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Femur – Muscle Attachment, Nerve Supply

The femur or thigh bone is the proximal bone of the hindlimb in tetrapod vertebrates (for example, the largest bone of the human thigh). The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia and kneecap, forming the knee joint. By most measures, the two (left and right) femurs are the strongest bones of the body, and in humans, the longest.

The femur, also called the thighbone, the upper bone of the leg or hind leg. The head forms a ball-and-socket joint with the hip (at the acetabulum), being held in place by a ligament (ligamentum teres femoris) within the socket and by strong surrounding ligaments. In humans the neck of the femur connects the shaft and head at a 125° angle, which is efficient for walking. The prominence of the femur at the outside top of the thigh provides attachment for the gluteus medius and minimus muscles. The shaft is somewhat convex forward and strengthened behind by a pillar of bone called the Linea Aspera. Two large prominences, or condyles, on either side of the lower end of the femur, form the upper half of the knee joint, which is completed below by the tibia (shin) and patella (kneecap). Internally, the femur shows the development of arcs of bone called trabeculae that are efficiently arranged to transmit pressure and resist stress. Human femurs have been shown to be capable of resisting compression forces of 800–1,100 kg (1,800–2,500 pounds).

Muscle Attachment of Femur

Biceps Femoris Long Head

Origin: Common (conjoint) tendon from the superior medial quadrant of the posterior ischial tuberosity (with semitendinosus)
Insertion: Majority onto the fibular head; also the lateral collateral ligament of the knee and lateral tibial condyle
Action: Flexion of the knee, and lateral rotation of the tibia; extension of the hip joint
Innervation: Tibial nerve (a portion of the sciatic nerve)
Arterial Supply: Perforating (muscular) branches of profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery

Biceps Femoris Short Head

Origin: Lateral lip of linea aspera, the lateral intermuscular septum of the thigh, and lateral supracondylar ridge of femur
Insertion: Majority on the fibular head; and lateral collateral ligament of the knee, and lateral tibial condyle
Action: Flexion of the knee, and lateral rotation of the tibia
Innervation: Common peroneal nerve (a portion of the sciatic nerve)
Arterial Supply: Perforating (muscular) branches of profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery

Semimembranosus

Origin: Superior lateral aspect of the ischial tuberosity
Insertion: The posterior surface of the medial tibial condyle
Action: Extension of the hip, flexion of the knee, and medial rotation of the tibia (specifically with knee flexion)
Innervation: Tibial nerve (a portion of the sciatic nerve)
Arterial Supply: Perforating (muscular) branches of profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery

Semitendinosus

Origin: The common (conjoint) tendon from the superior medial quadrant of the posterior ischial tuberosity (with biceps femoris long head)
Insertion: Superior aspect of the medial tibial shaft (into the distal portion of the pes anserinus along with the gracious and sartorius muscles)
Action: Extension of the hip and flexion of the knee, medial rotation of the tibia (specifically with knee flexion)
Innervation: Tibial nerve (a portion of the sciatic nerve)
Arterial Supply: Perforating (muscular) branches of profunda femoris artery, inferior gluteal artery, and the superior muscular branches of the popliteal artery

The rectus femoris is responsible for thigh flexion at the hip and knee extension.[rx]

Vastus Lateralis – The largest of the four muscles. Origin is from the greater trochanter and lateral lip of linea Aspera. It inserts at the lateral base and border of the patella, forming the lateral patellar retinaculum and the lateral side of the quadriceps femoris tendon.[rx]
Vastus Medialis – Originates at the inferior portion of the intertrochanteric line and medial lip of the linea Aspera. Inserts at the medial base and border of the patella, forming the medial patellar retinaculum and the medial side of the quadriceps femoris tendon.[rx]
Vastus Intermedius – Originates at the anterior and lateral surfaces of the femoral shaft. It inserts at the lateral border of the patella, forming the deep portion of the quadriceps tendon.[rx]
Rectus Femoris – Comprised of two proximal heads: The straight head consists of the anterior inferior iliac spine (ASIS) of the ilium. The reflected head consists of the ilium superior to the acetabulum. Inserts at the quadriceps femoris tendon.[rx]

Hip Flexors

Psoas major

Origin: T12-L5 vertebrae
Insertion: Lesser trochanter
Innervation: Femoral nerve

Psoas minor (present in 50% of the population)

Origin: T12-L1 vertebrae
Insertion: Iliopubic eminence
Innervation: L1 ventral ramus

Pectineus (flexes and adducts thigh)

Origin: Pectineal line of the pubis
Insertion: Pectineal line of femur
Innervation: Femoral nerve

Iliacus

Origin: Iliac fossa/ Sacral ala
Insertion: Lesser trochanter
Innervation: Femoral nerve
Hip Extensors and External Rotators-

Gluteus maximus

Origin: Ilium, dorsal sacrum
Insertion: ITB, gluteal tuberosity
Innervation: Inferior gluteal nerve

Obturator externus

Origin: Ischiopubic rami, obturator membrane
Insertion: Trochanteric fossa
Innervation: Obturator nerve

Short External Rotators

Piriformis

Origin: Anterior sacrum
Insertion: Superior greater trochanter
Innervation: Nerve to Piriformis (S2, posterior division of lumbosacral plexus)

Superior gemellus

Origin: Ischial spine
Insertion: Medial greater trochanter
Innervation: Nerve to obturator internus (L5-S2, anterior division of lumbosacral plexus)

Obturator internus

Origin: Ischiopubic rami, obturator membrane
Insertion: Medial greater trochanter
Innervation: Nerve to obturator internus (L5-S2, anterior division of lumbosacral plexus)

Inferior gemellus

Origin: Ischial tuberosity
Insertion: Medial greater trochanter
Innervation: Nerve to quadratus femoris (L4-S1, anterior division of lumbosacral plexus)

Quadratus femoris

Origin: Ischial tuberosity
Insertion: Intertrochanteric crest
Innervation: Nerve to quadratus femoris (L4-S1, anterior division of lumbosacral plexus)

Hip Abductors

Tensor fascia latae

Origin: Iliac crest, ASIS
Insertion: Iliotibial band/proximal tibia
Innervation: Superior gluteal nerve

Gluteus medius

Origin: Ilium between anterior and posterior gluteal lines
Insertion: Greater trochanter
Innervation: Superior gluteal nerve

Gluteus minimus

Origin: Ilium between anterior and posterior gluteal lines
Insertion: Greater trochanter
Innervation: Superior gluteal nerve

Hip Adductors

Adductor Magnus

Origin: Pubic ramus, ischial tuberosity
Insertion: Linea Aspera, adductor tubercle
Innervation: Obturator nerve, the sciatic nerve

Adductor longus

Origin: Body of pubis
Insertion: Linea Aspera
Innervation: Obturator nerve

Adductor Brevis

Origin: Body and inferior pubic ramus
Insertion: Pectineal line, Linea Aspera
Innervation: Obturator nerve

Gracilis

Origin: Body and inferior pubic ramus
Insertion: Proximal medial tibia (pes anserinus)
Innervation: Obturator nerve

There are many muscles involved in the movement of the hip joint, these include (in alphabetical order) the

Adductor longus, brevis, and magnus
Gluteus maximus, medius, and minimus
Gracilis
Hamstring muscles: semimembranosus, semitendinosus, and the biceps femoris
Iliacus
Obturator
Pectineus
Piriformis
Psoas major
Quadriceps muscles: rectus femoris, vastus intermedius, vastus lateralis, and vastus medialis
Quadratus femoris
Sartorius
Tensor fascia latae

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Nerves Supply of Hip Joint

Obturator nerve – Originates from nerve roots L2-L4 and exits through the obturator canal before splitting into an anterior division that runs anterior to obturator externus and a posterior division which runs posterior to obturator externus. The obturator nerve supplies sensory innervation to the inferomedial thigh via the cutaneous branch of the obturator nerve and motor innervation to gracilis (anterior division), adductor longus (anterior division), adductor brevis (anterior/posterior divisions), and adductor Magnus (posterior division).
Genitofemoral nerve – Originates from nerve roots L1-L2. It pierces the psoas muscle and continues down the anteromedial surface of psoas before dividing it into femoral and genital branches. The femoral branch provides sensory innervation to the proximal anterior thigh over the femoral triangle.
Lateral femoral cutaneous nerve – Originates from nerve roots L2-L3. Crosses inferior to the anterior superior iliac spine (ASIS) and provides sensory innervation to the lateral thigh. It has no motor function.
The femoral nerve – originates from nerve roots (L2-L4). It lies between the psoas major and iliacus and branches in the femoral triangle. The femoral nerve provides sensory innervation to the anteromedial thigh via anterior cutaneous branches and motor innervation to the psoas, pectineus, Sartorius, quadriceps (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis).
Sciatic nerve – originates from the sacral plexus and projects through the greater sciatic foramen descending down the posterior thigh deep to the hamstrings and superficial to adductor Magnus. The sciatic nerve has two distinct divisions: tibial division and common peroneal division.
Posterior femoral cutaneous nerve – Originates from nerve roots S1-S3 and passes through the greater sciatic foramen medial to the sciatic nerve. The posterior femoral cutaneous nerve provides sensory innervation to the posterior thigh and has no motor function.