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Nerve-Supply.--Obturator nerve (L. 2. 3.).
Actions. The muscle adducts and assists in flexing the thigh.

M. Adductor Brevis. The adductor brevis is a large muscle which arises from an elongated oval surface on the front of the body and upper part of the inferior ramus of the pubic bone, surrounded by the other muscles of this group (Fig. 366).

Directed distally and laterally the muscle expands, to be inserted, by a short aponeurotic tendon, behind the insertion of the pectineus, into the distal twothirds of the line leading from the lesser trochanter of the femur to the linea aspera, and to the proximal fourth of the linea aspera itself (Fig. 365, p. 410).

Nerve-Supply.--Obturator nerve (L. 2. 3. 4.).
Actions. The muscle adducts and flexes the thigh.

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Fig. 366.-MUSCLE-ATTACHMENTS TO THE OUTER SURFACE OF THE RIGHT PUBIS AND ISCHIUM.

M. Adductor Magnus.—The adductor magnus, the largest of the adductor group, is a roughly triangular muscle. It arises, mainly by fleshy fibres, by a curved origin from the lower part of the lateral border and a large portion of the adjoining inferior surface of the sciatic tuberosity, from the edge of the inferior ramus of the ischium, and from the anterior surface of the inferior ramus of the pubic bone, its most anterior fibres arising between the obturator externus and adductor brevis (Fig. 366). Its upper fibres are directed horizontally and laterally from the pubic bone towards the proximal part of the femur; the lowest fibres are directed distally from the sciatic tuberosity to the medial condyle of the femur; while the intermediate fibres radiate obliquely laterally and distally.

The muscle is inserted by tendinous fibres (1) into the space distal to the insertion of the quadratus femoris, proximal to the linea aspera; (2) into the

whole length of the linea aspera; (3) into the medial epicondylic line of the femur; (4) into the adductor tubercle on the medial condyle of the femur ;

and (5) into the medial intermuscular septum (Fig. 365, p. 410). The part of ! the muscle attached to the space proximal to the linea aspera is often separated

from the rest as the adductor minimus. The attachment of the muscle to the epicondylic ridge is interrupted for the passage of the femoral vessels into the popliteal fossa. The attachment to the medial condyle is by means of a strong tendon which receives the fibres arising from the ischium (the part of the muscle associated with the hamstring group). This tendon is closely connected with the tibial collateral ligament of the knee-joint.

The muscle is covered, anteriorly, by the other adductors and by the sartorius muscle. The profunda femoris artery separates it from the adductor longus muscle,

[graphic]

Obturator nerve.

GLUTÆUS MAXIMUS

Pelvic fascia

OBTURATOR INTERNUS

OBTURATOR EXTERNUS

Branch to hip-joint

Deep branch

Superficial branch
Descending muscular branches

PECTINEUS
Ascending branch to obturator

externus
Medial circumflex artery

Deep branch of medial circum-
flex artery of femur

QUADRATUS FEMORIS
Superficial branch of medial
circumflex artery
-Descending muscular branches
ADDUCTOR MAGNUS

-Branch to knee-joint

Branch to femoral artery

GRACILIS
FIG. 367.-SCHEME OF THE COURSE AND DISTRIBUTION OF THE Right. OBTURATOR NERVE,

while the femoral artery is in contact with the muscle as it pursues its course through the adductor canal. The posterior surface of the muscle is in relation with the hamstring muscles.

Nerve-Supply.-The adductor magnus is a double muscle, and has a double nerve-supply. The medial part of the muscle extending between the tuber ischiadicum and the medial condyle of the femur, associated with the hamstring group of muscles, derives its nerve from the nerve to the hamstring muscles, from the tibial nerve (L. 4. 5. S. 1.). This enters the muscle on its posterior surface.

The adductor portion of the muscle is supplied on its anterior surface by the deep branch of the obturator nerve (L. 3. 4.).

Actions. The adductor magnus is an adductor and extensor of the thigh.

M. Obturator Externus.—The obturator externus is placed deeply, under cover of the previous muscles. It is a fan-shaped muscle lying horizontally in the angle between the hip bone and the neck of the femur.

It arises from the surfaces of the pubic bone and ischium, which form the inferior half of the margin of the obturator foramen, and from the corresponding portion of the superficial surface of the obturator membrane (Figs. 366, p. 412 and 367, p. 413). Its fibres converge towards the greater trochanter, and end in a stout tendon

which, after passing distal to

and posterior to the hip-joint, Sacro-tuber. is inserted into the trochan. ous liga- teric fossa of the greater tro_GLUTÆUS chanter of the femur (Figs. MAXIMUS

365, p. 410, and 373, p. 417).
OBTURATOR
INTERNUS
BICEPS AND Nerve-Supply.—The deep part

of the obturator nerve (L. 3. 4.).

Actions. This muscle is mainly

a lateral rotator of the thigh ; it QUADRATUS also flexes and adducts it.

[graphic]

Trigonum Femorale.— The femoral triangle (O.T. Scarpa's triangle) is a large triangular space on the front

of the thigh in its proximal ADDUCTOR third, which contains the

femoral vessels in the proximal part of their course and the femoral nerve. It is bounded above by the inguinal liga

ment, laterally by the sartorius Fascia lata and medially by the medial border of

the adductor longus muscle. Its floor is formed laterally by the ilio-psoas, and

medially by the pectineus, adductor -GRACILIS

longus, and a small part of the adductor brevis.

Canalis Adductorius Hunteri.

The adductor canal (O.T. Hunter's BICEPS canal) lies in the middle third of the (short head) medial side of the thigh, and contains the

femoral vessels in the distal part of their course. It is bounded superficially by the

sartorius, under which is a dense fascia BICEPS Clong head) derived from the fascia lata, binding to

gether the vastus medialis, which forms the lateral wall of the canal, and the adductors, longus and magnus, which form the medial wall or floor of the canal. Besides the femoral vessels and their sheath, the canal contains the saphenous nerve.

THE MUSCLES OF THE

BUTTOCK.

This group includes the three glutæi muscles, the tensor fasciæ latæ, piriformis,

obturator internus and gemelli, and quadFIG. 368. —DEEP MUSCLES ON THE POSTERIOR ASPECT OF THE RIGHT THIGH.

ratus femoris.

The glutæus maximus and tensor fasciæ latæ muscles are in the same plane, invested by envelopes of the fascia lata. The glutæus medius, partially covered by the gluteus maximus, conceals the glutæus minimus ; while the piriformis, obturator internus, gemelli, and quadratus femoris intervene between the glutæus maximus and the posterior surface of the hip-joint.

M. Glutæus Maximus.—The glutæus maximus is a large quadrilateral muscle, with a crescentic origin. It arises from, (1) a portion of the area on the dorsum ilii above the posterior gluteal line (Fig. 369); (2) the tendon of the sacrospinalis muscle; (3) the dorsal surface of the sacrum and coccyx (Fig. 395, p. 443); and (4) the posterior surface of the sacro-tuberous ligament. The fibres which form its superior and lateral border take origin directly from the fascia lata which envelops the muscle.

The muscle forms a large fleshy mass, whose fibres are directed obliquely over the buttock, invested by the fascia lata, and are inserted, by short tendinous fibres, partly into the fascia lata over the greater trochanter of the femur (joining the ilio-tibial tract), and partly into the gluteal tuberosity (Fig. 370, p. 416). The fascia lata receives the insertion of the whole of the superficial fibres of the muscle and the superior half of the deep fibres. The inferior half of the deep portion of

[graphic]

Obliquus externus abdominis
(insertion)

Tensor fasciæ latæ (origin)

Glutæus maximus

(origin)

Sartorius (origin)

Rectus femoris (reflected head of origin)

1

Gemellus superior (origin)

Gemellus inferior (origin)

Semimembranosus (origin)
Biceps and semitendinosus (origin)

Quadratus femoris (origin)
Obturator externus (origin)

Adductor magnus (origin)

FIG. 369.-MUSCLE-ATTACHMENTS TO THE Right Dorsum ILII AND TUBER ISCHIADICUM.

the muscle is inserted, for the most part, into the gluteal tuberosity; but the most inferior fibres of all are inserted into fascia lata, and are thereby connected with the lateral intermuscular septum and the origin of the short head of the biceps.

The glutæus maximus is the coarsest and heaviest muscle in the body. By its weight it helps to form the fold of the nates. It is superficial in its whole extent. The glutæus medius is visible at its superior border, covered by the fascia lata ; at its lower border the hamstring muscles and sciatic nerve appear on their way to the thigh. Three bursa are deep to it: one (not always present) over the sciatic tuberosity, a second over the lateral side of the greater trochanter, and a third

over the vastus lateralis. The fibres of the glutæus maximus arising from the | coccyx may form a separate muscle (agitator caudæ).

Nerve-Supply.-Inferior gluteal nerve, from the sacral plexus (L. 5. S. 1. 2.).

Actions. The glutæus maximus is mainly an extensor of the thigh, and has a powerful action in straightening the lower limb, as in climbing or running. Its lower fibres also adduct the thigh and rotate it laterally.

M. Tensor Fasciæ Latæ.—The tensor fasciæ latæ arises from the iliac crest and the dorsum ilii just lateral to Piriformis (insertion)

the superior anterior spine, and

from the fascia covering its lateral Gluteus medius (insertion)

surface (Fig. 369, p. 415).

Invested, like the glutæus maximus, by the fascia lata, it is

inserted, distal to the level of the Obturator internus and greater trochanter of the femur,

gemelli (insertion) into the fascia, which forms the Obturator externus ilio- tibial tract (p. 404). (insertion)

The muscle is placed along the anQuadratus femoris

terior borders of the glutaus (insertion)

medius and gluteus minimus. Ilio-psoas (insertion)

Nerve - Supply. - The superior gluteal nerve from the sacral plexus

(L. 4. 5. S. 1.) ends in this muscle after Glutæus maximus

passing between the glutäus medius and (insertion)

glutæus minimus.

Pectineus (insertion) Adductor magnus

Actions. It assists in the abduction (insertion)

and rotation of the thigh ; and along Vastus medialis

with the glutæus maximus, by its in

(origin) Adductor brevis

sertion into the ilio-tibial tract, it helps (insertion)

to support the knee-joint in the extended position.

M. Glutæus Medius. — The glutæus medius arises from (1) the dorsum ilii, between the iliac crest and posterior gluteal line above and the anterior gluteal line below (Fig. 369, p. 415), and (2) the strong fascia lata covering its surface anteriorly.

It is a fan-shaped muscle, its fibres conFIG. 370.–MUSCLE - ATTACHMENTS TO THE

POSTERIOR ASPECT OF
PART OF THE LEFT FEMUR.

THE LUMBAR verging to the greater troLumbo

OF PETIT chanter, to be inserted by a dorsal fascia strong, short tendon into the postero-superior angle of the greater trochanter, and into a well-marked diagonal line

Fascia lata on its lateral surface (Fig. 370, and Fig. 372, p. 417). A bursa is placed deep to the tendon at its insertion.

The muscle is partly superficial, partly concealed by the glutæus maximus. It covers the glutæus minimus, and the superior gluteal nerve and the deep branches of the superior gluteal artery.

GRACILIS Nerve-Supply.—The superior ADDUCTOR MAGNUS gluteal nerve from the sacral plexus (L. 4. 5. S. l.).

Actions. — This muscle is a powerful abductor and medial

-Sciatic nerve rotator of the thigh.

BICEPS (long

Chead)
M. Glutæus Minimus.-
The glutæus minimus arises,
under cover of the glutaus Fig. 371.—THE RIGHT GLUTÆUS MAXIMUS MUSCLE.

[graphic]
[graphic]

THE

PROXIMAL

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