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A Summary of Lateral Rotation at the Hip Joint

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

 

Hip lateral rotation is the outward rotation of the thigh and leg (along the transverse plane) at the hip joint. The range of motion has been estimated to be between 10-55° with a mean approximately at 32-34° (Roaas & Andersson 1982, Cheatham et al. 2017). The sartorius, pectineus, obturator internus and externus, both gemelli, the gluteal group (maximus, medius, minimus), piriformis and quadratus femoris are the most significant contributors to lateral rotation (Visible Body 2019). It is important to note that other sources have suggested some contribution from the psoas muscles.

Obturator externus

The obturator externus’ origins are partially from the obturator membrane and primarily on the medial side of the obturator foramen. Its triangular shape covers the outer surface of the anterior pelvis (main and inferior surface of rami). Its flat body travels along the pelvis, beneath the acetabulum of the hip joint and inserts into the femoral trochanteric fossa.

Recently, variations of the obturator externus have been observed more frequently. A supernumerary muscle that somewhat mimics the external obturator has been found between the adductor brevis and adductor minimus, a portion of a. magnus. This muscle’s origins begin at the upper portion of the inferior pubic ramus and run downwards and laterally. Although its insertion can run into the a. minimus’ aponeurosis, it has been found that it can also insert into the superior pectineal line or the posterior portion of the lesser femoral trochanter (Nakamura et al. 1992). Ontogenetic variations of the external obturator have also begun to be documented (Yatsunami et al. 2004).

Just like the o. internus, the obturator externus is susceptible to abscess growth. In most cases magnetic resonance (MR) imaging is the most efficient way to detect the source of the problem (King et al. 2003, Kumar & Anderson 2008). However, initial scans in a specific case proved to be not provide helpful identification of the complications (King et al. 2003).

Previous Muscles

It is quite clear that the mechanisms that form the body, especially the portions of the lower extremities, are complex, with even single organisms capable of displaying multiple functions. Several muscles in the pelvic region have multiple functions and have been briefly discussed in other Kevin Orthopedic summaries. In order to avoid monotony, it is suggested to review the summaries below for additional information on other lateral rotator muscles:

Sartorius & Pectineus – Hip Flexion

Piriformis & Gemellus superior/inferior – Hip Extension

Quadratus femoris – Hip Adduction

Gluteal group & Obturator internus – Hip Abduction

Sketch of Pelvis Femur Tibia Fibula Gluteus maximus medius minimus sartorius pectineus obturator externus internus gemellus superior inferior quadratus femoris

 

 

Figure 1. Sketch of the right Hip Lateral Rotators, Anterior (left) and Posterior (right).

Muscle Overview – Hip Lateral Rotator

Sartorius [1]

Origin: Anterior superior iliac spine

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

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

Pectineus [2]

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 adduction at hip joint

Obturator externus [3]

Origin: Medial outline of the pelvic obturator foramen

Insertion: Trochanteric femoral fossa

Additional Actions: Stabilizes pelvis

Gluteus maximus [4]

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 rotation and abduction at the hip joint

Gluteus medius [5]

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 rotation and abduction at the hip joint

Gluteus minimus [6]

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 rotation and abduction at the hip joint

Piriformis [7]

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

Insertion: Superior great femoral trochanter

Additional Actions: abduction and extension at the hip joint

Superior gemellus [8]

Origin: Pelvic ischial spine, alongside the Obturator internus tendon

Insertion: Medial great femoral trochanter

Additional Actions: Adduction at hip joint; abduction when hip is flexed

Obturator internus* [9]

Origin: Surrounding the posterior obturator foramen of the pelvis

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

Additional Actions: Abduction when hip is flexed

Inferior gemellus [10]

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

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

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

Quadratus femoris [11]

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

Insertion: Intertrochanteric femoral crest

Additional Actions: Adduction at hip joint

*Lateral rotator during hip extension

 

References & Works Cited

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

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/.

Gray, H. 1918. “The Muscles and Fasciæ of the Lower Extremity,” Anatomy of the Human Body, 20th Ed. Lead & Febiger. Philadelphia & New York, USA. 473, 475, 477-478.

King, R. J., Laugharne, D., Kerslake, R. W., Holdsworth, B. J. 2003. “Case report: Primary obturator pyomyositis: A diagnostic challenge,” The Journal of Bone & Joint Surgery (Br) 85-B: 895-8. https://doi.org/10.1302/0301-620X.85B6.13824.

Kumar, A., Anderson, D. 2008. “Primary Obturator Externus Pyomyositis in a Child Presenting as Hip Pain: A Case Report,” Pediatric Emergency Care 24; 2: 97-98. https://journals.lww.com/pec-online/Abstract/2008/02000/Primary_Obturator_Externus_Pyomyositis_in_a_Child.6.aspx.

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

Nakamura, E., Masumi, S., Miura, M., Kato, S., Miyauchi, R. 1992. “A supernumerary muscle between the adductors brevis and minimus in humans,” Okajimas Folia Anatomica Japonica 69(2-3): 89-98. https://www.ncbi.nlm.nih.gov/pubmed/1436954.

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.

Robinson, P., White, L. M., Agur, A., Wunder, J., Bell, R. S. 2003. “Obturator Externus Bursa: Anatomic Origin and MR Imaging Features of Pathologic Involvement1,” Radiology 228: 230-234. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.652.1877&rep=rep1&type=pdf.

Yatsunami, M., Tai, T., Irie, Y., Ogawa, K., Miyauchi, R. 2003. “A Morphological Study on the Human Obturator Externus Muscle with Reference to Anomalous Muscle and Anomalous Fasciculus Originating from the Obturator Externus Muscle,” Okajimas Folia Anatomica Japonica 80(5-6): 103-114. https://doi.org/10.2535/ofaj.80.103.

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

 

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.