ArticlesAnatomyLower limbHip and thighPosterior hip musculature

ArticlesAnatomyLower limbHip and thighPosterior hip musculature

Posterior hip musculature

Author: Achudhan Karunaharamoorthy, MD • Reviewer: Dimitrios Mytilinaios, MD, PhD
Last reviewed: October 30, 2023
Reading time: 6 minutes

The posterior hip musculature comprises a group of muscles extending from the pelvic bone to the femur. These muscles are important for the stabilization of the pelvis during constant mechanical stress that it suffers. Also, the posterior hip muscles produce a movements within the hip joint, such are abduction, adduction, outward rotation and retroversion.

The hip joint is prone to injuries, especially in older people, whether it is due to some degenerative processes such as osteoporosis, or various accidental and pathological fractures. Strong and trained posterior hip muscles reduce the risk from the mechanical injuries.

Key facts
Posterior hip muscles	Obturator externus muscle Obturator internus muscle Superior gemellus muscle Inferior gemellus muscle Piriformis muscle Quadratus femoris muscle
Innervation	All supplied by direct branches of the sacral plexus, except the external obturator that is supplied by the obturator nerve (branch of the lumbar plexus)
Overall function	Stabilization of the pelvis and outward rotation of the hip joint

This article will discuss the anatomy and function of the posterior hip muscles.

Contents

Anatomy
Function
Clinical notes
Sources

+ Show all

Anatomy

Origins and insertion

During their course they cross the hip joint dorsally. At the femur they all insert either at or near the greater trochanter which is why they are also referred to as the pelvitrochanteric muscles.

Muscles

In detail they consist of:

Piriformis muscle - It runs from the anterior side of the sacral bone (facies pelvica) to the apex of the greater trochanter.

Key facts about the piriformis muscle
Origins	Anterior (pelvis) surface of the sacrum (between the S2 and S4), Gluteal surface of ilium near posterior inferior iliac spine (and sacrotuberous ligament)
Insertions	(Apex of) Greater trochanter of the femur
Innervartion	Nerve to piriformis (S1-S2)
Function	Hip joint: Thigh external rotation, Thigh abduction (from flexed hip); Stabilizes head of femur in acetabulum

Obturator externus muscle - The origin or proximal attachment of this muscle is found at the anterior surface of the obturator membrane, and bony boundaries of the obturator foramen. It inserts at the trochchanteric fossa of the femur.

Key facts about the obturator externus muscle
Origins	Anterior surface of obturator membrane, Bony boundaries of obturator foramen
Insertions	Trochanteric fossa of femur
Innervartion	Obturator nerve (L3, L4)
Function	Hip joint: Thigh external rotation, Thigh abduction (from flexed hip); Stabilizes head of femur in acetabulum

Obturator internus muscle - This muscles extends from ischiopubic ramus and posterior surface of the obturator membrane, to the medial surface of the greater trochanter of femur.

Key facts about the obturator internus muscle
Origins	Ischiopubic ramus, Posterior surface of obturator membrane
Insertions	Medial surface of greater trochanter of femur
Innervartion	Nerve to obturator internus (L5-S2)
Function	Hip joint: Thigh external rotation, Thigh abduction (from flexed hip); Stabilizes head of femur in acetabulum

Superior and inferior gemelli muscles - The superior gemellus muscle originates from the ischiadic spine whereas the inferior gemellus muscle has its origin at the ischial tuberosity. Both insert at the trochanteric fossa.

Key facts about the superior and inferior gemelli muscles
Superior gemellus muscle	Origins: Ischial spine Insertions: Medial surface of greater trochanter, (via tendon of obturator internus) Innervation: Nerve to obturator internus (L5-S2) Function: Hip joint: Thigh external rotation, Thigh abduction (from flexed hip); Stabilizes head of femur in acetabulum
Inferior gemellus muscle	Origins: Ischial tuberosity Insertions: Medial surface of greater trochanter, (via tendon of obturator internus) Innervation: Nerve to obturator internus (L5-S2) Function: Hip joint: Thigh external rotation, Thigh abduction (from flexed hip); Stabilizes head of femur in acetabulum

Quadratus femoris muscle - It runs from the ischial tuberosity to the intertrochanteric crest of the femur.

Key facts about the quadratus femoris muscle
Origins	(Lateral border of) Ischial tuberosity
Insertions	(Quadrate tubercle on) Intertrochanteric crest of femur
Innervation	Nerve to quadratus femoris (L4-S1)
Function	Hip joint: Thigh external rotation; Stabilizes head of femur in acetabulum

Innervation

The posterior hip muscles are innervated by direct branches of the sacral plexus – with the exception of the external obturator muscle.

Function

The main tasks of the posterior hip muscles are the stabilization of the pelvis and the external/lateral rotation of the hip joint. In addition particular muscles may support further hip movements: abduction (piriformis musclemuscle, external obturator muscle, gemelli muscles), adduction (quadratus femoris muscle) and retroversion (piriformis muscle, internal obturator muscle, gemelli muscles).

Clinical notes

Common causes for the insufficiency of the posterior hip muscles are fractures of the greater trochanter (e.g. by falling on the side), femoral neck fractures (often associated with osteoporosis in elderly) and ruptures during the implantation of a total hip endoprosthesis.

Every type of elevated trochanter (e.g. in coxa vara or hip dysplasia) and leg length discrepancies may lead to a weakening in the long term. Symptoms include local pain, limping up to the inability to walk.

Sources

All content published on Kenhub is reviewed by medical and anatomy experts. The information we provide is grounded on academic literature and peer-reviewed research. Kenhub does not provide medical advice. You can learn more about our content creation and review standards by reading our content quality guidelines.

References:

D. Drenckhahn/J. Waschke: Taschenbuch Anatomie, 1.Auflage, Urban & Fischer Verlag/Elsevier (2008), S.80
M. Schünke/E. Schulte/U. Schumacher: Prometheus – LernAtlas der Anatomie – Allgemeine Anatomie und Bewegungssystem, 2.Auflage, Thieme Verlag (2007), S.472-475
W. Graumann/ D.Sasse: CompactLehrbuch der gesamten Anatomie – Band 2 – Bewegungsapparat, Schattauer Verlag (2003), S.130-132 D.
Neumann: Differenzialdiagnostik des Leisten- und Hüftschmerzes. In: Universimed. (http://orthopaedie-unfallchirurgie.universimed.com/artikel/differenzialdiagnostik-des-leisten-und-h%C3%BCftschmerzes)
K. Richter: Trochanterhochstand. In: Engelhardt - Lexikon Orthopädie und Unfallchirurgie. Springer Medizin (http://www.lexikon-orthopaedie.com/pdx.pl?dv=0&id=02036)

Illustrators:

Piriformis muscle (dorsal view) - Liene Znotina
Obturator internus muscle (dorsal view) - Liene Znotina
Inferior gemellus muscle (dorsal view) - Liene Znotina
Quadratus femoris muscle (dorsal view) - Liene Znotina

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