For advanced education, exclusive content and biomechanical research. JOIN HERE

A Summary of Adduction at the Hip Joint

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

 

Hip adduction is the medial, superior raise of the thigh and leg at the hip joint, crossing the other leg and the body’s sagittal plane. The range of motion has been estimated to vary within 15-45° with a general mean of 20-30° (Roaas & Andersson 1982, Washington State DSHS 2014, Quinn 2019). The pectineus, adductors (longus, brevis, magnus), gracilis, gemelli (superior, inferior) and quadratus femoris are the most significant contributors to hip adduction (Visible Body 2019). It is important to note that other sources have suggested some contribution by the obturator externus (Platzer 2004), but the muscle’s insertion does not necessarily favor that assumption.

Anterior and Medial Compartments

The adductor group makes up the medial compartment of the thigh. The adductor longus is a flat, triangular muscle that lies on the same plane as the pectineus, above all other adductors and attaches just laterally from the pubic symphysis. As its body widens, it inserts at the femoral linea aspera, just between the vastus medialis and adductor magnus. According to Platzer, this muscle can be a partial culprit in giving assistance to hip/femoral anteversion (242).

The adductor brevis muscles are also triangular in shape and their narrow attachment is on the anterior surfaces of the superior and inferior pubic rami just between the gracilis and obturator externus. As the body of the muscle proceeds distally from its origin, deeper than the pectineus and a. longus, it attaches at the distal lesser femoral trochanter and into the proximal linea aspera on the femur. According to one study on 50 cadavers, the adductor brevis was dually innervated, potentially giving the muscle a greater energy supply (Miura et al. 1994).

Along with the other adductors, adductor magnus is triangular. However, its surface area is gigantic in size compared to the other adductors. The muscles originate from the ischial tuberosities, inferior rami and the ischium on each side of the pelvis and its proximal, upper body sits deeper to the adductor brevis when viewed from the anterior. The adductor magnus has two insertions at the adductor tubercle on the medial femoral condyle and the medial linea aspera, with a gap on the linea aspera just at the distal shaft, which separates the two insertion points. Because of this muscles’ unique shape and incomplete separation of its portions, some have considered it as two separate muscles, a. magnus and a. minimus (Platzer 2004). It is possible that the basal adductor magnus shapes in earlier tetrapods forms have left traces of ancestral fibers in the human knee (Eizenberg et al. 2008).

The gracilis is the most superficial muscle of the medial compartment and part of the pes anserinus. It is a thin, yet broad band that begins from the lateral pubic symphysis, along the inferior ramus and tapers at its distal body. Its insertions attach at the medial superior tibial shaft, distal to condyle and just beneath the sartorius’ insertions, via pes anserinus. The gracilis muscle is used in several various types of transplant surgeries (Pickrell et al. 1952, Zmora et al. 2003, Vigato et al. 2007) including facial reconstruction (John Hopkins Medicine). The topics and descriptions of the pectineus muscles are summarized in the hip flexion summary.

Posterior Compartments of the Deep Buttock

The quadratus femoris is a quadrilateral muscle that originates from the posterior border of the pelvis’ ischial tuberosities. It is deeper than the superficial hamstring origins and sits between the inferior gemellus and the upper adductor magnus. The quadratus femoris’ flat body inserts at the femoral intertrochanteric crest. Case studies of inflammation (Klinkert et al. 1997), tears (O’Brien & Bui-Mansfield 2007) or impingement (Kassarjian 2008, Torriani et al. 2009, Lee et al. 2013) of the quadratus femoris has shown that this muscle can be a contribution to groin pain in patients. The topics and descriptions regarding the superior and inferior gemelli are summarized in the hip extension summary.

anterior and posterior pelvis femur tibia and fibula heads gracilis adductor magnus longus brevis pectineus, superior and inferior gemelli, quadratus femoris sketch

Figure 1. Sketch of the right Hip Adductors, Anterior (Left) and Posterior (Right).

Muscle Overview – Hip Adductors

Pectineus [1]

Origin: Pectineal line of superior ramus of the pubis

Insertion: Posterior femur and from the distal lesser trochanter to the linea aspera

Additional Actions: Flexion and lateral rotation at hip joint

Adductor longus [2]

Origin: Anterior pubic bone, just lateral from pubic symphysis

Insertion: Femoral linea aspera, between vastus medialis and adductor magnus

Additional Actions: Medial rotation at hip joint

Adductor brevis [3]

Origin: Narrow origin on the anterior surfaces of the superior and inferior rami of pubis

Insertion: Distal lesser femoral trochanter and into the proximal linea aspera

Additional Actions: Medial rotation at hip joint

Adductor magnus [4]

Origin: Pelvic ischial tuberosity, inferior rami and the ischium

Insertion: Adductor tubercle on the medial femoral epicondyle and medial linea aspera

Additional Actions: Medial rotation at hip joint

Gracilis [5]

Origin: Just lateral of the pubic symphysis and along the inferior pubic ramus

Insertion: Medial superior tibial shaft, distal to condyle, beneath sartorius’ insertions, via pes anserinus

Additional Actions: Flexion and medial rotation at knee joint

Superior gemellus [6]

Origin: Pelvic ischial spine, alongside the Obturator internus tendon

Insertion: Medial great femoral trochanter

Additional Actions: Lateral rotation, extension at hip joint; abduction when hip is flexed

Inferior gemellus [7]

Origin: Pelvic ischial tuberosity, inferior to Obturator internus tendon groove

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

Additional Actions: Lateral rotation, extension at hip joint; abduction when hip is flexed

Quadratus femoris [8]

Origin: Posterior border of the pelvic ischial tuberosity, beneath the hamstrings

Insertion: Femoral intertrochanteric crest

Additional Actions: Lateral rotation at hip joint

References & Works Cited

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

Eizenberg, N., Briggs, C., Adams, C., Ahern, G. 2008. “Section II: Body Systems and Organ Structure,” General Anatomy: Principles and Applications, 2nd Ed. McGraw-Hill, AU. pp.53.

“Facial Reanimation: Gracilis Muscle Transplant (Free Flap),” John Hopkins Medicine. Surgery Info. Accessed 28 Mar 2019. https://www.hopkinsmedicine.org/otolaryngology/specialty_areas/facial-plastic-reconstructive/documents/Team_Instructions_Gracilis_Free_Flap_7.5.18.pdf.

Gray, H. 1918. “The Muscles and Fasciæ of the Lower Extremity,” Anatomy of the Human Body, 20th Ed. Lead & Febiger. Philadelphia & New York, USA. 466-477.

Kassarjian, A. 2008. “Signal Abnormalities in the Quadratus Femoris Muscle: Tear or Impingement?” American Journal of Roentgenology 190; 6: W379-W379. https://www.ajronline.org/doi/full/10.2214/AJR.07.3540.

Klinkert Jr., P. Porte, R. J., de Rooij, T. P. W., de Vries, A. C., 1997. “Quadratus femoris tendinitis as a cause of groin pain,” British Journal of Sports Medicine 31: 348-350. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1332577/.

Lee, S., Kim, I., Lee, S. M., Lee, J. 2013. “Ischiofemoral Impingement Syndrome,” Annals of Rehabilitation Medicine 37(1): 143-146. https://dx.doi.org/10.5535%2Farm.2013.37.1.143.

Miura, M., Nakamura, E., Kato, S., Usui, T., Miyauchi, R., 1994. “The True Nature of the Adductor Brevis Dually Innervated by the Anterior and Posterior Branches of the Obturator Nerve in Humans,” Okahimas Folia Anatomica Japonica 71; 2-3: 67-82. https://doi.org/10.2535/ofaj1936.71.2-3_67.

Moses, S. 2014. “Hip Range of Motion,” Family Practice Notebook. Accessed 27 Mar 2019.

https://fpnotebook.com/Ortho/Exam/HpRngOfMtn.htm.

O’Brien, S. D., Bui-Mansfield, L. T. 2007. “MRI of Quadratus Femoris Muscle Tear: Another Cause of Hip Pain,” American Journal of Roentgenology 189; 5: 1185-1189. https://www.ajronline.org/doi/full/10.2214/AJR.07.2408.

Pickrell, K. L., Broadbent, T. R., Masters, F. W., Metzger, J. T. 1952. “Construction of a Rectal Sphincter and Restoration of Anal Continence by Transplating the Gracilic Muscle: A Report of Four Cases in Children,” Annals of Surgery 135(6): 853-862. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1802208/.

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.

Torriani, M., Souto, S. C. L., Thomas, B. J., Ouellette, H., Bredella, M. A. 2009. “Ischiofemoral Impingement Syndrome: An Entity With Hip Pain and Abnormalities of the Quadratus Femoris Muscle,” American Journal of Roentgenology 193; 1: 186-190. https://www.ajronline.org/doi/full/10.2214/AJR.08.2090.

Vigato, E., Macchi, V., Tiengo, C., Azzena, B., Porzionato, A., Morra, A., Stecco, C., Dodi, G., Mazzoleni, F., De Caro, R. 2007. “The clinical role of the gracilis muscle: an example of multidisciplinary collaboration,” Pelviperineology 26; 4. http://www.pelviperineology.org/coloproctology/gracilis_muscle_clinical_role.html.

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.

Zmora, O., Potenti, F. M., Wexner, S. D., Pikarsky, A. J., Efron, J. E., Nogueras, J. J., Pricolo, V. E., Weiss, E. G. 2003. “Gracilis Muscle Transposition for Iatrogenic Rectourethral Fistula,” Annals of Surgery 237(4): 483-487. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1514481/.

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.