Medial Rotators Of Hip Joint

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The medial rotators of the hip joint consist of the tensor fasciae latae, gluteus minimus and gluteus medius (anterior fibers).

Patient: Sitting on a table, with the knees bent over the side and the subject holding on to the table.

Fixation: The weight of the trunk stabilizes the patient during this test. Stabilization is also given in the form of counterpressure, as described below under Pressure.

Test: Medial rotation of the thigh, with the leg in a position of completion of the outward arc of motion.

Pressure: With one hand, the examiner applies counter-pressure at the medial side of the lower end of the thigh. With the other hand, the examiner applies pressure to the lateral side of the leg, above the ankle, pushing the leg inward in an effort to rotate the thigh laterally.

Weakness: Results in lateral rotation of the lower extremity in standing and walking.

Contracture: Medial rotation of the hip, with in-toeing and a tendency toward knock-knee in weight bearing.

Shortness: Inability to laterally rotate the thigh through the full range of motion, and inability to sit in a cross-legged position (i.e., tailor fashion).

Note: If the rotator test is done in a supine position, the pelvis will tend to tilt anteriorly if much pressure is applied, but this is not a substitution movement. Because of its attachments, the tensor fasciae latae, when contracting to maximum, pulls forward on the pelvis as it medially rotates the thigh.

Obturator ■ internus

Lateral Rotatio

Quadratus femoris

Piriformis Superior View

Obturator ■ internus

Quadratus femoris

Piriformis Superior View

PIRIFORMIS

Origin: Pelvic surface of the sacrum between (and lateral to) the first through fourth pelvic sacral foramina, margin of the greater sciatic foramen and pelvic surface of the sacrotuberous ligament.

Insertion: Superior border of the greater trochanter of the femur.

QUADRATUS FEMORIS

Origin: Proximal part of the lateral border of the tuberos-ity of the ischium.

Insertion: Proximal part of the quadrate line, extending distally from the intertrochanteric crest.

OBTURATOR INTERNUS

Origin: Internal or pelvic surface of the obturator membrane and margin of the obturator foramen, pelvic surface of the ischium posterior and proximal to the obturator foramen, and to a slight extent, the obturator fascia.

Insertion: Medial surface of the greater trochanter of the femur, proximal to the trochanteric fossa.

OBTURATOR EXTERNUS

Origin: Rami of the pubis and ischium, and extern surface of the obturator membrane.

Insertion: Trochanteric fossa of the femur.

Nerve: Obturator, L3, 4.

GEMELLUS SUPERIOR

Origin: External surface of the spine of the ischium-

Insertion: With the tendon of the obturator intemus, into the medial surface of the greater trochanter of the femur.

GEMELLUS INFERIOR

Origin: Proximal part of the tuberosity of the ischium-

Insertion: With the tendon of the obturator intemus, into the medial surface of the greater trochanter of the femur.

LATERAL ROTATORS OF HIP JOINT

All the muscles cited on this page laterally rotate the hip joint. In addition, the obturator externus may assist in adduction of the hip joint, and the piriformis, obturator intemus, and gemelli may assist in abduction when the hip is flexed. The piriformis may assist in extension.

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