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Tensor Fasciae Lata Muscle Anatomy | OrthoFixar 2024

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Tensor Fasciae Lata Muscle Anatomy

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The tensor fasciae lata (TFL) is a fusiform muscle approximately 15 cm long that is enclosed between two layers of fascia lata.

Tensor Fasciae Lata Muscle Anatomy

The tensor fasciae lata muscle originates from the anterior superior iliac spine (ASIS) and anterior aspect of the iliac crest and inserts distally to the iliotibial band, which comprises the fascial aponeurosis of the gluteus maximus and the tensor fascia latae. The iliotibial band then runs along the lateral aspect of the thigh, inserting on the lateral condyle of the tibia to the Gerdy tubercle.

See Also: Hip Muscles Anatomy

The Tensor fasciae latae is innervated by superior gluteal nerve. It gets its blood supply from the superior gluteal and lateral circumflex femoral artery.

The tensor fasciae is primarily a flexor of the thigh because of its anterior location, to produce flexion, the tensor fasciae lata acts in concert with the iliopsoas and rectus femoris. When the iliopsoas is paralyzed, the tensor fasciae lata undergoes hypertrophy in an attempt to compensate for the paralysis. It also works in conjunction with other abductor/medial rotator muscles (gluteus medius and minimus). It lies too far anteriorly to be a strong abductor and thus probably contributes primarily as a synergist or fixator.

The tensor fasciae latae tenses the fascia lata and iliotibial tract. Because the iliotibial tract is attached to the femur via the lateral intermuscular septum, the tensor produces little if any movement of the leg. However, when the knee is fully extended, it contributes to (increases) the extending force, adding stability, and plays a role in supporting the femur on the tibia when standing if lateral sway occurs. When the knee is flexed by other muscles, the tensor fasciae latae can synergistically augment flexion and lateral rotation of the leg.

Tensor Fasciae Lata Muscle
OriginAnterior superior iliac spine
Outer lip of anterior iliac crest and fascia lata
InsertionIliotibial band
InnervationSuperior gluteal nerve (L4, L5, S1)
Blood SupplySuperior gluteal and lateral circumflex femoral artery
ActionHelps stabilize and steady the hip and knee joints by putting tension on the iliotibial band of fascia
Thigh internal rotation
Leg external rotation
Flexion of the hip joint

Though the tensor fasciae lata typically terminates before the greater trochanter, in approximately one-third of patients the tensor fasciae latae can extend distally to the greater trochanter. This is of clinical significance as the tensor fasciae latae fibers must be split when performing a lateral approach to the proximal femur in those patients.

Surgical Considerations

In orthopedics, there are four basic surgical approaches to the hip joint: anterior, anterolateral, posterior, and medial. The tensor fasciae latae muscle is used as a landmark in the anterior and anterolateral approaches.

The anterior approach uses the internervous plane between Sartorius (femoral nerve) and tensor fasciae lata (superior gluteal nerve). The anterolateral approach uses the intermuscular plane between TFL and gluteus medius. Since both muscles are innervated by the superior gluteal nerve, there is no true internervous plane here. However, the superior gluteal nerve enters the tensor fasciae lata close to its origin at the iliac crest, so as long as the surgical plane is not extended proximal to the tensor fasciae lata insertion, the nerve remains safe.

In reconstructive surgery, tensor fasciae lata can be used for soft tissue coverage. It has been used for local, regional, and free flaps. Due to its small size, tensor fasciae lata is not often the first choice for free flaps, but it can be used when latissimus dorsi and rectus abdominis flaps are unavailable. When a large area needs coverage, TFL can be used with an anterolateral thigh flap using the lateral circumflex system of the femoral vessels.

Clinical Significance

The tensor fasciae lata can become clinically significant in cases of tightening, friction over bony prominences, or through its attachment to the IT band. It can become tight in prolonged seated positions, leading to an anterior tilt of the pelvis and/or medial rotation of the femur.

External snapping hip syndrome is a condition where patients feel a palpable snap on the lateral aspect of their hip during various movements. The most common cause is the IT band moving over the greater trochanter due to thickening of the posterior band of the IT fascia. This condition can progress to become painful, and treatment typically includes oral NSAIDs and physical therapy.

IT band syndrome is a common overuse injury in runners and cyclists, causing lateral knee pain. The etiology is controversial but can be divided into three categories:

  • IT band friction over the lateral femoral epicondyle,
  • compression of the fat and connective tissue deep to the IT band,
  • chronic inflammation of the IT band bursa. Treatment is conservative, starting with NSAIDs, physical therapy, and possibly corticosteroid injections.

Geriatric patients may suffer from weakened tensor fasciae lata actions due to Vitamin B12 deficiency, leading to nerve demyelination and large fiber peripheral neuropathy. This causes weakness in the lower extremities, compromising tensor fasciae lata-based hip flexion.

References & More

  1. Cael, C. (2010). Functional anatomy: Musculoskeletal anatomy, kinesiology, and palpation for manual therapists. Philadelphia, PA: Wolters Kluwer Health/Lippincott, Williams & Wilkins.
  2. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Clinically Oriented Anatomy (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
  3. Clinically Oriented Anatomy – 8th Edition
  4. Trammell A.P., Nahian A., Pilson H. StatPearls [Internet]. Treasure Island (FL) StatPearls Publishing; 2021 Aug 13. Anatomy, bony pelvis and lower limb, tensor fasciae latae muscle. 2021 Jan–. PMID: 29763045. [PubMed]
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