9/12 Gluteal Region Flashcards
gluteal region surface anatomy
- Located posterior to pelvis
- Superior & inferior boundaries:
– Iliac crest
– Gluteal sulcus : • Groove beneath gluteal fold
ilium/ischium/pubis
what are the three muscle attach lines on the ilium?
anterior and posterior gluteal line
inferior gluteal line
which two areas on ilium are palpable?
iliac crest and posterior superior iliac spine
medial aspect
sacrum
sacrum anterior aspect
femur
Two ligaments form two important foramina for the passage of structures into and out of the gluteal region
- Greater sciatic foramen (all exit): • Gluteal neurovascular bundles
– Piriformis m. • Sciatic nerve • Posterior Femoral Cutaneous n. • pudendal n. and internal pudendal a. • Obturator internus/superior gemellus nerve
- Lesser sciatic foramen:
- pudendal n. and internal pudendal artery (enter)
- Obturator internus/superior gemellus nerve (enter)
- Obturator internus (exit)
which two ligaments form the greater and lesser sciatic foramen?
greater - sacrospinous ligament
lesser - sacrotuberous ligament
Nerves of the Gluteal Region
- Cluneal (op. sp.Clunial) nerves: – Cutaneous
- Deep nerves: – Sacral plexus branches • Leave pelvis via _______
greater sciatic foramen
Cluneal (Clunial) Nerves
(cutaneous nerves of gluteal region )
what are the three vertebral segments for superior middle and inferior cluneal N.?
Superior - L1-L3
middle - S1-S3
inferior - S1-S3
deep gluteal region nerves
deep gluteal region nerves
list the two nerves?
- Superior gluteal nerve: – Leaves pelvis superior to piriformis with superior gluteal artery – Runs between gluteus medius and gluteus minimus – Supplies gluteus medius, gluteus minimus, tensor fasciae latae
- Inferior gluteal nerve: – Leaves pelvis inferior to piriformis with inferior gluteal artery – Supplies gluteus maximus
which is the largest nerve in the body?
sciatic nerve
sciatic nerve divides into which two nerves?
- Leaves pelvis inferior to piriformis
- Runs inferiorly deep to gluteus maximus
- Usually divides about half way down thigh into tibial & common fibular nerves
- Does not supply any gluteal structures
which cutaneous nerve innervates the largest body area?
Posterior Femoral Cutaneous Nerve
*Supplies more skin than any other cutaneous nerve
Obturator Internus/ Superior Gemellus Nerve
enters the pelvis region through? and exit?
- Leaves pelvis via greater sciatic foramen
- Reenters pelvis via lesser sciatic foramen
Pudendal Nerve (Anterior divisions of S2-S4 ventral rami)
- Most medial structure exiting greater sciatic foramen
- Reenters pelvis via lesser sciatic foramen to supply perineal structures
3 Branches arising from the internal illiac a.
• Superior gluteal art. • Inferior gluteal art. • Internal pudendal art.
Superior Gluteal Artery
- Largest internal iliac artery branch
- Superficial branch: – _____M.
- Deep branch: – Gluteus medius, minimus, tensor fascia lata
Gluteus maximus
Inferior Gluteal Artery
• Supplies to which three muscles?
It participates in which special blood supply in the thigh?
– Gluteus maximus
– Small lateral rotators
– Superior hamstrings
• Participates in cruciate anastomosis of thigh: – Transverse branch of the medial circumflex femoral artery – Terminal part of the transverse branch of the lateral circumflex femoral artery – First perforating artery – The inferior gluteal artery
*May provide blood to the leg if the femoral artery is occluded or severed
Internal Pudendal Artery
- Reenters pelvis via _____with pudendal nerve
- Supplies _____ muscles & ext. genitalia
- Does not supply any gluteal structures
lesser sciatic foramen
perineal
arteries of the gluteal region
Intragluteal injections
should be made in the supero-lateral part of gluteal region in order to avoid the _____ nerve and other gluteal nerves and vessels
sciatic
Gluteal Musculature (Superficial)
Gluteus Maximus
- Largest gluteal muscle
- Chief extensor of the thigh & lateral rotation
- Slight extension of leg when working with tensor fascia lata
- Innervated by which nerve?
Inferior gluteal nerve
deep gluteal muscles
after reflecting gluteal maximus M.
Gluteus Medius and Minimus
- Both partially covered by gluteus maximus
- Gluteus medius over gluteus minimus
- Thigh abduction & medial rotation (particularly gluteus minimus)
- innervated by which nerve?
Superior gluteal nerve
walking gait cycle
Gluteus Medius and Minimus
- Condition names: – Gluteal gait or Duchenne’s Limp – Positive Trendelenburg’s sign
- Cause: – Superior gluteal nerve injury
- Effect: – Patient loses steadying action of gluteus medius and minimus – Lean toward effected side during stance phase of gait
Tensor Fascia Lata
- Enclosed by _____
- Innervation: – ______
- Function: – Abducts, medially rotates, and flexes thigh – Slight extension of knee along with the gluteus maximus
fascia lata
Superior gluteal nerve
Distinct Feature of the Fascia Lata: iliotibial tract (“IT Band”)
– Runs from iliac tubercle to a tubercle (Gerdy’s) on lateral tibial condyle
– Reinforced by tendinous fibers from tensor fasciae latae and gluteus maximus
– Function: • Assists in decelerating adduction of thigh • Laterally stabalizes knee • Extends leg, compensate for quadriceps paralysis via gluteus maximus flexion • Pulls patella laterally, antagonist of vastus medialis, and synergist with flexing vastus lateralis for this action • Stretch to treat chondromalacia patella
Piriformis
- Lies deep to gluteus maximus
- Medial to gluteus medius
- Demarcates gluteal blood vessels and nerves…
Obturator Internus
- L., Occlude or stop up
- Leaves pelvis through lesser sciatic foramen
Superior and Inferior Gemelli
- L., Twins
- “Extrapelvic parts of obturator internus”
- With obturator internus form the “_____”
triceps coxae
Obturator Externus
- Deep to pectineus
- Attachments: – External margins of obturator foramen – Trochanteric fossa
- Innervation: – Obturator nerve
obturator muscles
Quadratus Femoris
schematic of gluteal muscles
Ischial bursa
Trochanteric bursa
gluteofemoral bursa
