Hip Joint: Anatomy

Bony Structure of the Hip Joint

The hip joint is a multi-axial joint that connects the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy to the lower extremities. As compared with the glenohumeral joint (shoulder), the hip has less range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs and is designed primarily for weight bearing and stability.

• Type: ball-and-socket diarthrodial joint
• Articular surfaces: 
  • Head of the femur
  • Acetabulum of the hip bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types (acetabular labrum: a ring of cartilage Cartilage Cartilage is a type of connective tissue derived from embryonic mesenchyme that is responsible for structural support, resilience, and the smoothness of physical actions. Perichondrium (connective tissue membrane surrounding cartilage) compensates for the absence of vasculature in cartilage by providing nutrition and support. Cartilage: Histology that increases the depth and stability of the articular surface)
• Supporting structures:
  • Fibrous Fibrous Fibrocystic Change capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides
  • Intra-articular and extra-articular ligaments
  • Iliopectineal, trochanteric, and ischial bursae
• Functions:
  • Connects the axial Axial Computed Tomography (CT) skeleton to the lower limbs
  • Bears weight during static (i.e. standing) and dynamic (i.e. walking and running) conditions
  • Allows for flexion-extension, lateral-medial rotation Rotation Motion of an object in which either one or more points on a line are fixed. It is also the motion of a particle about a fixed point. X-rays, abduction-adduction, and circumduction of the thigh Thigh The thigh is the region of the lower limb found between the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into 3 fascial compartments. Thigh: Anatomy

Supporting Structures of the Hip Joint

Articular capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides

Consists of 2 layers:

1. Fibrous Fibrous Fibrocystic Change capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides:
   • The external layer of the capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides
   • Attaches proximally to the acetabulum, close to the rim
   • Attaches distally around the proximal end of the femur:
     • Anteriorly, to the intertrochanteric line (thickest area)
     • Superiorly, to the base of the femoral neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess (thickest area)
     • Posteriorly, about 1 cm from the intertrochanteric crest
     • Inferiorly, on the femoral neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess close to the lesser trochanter 
   • Has deep circular fibers that form a collar around the femoral neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess, called the zona orbicularis (or annular Annular Dermatologic Examination ligament) 
2. Synovial membrane:
   • The internal layer of the capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides
   • Produces synovial fluid, a viscous substance that lubricates and circulates nutrients to the joint
   • Originates at the margin of the articular surface of the femoral head, covers a portion of the femoral neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess, is reflected on the internal surface of the capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides, reaches the fat tissue contained in the acetabular fossa, and encloses the ligament of the head of the femur

Ligaments

Can be divided into 2 groups:

1. Intra-articular: 
   • Ligament of the femoral head or round ligament Round ligament A fibromuscular band that attaches to the uterus and then passes along the broad ligament, out through the inguinal ring, and into the labium majus. Uterus, Cervix, and Fallopian Tubes: Anatomy of the femur: carries the artery to the femoral head
   • Transverse ligament of the acetabulum
2. Extra-articular ligaments, which support the capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides:
   • Iliofemoral or “Y ligament of Bigelow”: strongest ligament of the human body
   • Pubofemoral: prevents over-abduction
   • Ischiofemoral ligaments: prevent over-extension

Bursae

Bursae are small, synovial fluid-filled sacs that reduce friction between the bony components of the joint and the surrounding muscles. 

• Trochanteric bursa: between the greater trochanter and the iliotibial tract Iliotibial tract Thigh: Anatomy
• Ischial bursa: between the ischial tuberosity Ischial Tuberosity Chronic Apophyseal Injury and the gluteus maximus Gluteus maximus Gluteal Region: Anatomy 
• Subgluteus medius bursa: between the superior surface of the greater trochanter and the gluteus medius Gluteus medius Gluteal Region: Anatomy
• Subgluteus minimus bursa: between the superior surface of the greater trochanter and the gluteus minimus Gluteus minimus Gluteal Region: Anatomy
• Iliopectineus or iliopsoas bursa:
  • The largest bursa of the human body
  • Located between the fibrous Fibrous Fibrocystic Change capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides of the hip and the iliopsoas

Flexor Muscles of the Hip Joint

The primary flexor muscles of the hip are the iliopsoas and rectus femoris Rectus femoris Thigh: Anatomy.

Extensor Muscles of the Hip Joint

The primary extensor muscle of the hip is the gluteus maximus Gluteus maximus Gluteal Region: Anatomy, assisted by the biceps femoris Biceps femoris Thigh: Anatomy, semitendinosus Semitendinosus Thigh: Anatomy, and semimembranosus Semimembranosus Thigh: Anatomy muscles.

Abductor Muscles of the Hip Joint

Adductor Muscles of the Hip Joint

External Rotator Muscles of the Hip Joint

Neurovasculature of the Hip

Blood supply

The arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology that supply the hip joint originate from the common iliac artery, which bifurcates into the internal and external iliac arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology.

• Internal iliac artery—divides into a posterior trunk and the anterior trunk, which has multiple branches:
  • Gluteal arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology: superior and inferior branches
  • Obturator artery: gives rise to the artery of the head of the femur within the ligament of the head of the femur
• External iliac artery—becomes the femoral artery Femoral Artery The main artery of the thigh, a continuation of the external iliac artery. Femoral Region and Hernias: Anatomy after passing under the inguinal ligament Inguinal Ligament Femoral Region and Hernias: Anatomy:
  • Profunda femoris, a deep branch of the femoral artery Femoral Artery The main artery of the thigh, a continuation of the external iliac artery. Femoral Region and Hernias: Anatomy, provides blood supply to the hip joint along with its branches:
    • Medial circumflex femoral artery Femoral Artery The main artery of the thigh, a continuation of the external iliac artery. Femoral Region and Hernias: Anatomy (MCFA)
    • Lateral circumflex femoral artery Femoral Artery The main artery of the thigh, a continuation of the external iliac artery. Femoral Region and Hernias: Anatomy (LCFA)
• The branches of the internal iliac (inferior gluteal) and the external iliac (profunda femoris) arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology form an important connection at the hip: the cruciate anastomosis.

The veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins: Histology of the hip joint accompany the arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology in trajectory and name.

Innervation

The femoral and obturator nerves, arising from the lumbar plexus (T12–L4), and multiple smaller nerves arising from the sacral plexus Sacral plexus Pelvis: Anatomy (L4– S4 S4 Heart Sounds), innervate the hip joint. 

• Anterior/medial thigh Thigh The thigh is the region of the lower limb found between the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into 3 fascial compartments. Thigh: Anatomy:
  • Femoral nerve Femoral Nerve A nerve originating in the lumbar spinal cord (usually L2 to L4) and traveling through the lumbar plexus to provide motor innervation to extensors of the thigh and sensory innervation to parts of the thigh, lower leg, and foot, and to the hip and knee joints. Femoral Region and Hernias: Anatomy (L2–L4): innervates the anterior thigh Thigh The thigh is the region of the lower limb found between the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into 3 fascial compartments. Thigh: Anatomy muscles and anterior aspect of the hip joint 
  • Obturator nerve Obturator Nerve A nerve originating in the lumbar spinal cord (L2 to L4) and traveling through the lumbar plexus to the lower extremity. The obturator nerve provides motor innervation to the adductor muscles of the thigh and cutaneous sensory innervation of the inner thigh. Thigh: Anatomy (L2–L4): primarily innervates the adductor muscles and inferior aspect of the joint
  • Saphenous nerve Saphenous nerve Foot: Anatomy: the terminal cutaneous branch of the femoral nerve Femoral Nerve A nerve originating in the lumbar spinal cord (usually L2 to L4) and traveling through the lumbar plexus to provide motor innervation to extensors of the thigh and sensory innervation to parts of the thigh, lower leg, and foot, and to the hip and knee joints. Femoral Region and Hernias: Anatomy
• Posterior thigh Thigh The thigh is the region of the lower limb found between the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into 3 fascial compartments. Thigh: Anatomy/ gluteal region Gluteal region The gluteal region is located posterior to the pelvic girdle and extends distally into the upper leg as the posterior thigh. The gluteal region consists of the gluteal muscles and several clinically important arteries, veins, and nerves. The muscles of the gluteal region help to move the hip joint during walking, running, standing, and sitting. Gluteal Region: Anatomy:
  • Sciatic nerve Sciatic Nerve A nerve which originates in the lumbar and sacral spinal cord (l4 to s3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. Gluteal Region: Anatomy (L4– S3 S3 Heart Sounds): passes through the greater sciatic foramen to the gluteal region Gluteal region The gluteal region is located posterior to the pelvic girdle and extends distally into the upper leg as the posterior thigh. The gluteal region consists of the gluteal muscles and several clinically important arteries, veins, and nerves. The muscles of the gluteal region help to move the hip joint during walking, running, standing, and sitting. Gluteal Region: Anatomy; the sciatic nerve Sciatic Nerve A nerve which originates in the lumbar and sacral spinal cord (l4 to s3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. Gluteal Region: Anatomy is the longest and widest nerve in the body
  • Superior gluteal nerve Superior gluteal nerve Gluteal Region: Anatomy (L4– S1 S1 Heart Sounds): innervates the gluteus medius Gluteus medius Gluteal Region: Anatomy, gluteus minimus Gluteus minimus Gluteal Region: Anatomy, and tensor fascia Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests muscles, nerves, and other organs. Cellulitis latae muscles, and the superior aspect of the joint
  • Inferior gluteal nerve Inferior gluteal nerve Gluteal Region: Anatomy (L5– S2 S2 Heart Sounds): innervates the gluteus maximus Gluteus maximus Gluteal Region: Anatomy muscle
  • Quadratus femoris Quadratus femoris Gluteal Region: Anatomy nerve: innervates the posterior aspect of the joint, inferior gemellus Inferior gemellus Gluteal Region: Anatomy muscle, and quadratus femoris Quadratus femoris Gluteal Region: Anatomy muscle

Clinical tip: The knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint: Anatomy is also innervated by the femoral, obturator, and sciatic nerves, explaining the pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways referral patterns from the knee to the hip.

Clinical Relevance

The following are clinically relevant to the hip joint and region:

• Legg-Calve-Perthes disease: also known as idiopathic Idiopathic Dermatomyositis avascular Avascular Corneal Abrasions, Erosion, and Ulcers necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage of the proximal femoral head, characterized by idiopathic Idiopathic Dermatomyositis avascular Avascular Corneal Abrasions, Erosion, and Ulcers necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage of the femoral head. Legg-Calve-Perthes disease presents as a limp with an insidious onset and associated hip pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways.
• Slipped capital femoral epiphysis Slipped Capital Femoral Epiphysis Slipped capital femoral epiphysis (SCFE) is an orthopedic disorder of early adolescence characterized by the pathologic “slipping” or displacement of the femoral head, or epiphysis, on the femoral neck. Slipped Capital Femoral Epiphysis: an orthopedic disorder of early adolescence characterized by the pathologic “slipping” or displacement Displacement The process by which an emotional or behavioral response that is appropriate for one situation appears in another situation for which it is inappropriate. Defense Mechanisms of the femoral head, or epiphysis Epiphysis The head of a long bone that is separated from the shaft by the epiphyseal plate until bone growth stops. At that time, the plate disappears and the head and shaft are united. Bones: Structure and Types, on the femoral neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess. 
• Hip fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures: classified according to the fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures‘s anatomic location as intracapsular or extracapsular. A low-impact fall is the typical mechanism of injury in the elderly, often associated with osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis. Motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology vehicle accidents and other high-velocity trauma are common in younger individuals.
• Fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures and necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage of the femoral neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess: If the fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures is secondary to trauma or osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis, the blood supply of the femoral head can be compromised, which may lead to post-traumatic avascular Avascular Corneal Abrasions, Erosion, and Ulcers necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage.
• Hip dislocation: mostly commonly occurs in cases of high-energy trauma, such as motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology vehicle accidents. Posterior dislocation (90%) is the most common, and the extremity generally presents as adducted and internally rotated. Hip dislocations may be associated with avascular Avascular Corneal Abrasions, Erosion, and Ulcers necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage and sciatic nerve Sciatic Nerve A nerve which originates in the lumbar and sacral spinal cord (l4 to s3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. Gluteal Region: Anatomy injury.
• Hip dysplasia: an innate or acquired malformation of the hip generally seen in newborns. Characterized by hip instability, resulting in subluxation Subluxation Radial Head Subluxation (Nursemaid’s Elbow) or dislocation. Early diagnosis is essential because late diagnosis may result in irreversible damage to the joint, which may lead to a painful hip and abnormal gait Gait Manner or style of walking. Neurological Examination. 
• Osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis: characterized by hyaline articular cartilage Cartilage Cartilage is a type of connective tissue derived from embryonic mesenchyme that is responsible for structural support, resilience, and the smoothness of physical actions. Perichondrium (connective tissue membrane surrounding cartilage) compensates for the absence of vasculature in cartilage by providing nutrition and support. Cartilage: Histology loss but also involves changes to the subchondral bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types, synovium, and surrounding joint structures. Osteoarthritis Osteoarthritis Osteoarthritis (OA) is the most common form of arthritis, and is due to cartilage destruction and changes of the subchondral bone. The risk of developing this disorder increases with age, obesity, and repetitive joint use or trauma. Patients develop gradual joint pain, stiffness lasting < 30 minutes, and decreased range of motion. Osteoarthritis is the most common form of arthritis Arthritis Acute or chronic inflammation of joints. Osteoarthritis, and is principally a disease of aging. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship experience a loss of range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs and a painful joint.
• Piriformis syndrome Piriformis syndrome A chronic pelvic pain characterized by pain deep in the buttock that may radiate to posterior aspects of the leg. It is caused by the piriformis muscle compressing or irritating the sciatic nerve due to trauma, hypertrophy, inflammation or anatomic variations. Examination of the Lower Limbs: also called deep gluteal syndrome or wallet neuritis, is characterized by a combination of symptoms involving the hip, buttock, and upper thigh Thigh The thigh is the region of the lower limb found between the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into 3 fascial compartments. Thigh: Anatomy. Described as peripheral neuritis of the sciatic nerve Sciatic Nerve A nerve which originates in the lumbar and sacral spinal cord (l4 to s3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. Gluteal Region: Anatomy and may be related to irritation of the sciatic nerve Sciatic Nerve A nerve which originates in the lumbar and sacral spinal cord (l4 to s3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. Gluteal Region: Anatomy at the level of the piriformis Piriformis Vagina, Vulva, and Pelvic Floor: Anatomy muscle. May be caused by trauma, hematoma Hematoma A collection of blood outside the blood vessels. Hematoma can be localized in an organ, space, or tissue. Intussusception, excessive sitting, and anatomic variations of the muscle and nerve. 
• Trendelenburg gait Trendelenburg Gait Legg-Calvé-Perthes Disease: abnormal gait Gait Manner or style of walking. Neurological Examination secondary to weakness of the hip abductors, primarily the gluteus medius Gluteus medius Gluteal Region: Anatomy and gluteus minimus Gluteus minimus Gluteal Region: Anatomy muscles, which are essential to maintaining the balance of the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy during the gait Gait Manner or style of walking. Neurological Examination cycle. Weakness of the hip abductors causes a drop of the contralateral pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy while walking, or Trendelenburg gait Trendelenburg Gait Legg-Calvé-Perthes Disease.