additional Actions: Medial and lateral rotation at the hip joint

Piriformis [5]

Origin: Pelvic anterior sacrum, between its sagittal plane and the anterior sacral foramina

Insertion: Superior great femoral trochanter

Additional Actions: Lateral rotation and extension at the hip joint

Superior gemellus* [6]

Origin: Pelvic ischial spine, alongside the Obturator internus tendon

Insertion: Medial great femoral trochanter

Additional Actions: Lateral rotation, adduction, extension at hip joint

Inferior gemellus* [7]

Origin: Pelvis ischial tuberosity, inferior to obturator internus tendon groove

Insertion: Medial great femoral trochanter, superior to trochanteric fossa with obturator internus

Additional Actions: Lateral rotation, adduction and extension at the hip joint

Obturator internus* [8]

Origin: Surrounding the posterior obturator foramen of the pelvis

Insertion: Medial great femoral trochanter, superior to the trochanteric fossa

Additional Actions: Lateral rotation at hip joint when extended

Tensor Fascia Lata [9]

Origin: Anterior superior iliac spine

Insertion: Proximal iliotibial tract

Additional Actions: Medial rotation at the hip joint; knee joint stabilization

*Abductor during hip flexion

 

References & Works Cited

Barclay, T. 2018. “Anatomy Explorer,” innerbody.com. Accessed 19 Mar 2019. https://www.innerbody.com/anatomy/muscular/leg-foot.

Birkbeck, D., Watson, J. T. 1995. “Obturator internus pyomyositis. A case report.” Clinical Orthopaedics and Related Research 1(316): 221-226. https://europepmc.org/abstract/med/7634710.

Cheatham, S., Hanney, W. J., Kolber, M.J. 2017. “Hip Range of Motion in Recreational Weight Training Participants: A Descriptive Report,” International Journal Sports Physical Therapy 12(5): 764-773. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685413/.

Gajraj, N. M. 2005. “Botulinum Toxin  a Injection of the Obturator Internus Muscle for Chronic Perineal Pain,” Journal of Pain 6; 5: 333-337. https://doi.org/10.1016/j.jpain.2005.01.353.

Gray, H. 1918. “The Muscles and Fasciæ of the Lower Extremity,” Anatomy of the Human Body, 20th Ed. Lead & Febiger. Philadelphia & New York, USA. 474-475, 477.

Grimaldi, A., Richardson, C., Durbridge, G., Donnelly, W., Darnell, R., Hides, J. 2009. “The association between degenerative hip joint pathology and size of the gluteus maximus and tensor fascia lata muscles,” Manual Therapy 14; 6: 611-617. https://www.sciencedirect.com/science/article/abs/pii/S1356689X08001689.

Hardcastle, P., Nade, S. 1985. “The significance of the Trendelenburg test,” The Bone & Joint Journal. Nov Issue. https://doi.org/10.1302/0301-620X.67B5.4055873.

Koshima, I., Urushibara, K., Inagawa, K., Moriguchi, T. 2001. “Free tensor  fasciae latae perforator flap for the reconstruction of defects in the extremities,” Plastic and Reconstructive Surgery 107(7): 1759-1765. https://europepmc.org/abstract/med/11391196.

Macnicol, M. F., Makris, D. 1991. “Distal transfer of the greater trochanter,” The Bone & Joint Journal. Sep Issue. https://doi.org/10.1302/0301-620X.73B5.1894678.

Moses, S. 2014. “Hip Range of Motion,” Family Practice Notebook. Accessed 27 Mar 2019. https://fpnotebook.com/Ortho/Exam/HpRngOfMtn.htm.

Papadopooulos, M., Chugh, S., Fitzgerald, R., Thomas, R. J. 2000. “Obturator Internus Pyomyositis,” Orthopedics 23(4): 383-384. https://doi.org/10.3928/0147-7447-20000401-20.

Platzer, W. 2004. Color Atlas of Human Anatomy, Vol. 1: Locomotor System 5th Ed. Thieme. New York, USA.

Quinn, E. 2019. “Generally Accepted Values for Normal Range of Motion (ROM) in Joints,” verywellhealth.com. Accessed 19 Mar 2019. https://www.verywellhealth.com/what-is-normal-range-of-motion-in-a-joint-3120361.

Roaas, A., Andersson, G. B. J., 1982. “Normal Range of Motion of the Hip, Knee and Ankle Joints in Male Subjects, 30-40 Years of Age,” Acta Orthopaedica Scandinavica, 53:2, 205-208. https://www.tandfonline.com/doi/abs/10.3109/17453678208992202.

Viani, R. M., Bromberg, K., Bradley, J. S. 1998. “Obturator Internus Muscle Abscess in Children: Report of Seven Cases and Review,” Clinical Infectious Diseases 28: 117-122.

Visible Body. 2019. “Muscle Premium,” VisibleBody.com. Purchasable Application. Accessed 21 Feb 2019.

Washington State DSHS. 2014. “Range of Joint Motion Evaluation Chart,” Washington State Department of Social & Health Services. Accessed 20 Mar 2019. https://www.dshs.wa.gov/sites/default/files/FSA/forms/pdf/13-585a.pdf.

Weil, R. 2017. “What’s the Strongest Muscle in the Human Body?” Medicinenet.com. Accessed 29 Mar 2019. https://www.medicinenet.com/strongest_muscle_in_the_human_body/ask.htm.


Kevin B. Rosenbloom, C.Ped, Sports Biomechanist

Kevin B. Rosenbloom, founder and president of Kevin Orthopedic, is a renowned certified pedorthist and sports biomechanist practicing in Santa Monica, CA. With his continuing research on the historical development of foot and ankle pathologies, comparative evolution of lower extremities and the modern environmental impacts on ambulation, he provides advanced biomechanical solutions for his patients and clients.