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Superior Gemellus Muscle Anatomy

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Origin
  • Ischial spine
Insertion
  • Medial surface of the greater trochanter
Action
  • Lateral rotation of hip
  • Assists with abduction when hip is flexed
Innervation
  • Primarily the nerve to obturator internus (L5, S1)
  • Additionally the nerve to the quadratus femoris in some individuals
Blood Supply
  • Inferior gluteal artery and internal pudendal/gemellar branches
  • Possible superior gluteal artery contribution
Last updated: Estimated Reading Time: 5 min

Location & Overview

The superior gemellus is one of two gemellus muscles, the other being the inferior gemellus. It is located superior to (above) the inferior gemellus and sits just inferior to (below) the piriformis muscle. Together, the gemellus muscles are termed the gemelli muscles and are two of the six external rotator muscles in the gluteal region. The six external rotator muscles are the superior gemellus, inferior gemellus, obturator externus, obturator internus, quadratus femoris, and piriformis. The superior gemellus has a close association with the obturator internus, as they are next to each other and connect via a conjoined tendon. The muscle combination of the superior gemellus, inferior gemellus, and obturator internus is occasionally referred to as the ‘triceps coxae’.[1,2]

Superior gemellus
Pictured here, we can see the superior gemellus muscle from a posterior view.
Deep six hip external/lateral rotators
Pictured here are the deep six hip external rotator muscles: the piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, and quadratus femoris. These muscles play an important role in stabilizing the hip joint and facilitating hip lateral rotation.

Origin & Insertion

The superior gemellus originates at the ischial spine, a pointed bony projection on the posterior part of the ischium, situated between the greater and lesser sciatic notches in the pelvis. The muscle inserts on the medial surface of the greater trochanter, a prominent bony projection located at the upper part of the femur.[1,2]

Superior gemellus origin, marked in red
Here we can see the origin of the superior gemellus marked in red on the ischial spine.
Superior gemellus insertion, marked in blue
Here we can see the insertion of the superior gemellus marked in blue on the medial surface of the greater trochanter.

Action & Function

The primary action of the superior gemellus is lateral (external) rotation of the hip joint. When the hip is flexed, it can also assist with abduction of the hip. However, it is worth noting that the abduction force that the gemelli muscles can provide is significantly weaker compared with larger muscles, such as the gluteal muscles.[1,2]

Image of a person demonstrating the movement of external rotation.
This image shows an example of hip external rotation, which involves rotating the leg from the hip joint outward (laterally). External rotation is also referred to as lateral rotation. The opposite of external rotation is internal rotation (medial rotation). External rotation of the hip joint is the primary action of the superior gemellus.
Image of a person demonstrating the movement of hip abduction.
This image shows an example of hip abduction, which involves moving the leg out to the side (laterally). The opposite of hip abduction is hip adduction. The superior gemellus can weakly assist with hip abduction, but only when the hip is flexed.

Innervation

The superior gemellus is innervated by the nerve to obturator internus, which has its spinal roots in L5 and S1. This is the same nerve supply as the obturator internus muscle.[1,2]

However, there is some variability in this innervation. In a study conducted by Htar Htar Aung et al. (2001), it was shown that the superior gemellus muscle received dual innervation from both the nerve to the obturator internus and the nerve to the quadratus femoris approximately 60.4% of the time. Htar Htar Aung et al. (2001) also confirmed that these two nerves are distinct, as they follow different pathways and do not communicate with each other.[3]

Nerve to the obturator internus
This image shows the nerve to the obturator internus, which innervates the obturator internus and the superior gemellus muscle.
Nerve to quadratus femoris
This image shows the nerve to the quadratus femoris, which, in combination with the nerve to the obturator internus, innervates the superior gemellus muscle in about 60.4% of cases.

Blood Supply

The superior gemellus receives arterial supply from the inferior gluteal artery, branches of the internal pudendal artery, and gemellar branches, with a possible contribution from the superior gluteal artery described in some sources. This places its blood supply in the same posterior hip arterial region as the obturator internus tendon and the other gemelli muscles.[4,5]

References

  1. [1] Dalley AF II, Agur AMR. Moore’s Clinically Oriented Anatomy. 9th ed. Wolters Kluwer Health; 2022.
  2. [2] Lezak B, Massel DH. Anatomy, Bony Pelvis and Lower Limb, Gemelli Muscles. (Updated 2022 Aug 29). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557420/
  3. [3] Aung HH, Sakamoto H, Akita K, Sato T. Anatomical study of the obturator internus, gemelli and quadratus femoris muscles with special reference to their innervation. Anat Rec. 2001 May 1;263(1):41-52. doi: 10.1002/ar.1075. PMID: 11331970.
  4. [4] Lezak B, Massel DH. Anatomy, Bony Pelvis and Lower Limb, Gemelli Muscles. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
  5. [5] Standring S, editor. Gray’s anatomy: the anatomical basis of clinical practice. 42nd ed. Amsterdam: Elsevier; 2021.

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