Logan Steele
The thigh is made up of a dense arrangement of many muscles. The hip abductors are a group of muscles located on the lateral thigh that move the lower limb at the hip joint. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae. The gluteus maximus, the largest and heaviest muscle in the body, also abducts the thigh at the hip joint. The sartorius muscle, the longest muscle in the human body, weakly abducts the thigh. These muscles contribute to pelvic stabilization during walking and running, abduction, and rotation at the hip joint.
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Gluteus maximus
The gluteus maximus is the outermost muscle of the buttocks and the largest and most superficial of the three gluteal muscles. It is also the only muscle innervated by the inferior gluteal nerve. The gluteus maximus is a tensor of the fascia lata, and by its connection with the iliotibial band, it steadies the femur on the articular surfaces of the tibia during standing. It is involved in several sports, from running to weightlifting.
The gluteus maximus is one of the hip and thigh muscles, along with the gluteus medius, gluteus minimus, and tensor fasciae latae. These muscles have a variety of functions on the hip joint, including extension, external and internal rotation, and abduction and adduction of the thigh at the hip joint. The gluteus maximus is the only muscle of this group that is innervated by the inferior gluteal nerve. The gluteus maximus muscle is vascularized by the muscular branches of the inferior gluteal and superior gluteal arteries, the branches of the internal iliac artery.
The gluteus maximus muscle originates from several sites, including the posterolateral aspect of the sacrum and coccyx, the sacrotuberous ligament, the gluteal surface of the ilium, the thoracolumbar fascia, and the gluteal aponeurosis. The muscle fibres take an inferolateral course, converging towards the femur. The most superficial three-quarters of the muscle form a tendinous lamina that inserts between the two layers of the fascia lata, contributing to the formation of the iliotibial tract. The remaining deep one-quarter of the muscle inserts into the gluteal tuberosity of the femur via a broad aponeurosis.
The gluteus maximus has four actions on the hip joint: extension, external rotation, abduction, and adduction of the thigh. When its proximal attachment is fixed, the gluteus maximus acts as the main extensor of the hip joint, pulling the shaft of the femur posteriorly. The external rotation of the thigh occurs simultaneously with the extension, assisting in raising the medial longitudinal arch of the foot. On the other hand, when its distal attachment is fixed, the gluteus maximus pulls the pelvis posteriorly, helping to bring the trunk from a flexed to an upright position.
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Gluteus medius
The gluteus medius is a fan-shaped muscle located on the lateral aspect of the upper buttock, below the iliac crest. It is one of the three gluteal muscles, along with gluteus maximus and gluteus minimus. The gluteus maximus covers all of the gluteal muscles except for the anterosuperior third of the gluteus medius. This uncovered part of the gluteus medius is where buttocks dorsogluteal intramuscular injections are typically applied.
The gluteus medius is a primary hip abductor, working with the gluteus minimus and the tensor fascia lata to abduct and internally rotate the thigh at the hip joint. The gluteus medius also assists in stabilising the pelvis and maintaining the trunk upright when standing on one leg, running, or walking. When a limb is off the ground, the gluteus medius works to maintain the side of the pelvis that drops, allowing the other limb to swing forward for the next step.
The muscle fibres of the gluteus medius take distinct courses based on their position. The fibres of the posterior portion pass forwards and downwards, the fibres of the middle portion pass downwards, and the fibres of the anterior portion pass backwards and downwards. All the fibres combine to form a flattened tendon that attaches to the greater trochanter of the femur. The gluteus medius is supplied by the superior gluteal nerve (root L4, L5, and S1) and the superior gluteal artery, a branch of the internal iliac artery.
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Gluteus minimus
The gluteus minimus is one of the three gluteal muscles, the others being gluteus maximus and gluteus medius. It is the smallest of the three and lies deep to the gluteus medius. The gluteus minimus is fan-shaped and is similar to the gluteus medius in function, structure, nerve supply, and blood supply. It is innervated by the superior gluteal nerve (L4, S1).
The gluteus minimus acts in synergy with the gluteus medius to abduct and internally rotate the thigh. Its main function is the abduction of the femur, and internal rotation and flexion can occur depending on the position of the femur. With the hip flexed, the gluteus minimus internally rotates the thigh, and with the hip extended, it externally rotates the thigh. It also stabilises the hip and pelvis, especially during single-limb support in the gait. The gluteus minimus is composed of two distinct segments (anterior and posterior) with two different roles. The anterior segment reduces the stresses on the hip anterosuperior structures, while the posterior segment stabilises the head of the femur.
Weakness in the gluteus minimus results in a trendelenburg gait, where the pelvic drops on the unsupported side. Gluteus minimus tendinopathy often results in Greater Trochanteric Pain Syndrome (GTPS). Tenderness at the greater trochanter is due principally to tension in the hip abductors, primarily the gluteus medius and the tensor fasciae latae.
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Tensor fasciae latae
The tensor fasciae latae (TFL) is a fusiform-shaped muscle located in the proximal anterolateral thigh. It is the most anterior of the gluteal muscle group, which also includes the gluteus maximus, gluteus medius, and gluteus minimus. The TFL originates from the anterior superior iliac spine and the outer lip of the iliac crest and then descends over the gluteus medius, gluteus minimus, and the lateral aspect of the thigh to insert onto the iliotibial tract. The iliotibial tract, or iliotibial band (ITB), is a thick band of fascia that runs along the outside of the thigh, from the iliac crest to the tibia.
The TFL is innervated by the superior gluteal nerve (L4-S1) and supplied by the superior gluteal artery. It is the only muscle in the gluteal group that crosses the knee joint, allowing it to act on both the hip and the leg. The basic functional movement of the TFL is walking, and it is heavily utilized in horse riding, hurdling, and water skiing. The TFL is clinically important for aiding in pelvis stability during standing and walking.
The TFL works in synergy with the gluteus medius and gluteus minimus to abduct and medially rotate the femur. It also assists in hip flexion and internal rotation through its attachment to the tibia via the IT band. Additionally, the TFL acts on the tibia to aid in the lateral rotation of the tibia. The TFL is involved in stabilizing both the hip and knee joints.
Tenderness at the greater trochanter, a bony protrusion at the side of the hip, is often due to tension in the hip abductors, primarily the gluteus medius and the tensor fasciae latae. This tension can cause pain during active abduction. The Ober's test is used to evaluate a tight, contracted, or inflamed TFL and ITB, and Noble's test and the Renne test are also used to detect iliotibial band syndrome.
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Sartorius
The sartorius muscle is the longest muscle in the human body. It is a long, thin, superficial muscle that runs down the length of the thigh in the anterior compartment. The sartorius muscle originates from the anterior superior iliac spine, and part of the notch between the anterior superior iliac spine and anterior inferior iliac spine. It runs obliquely across the upper and anterior part of the thigh in an inferomedial direction. It passes behind the medial condyle of the femur to end in a tendon. This tendon curves anteriorly to join the tendons of the gracilis and semitendinosus muscles in the pes anserinus, where it inserts into the superomedial surface of the tibia.
The sartorius is innervated by the femoral nerve, which receives its nerve supply from L2, L3, and L4 nerve roots. The femoral nerve innervates both the hip flexor and quadriceps muscle groups. The femoral nerve (motor divisions and branches) innervates the following muscles: Typically, the sartorius receives its innervation via the femoral nerve, although cadaveric studies have shown that the obturator nerve also provides additional innervation. The innervation to sartorius is derived explicitly from the anterior division of the femoral nerve. The posterior division supplies innervation to the muscles of the quadriceps.
The sartorius muscle can move the hip joint and the knee joint, but all of its actions are weak, making it a synergist muscle. At the hip, it can flex, weakly abduct, and laterally rotate the femur. At the knee, it can flex the leg; when the knee is flexed, the sartorius medially rotates the leg. Sitting cross-legged demonstrates all four actions of the sartorius. The muscle may be split into two parts, and one part may be inserted into the fascia lata, the femur, the ligament of the patella, or the tendon of the semitendinosus. The tendon of insertion may end in the fascia lata, the capsule of the knee joint, or the fascia of the leg.
The sartorius muscle is sometimes called the "tailor's muscle". This name likely refers to the cross-legged position in which tailors once sat. The word "sartorius" comes from the Latin word "sartor", meaning patcher or tailor. In French, an older name for this muscle is "couturier" (seamstress or dressmaker), with a similar reference to "sitting as a tailor".
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Frequently asked questions
The primary hip abductor muscles are the gluteus medius, gluteus minimus, and tensor fasciae latae.
The secondary hip abductors are the piriformis, sartorius, and superior fibres of the gluteus maximus.
The hip abductor muscles contribute to pelvic stabilization during walking and running, and abduction and rotation at the hip joint.
Hip abductor weakness can cause insufficient pelvic stabilization during locomotion, which can lead to pain and injury in the outer hip soft tissues, increased medial femoral rotation, and valgus knee moments.
