Anterior Inferior Iliac Spine

Anterior inferior iliac spine (A I IS) Rectus femoris... 

Fig. 4.12. Ultrasound demonstrating avulsion (arrow) of the anterior inferior iliac spine (asterisk) which is attached to the rectus femoris tendon (arrowheads)...

In the pelvis, avulsion occurs primarily at six sites, which not surprisingly are the sites of the major muscle attachments. The three commonest sites are the anterior superior iliac spine (ASIS) (the origin of sartorius), the anterior inferior iliac spine (AIIS) (the rectus femoris origin) and the ischial tuberosity (the origin of the hamstring group). With these fractures acutely there is a clinical history of severe exertion, followed by pain and reduced function (Wootton et al. 1990) (Fig. 12.23). 

Fig. 12.24. Sites of pelvic avulsion injuries. A, iliac crest (abdominal muscle insertion). B, anterior superior iliac spine (sartorious muscle origin). C, anterior inferior iliac spine (rectus femoris origin). D, greater trochanter (gluteal insertions). Ey Lesser trochanter (illiopsoas). F, ischial tuberosity (hamstring muscle). G, body of pubis and inferior pubic ramus (adductors and gracillis)...

Physician position standing at the side of the table opposite the tender point, which is located on the inferior medial surface of the anterior inferior iliac spine. 

The abdominal L2 tender point is an additional tender point for the second lumbar vertebra and is found 2 inches lateral to the umbilicus. The treatment is the same as for the anterior inferior iliac spine tender point except that the thighs are rotated toward the tender point (the equivalent of rotation away from the tender point at the vertebral level) (Fig. 50-4). 

The hip bones give rise to many muscular attachments. Cranial to the acetabulum, the ilium also has two prominent projections on its anterior margin the anterior superior iliac spine, which may easily be visible through the skin of slender subjects, and the anterior inferior iliac spine (Fig. 12.1a). The first gives insertion to the tensor fasciae latae and sartorius, the second to the rectus femoris. Medially, the iliac fossa... 

From lateral to medial, the deep layer of anterior muscles includes the rectus femoris, the iliopsoas and the pectineus (Fig. 12.2). The rectus femoris muscle has three separate proximal tendons direct (straight), indirect and reflected. The direct tendon originates from the anterior inferior iliac spine and continues down into a superficial aponeurosis which covers the anterior aspect of the proximal muscle (superficial aponeurosis) the indirect tendon arises from the superior acetabular ridge and forms a sagittal-oriented band (central aponeurosis) that is located inside the proximal muscle belly the thin reflected tendon is directed more medially to merge... 

Fig. 12.2. Anatomy of the anterior muscles and tendons of the hip. Schematic drawing of an anterior view through the hip illustrates the relationships of the anterior muscles to each other. The superficial tensor fasciae latae (Tfl) and sartorius (Sfl) arise from the anterior superior iliac spine (straight arrow). On a deeper plane, the rectus femoris (Rf) originates from the anterior inferior iliac spine (arrowhead). Observe the iliacus and the psoas muscles which join distally to insert through a common tendon onto the lesser trochanter (curved arrow). Medially to the iliopsoas tendon, the pectineus muscle (Pe) can be seen arising from the anterior aspect of the superior ramus of the pubis (Pb)...

After that, the probe should be positioned around the anterior inferior iliac spine. This apophysis can easily be identified as a linear bright structure with posterior acoustic shadowing, located in a more caudal and deep position relative to the anterior superior iliac spine. The direct tendon of the rectus femoris takes its origin from the anterior inferior iliac spine. A careful scanning technique based on short-... 

Overuse tendinopathies of the hip affect mostly the tendon of the tensor fasciae latae (Bass and Connel 2002) and the rectus femoris tendon. Patients complain of localized anterior hip pain vdiich comes on after or, in more severe disease, during sport activities. This condition typically involves sprinters and is secondary to a forceful extension of the hip. Physical examination reveals tenderness over the anterior superior and anterior inferior iliac spines. Contraction of the muscle against resistance can increase the local pain. Clinically, the diagnosis of tensor fasciae... 

Fig. 12.29a-c. Rectus femoris tendon tear, a Long- and b short-axis 12-5 MHz US images obtained over the insertion of the proximal tendon of the rectus femoris on the anterior inferior iliac spine (AIIS) reveals a complete tear of the direct rectus femoris tendon (arrowhead) which appears retracted downward. A hypoechoic collection reflecting the hematoma (asterisk) is seen between the retracted tendon and the iliac spine. Superficial to the ruptured tendon, the iliacus and the sartorius (Sa) muscles can be appreciated, c Corresponding long-axis 12-5 MHz US image on the contralateral side demonstrates the intact rectus femoris tendon (arrows) which inserts into the anterior inferior iliac spine... 

Fig. 13.2a-c Normal quadriceps muscle, a-c Schematic drawings of a coronal view through the anterior thigh showing the muscle bellies forming the quadriceps from deep (a) to superficial (c). a,b The vastus intermedius (VI) is the deepest muscle. On each side, it is partially covered by the vastus lateralis (VX) and the more distal vastus medialis (VM). c The rectus femoris (RF) is located more superficially. It arises from a direct (DT) and an indirect (IT) tendon from the anterior inferior iliac spine and inserts into a long flat tendon (asterisk) that forms the superficial layer of the quadriceps tendon... 

From the anterior inferior iliac spine and the brim of the acetabulum. 

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