6.1
Iliopsoas
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Surface anatomy : Two (iliacus and psoas) muscles are deep in the abdominal cavity and superficial distal to the inguinal ligament and medial to the Sartorius muscle.
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Origin : Iliac fossa for iliacus and lumbar spine for psoas muscles.
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Insertion : Lesser trochanter of the femur.
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Function : Flexion hip.
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Motor point (MP) : Three different techniques.
- 1.
Suprainguinal approach (Fig. A) 16–18 : Distal one-third point between anterior superior iliac spine (A) and umbilicus (B). At supine position, press down medial side of anterior superior iliac spine with fingers and then pushing away internal organs medially. Insert needle slowly until hit the bone (iliac bone). Then slowly pull the needle back.
- 2.
Infrainguinal approach (Fig. B) 18,19 : At supine positon, using ultrasound, identify the muscle over the femoral head or at the inferiomedial to the ASIS (A). At this site, femoral nerve is close to medial side. Insert needle cranially (but less likely motor point targeted).
- 3.
Posterior approach 20 : At side lying or prone position, using ultrasound or CT, identify the muscle.
- 1.
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Injection tip : For suprainguinal approach, a long injection needle is needed. Push the motor point with fingers as much as deep down and medially to avoid internal organ puncture. Then slowly insert a needle down to hit the iliac bone. Then slowly pull back the needle with electrical stimulation. If the needle is close to the femoral nerve, then strong knee extension is noted. If needle is placed superficially, then abdominal muscles contract.
6.2
Tensor fascia lata
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Surface anatomy : Superficial muscles from lateral side of ASIS to the lateral knee.
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Origin : Iliac crest.
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Insertion : Iliotibial band.
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Function : Internal rotation and flexion hip.
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Motor point : Midpoint between anterior superior iliac spine (A) and greater trochanter (B).
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Injection tip : At supine, put the thumb at the anterior superior iliac spine and middle finger at the greater trochanter, the index finger tip will be placed on the motor point. The muscle is bulged with internal rotation of the hip at the motor point.
6.3
Gluteus maximus
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Surface anatomy : The largest and superficial muscle from the buttock.
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Origin : Posterior ilium and sacrum.
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Insertion : Greater tuberosity of femur.
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Function : Extension and external rotation hip.
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Motor point (MP) : Midpoint between the greater trochanter (A) and the ischial tuberosity (B).
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Injection tip : At prone with slight hip abduction, insert the needle slowly into deep. If sciatic nerve is stimulated, pull back the needle. The sciatic nerve is deep to the muscle.
6.4
Gluteus medius
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Surface anatomy : Upper right quadrant of the buttock (partially covered with gluteus maximus in the lower part).
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Origin : Posterior ilium.
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Insertion : Greater trochanter of femur.
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Function : Abduction hip.
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Motor point : Midpoint between upper most iliac crest (A) and greater trochanter (B).
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Injection tip : At prone with slight hip abduction or at side lying position.
6.5
Gluteus minimus
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Surface anatomy : Difficult to be identified superficially because most of the muscle is covered by gluteus maximus and medius in the upper right quadrant of the buttock.
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Origin : outer surface of the ilium (between the anterior and inferior gluteal line) and he margin of the greater sciatic notch.
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Insertion : Greater trochanter of femur.
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Function : Abduction hip.
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Motor point : Midpoint between the midpoint (A), which is in the middle of top of iliac crest (B) and superior anterior iliac spine (C), and greater trochanter (D).
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Injection tip : At prone with slight hip abduction or at side lying position. MP is deep (through gluteus medius).
6.6
Deep hip external rotators (piriformis, gemellus, obturators, quadrutus femoris)
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Surface anatomy : Small and deep muscles of the lower lateral quadrant buttock (covered with gluteus maximus).
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Origin : Posterior ilium, ischium, and sacrum.
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Insertion : Greater trochanter and intertrochanteric crest of femur.
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Function : External rotation hip.
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Motor point (MP) : Midpoint between greater trochanter (A) and ischial tuberosity (B) (superficially same point as the gluteus maximus MP but deeper).
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Injection tip : At prone with slight hip abduction, since the muscle is deep, insert the needle slowly into deep (lateral to the sciatic nerve).
6.7
Sartorius
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