Anatomy: Gluteal and Posterior Thigh Flashcards
Hip Bone major parts
Ilium (top)
Ischium (back)
Pubis
Acetabulum - socket for femoral head
Extends from sacrum/coccyx to ischial tuberosity
sacrotuberous ligament
extends from sacrum/coccyx to ischial spine
sacrospinous ligament
Two ligaments convert greater and lesser sciatic notches into greater and lesser sciatic foramina
Other purpose?
Sacrotuberous and Sacrospinous ligaments
- also prevent outward thrust of sacrum
Greater sciatic foramen
passageway for structures entering or leaving pelvis
Lesser sciatic foramen
passageway for structures entering or leaving the perineum
Gluteus Maximus
N: Inferior Gluteal Nerve
Forcefully extends and laterally rotates thigh at hip joint, extends leg at knee joint through IT band
Superficial Gluteal Muscles
Gluteus Maximus, Medius, Minimus
Tensor Fasciae Latae
Gluteus Medius and Minimus
N: Superior Gluteal Nerve
Abduct thigh at hip joint and steady pelvis, medial rotators
Tensor Fasciae Latae
N: Superior Gluteal Nerve
Action: Assists gluteus maximus in extending knee joint
Embedded in tensor fascia - inserts into IT band
Lateral Rotators of thigh at hip joint
Piriformis
Obturator internus
Gemellus Superior and Inferior
Quadratus femoris
Intragluteal injections
Upper outer quadrant - avoid sciatic nerve and gluteal nerves
The inferior gluteal artery is a branch of the __________
The inferior gluteal artery is a branch of the internal iliac artery in the pelvis.
Gluteal gait or lurch
Paralysis of G. Maximus due to damage/lesion to inferior gluteal nerve (L5-S2)
Limited hip extension on affected side during mid-stance, compensated for by
hyperextension of trunk.
The deep fascia of the thigh, the ______, is a tough fascia which forms a sleeve around the muscles of the thigh. Laterally, it splits to enclose the belly of the muscle, __________. This muscle pulls on the thickened portion of the fascia lata overlying the vastus lateralis called the ________
The deep fascia of the thigh, the fascia lata, is a tough fascia which forms a sleeve around the muscles of the thigh. Laterally, it splits to enclose the belly of the muscle, tensor fasciae latae. This muscle pulls on the thickened portion of the fascia lata overlying the vastus lateralis called the ILIOTIBIAL TRACT (IT Band)
Iliotibial band syndrome (ITBS) is the result of ________ This is an overuse injury with symptoms that include inflammation and irritation of the iliotibial band. The pain is typically felt on the ___________ , and is often more intense when descending stairs, or getting up from a seated position.
Iliotibial band syndrome (ITBS) is the result of irritation of the distal portion of the iliotibial tendon as it rubs against the lateral femoral condyle, or less commonly, proximally, the greater trochanter. This is an overuse injury with symptoms that include inflammation and irritation of the iliotibial band. The pain is typically felt on the lateral aspect of the knee or lower thigh, and is often more intense when descending stairs, or getting up from a seated position.
Weaver’s Bottom (Ischial bursitis)
cycling, rowing and other activities that require repetitive hip extension while seated may overwhelm the bursa’s ability to dissipate applied stress.
Trochanteric bursitis
deep gluteal pain felt over the trochanteric bursa, usually due to repetitive action like climbing stairs or running on a steeply elevated treadmill or hills. The gluteus maximus rubs over the greater trochanter causing this friction bursitis.
Superior gluteal nerve innervates _________ (3)
The superior gluteal artery is a branch of the ____________
This neurovascular bundle runs between the ________
Superior gluteal nerve innervates G. medius and G. minimus and Tensor Fasciae Latae
The superior gluteal artery is a branch of the internal iIliac artery in the pelvis.
This neurovascular bundle runs between the medius and minimus.
Gluteus gait or limp (Trendelenburg’s sign)
is due to paralyzed gluteus medius and minimus muscles as a result of injury to the superior gluteal nerve; the normal steadying effect of these muscles is lost so when the foot is raised on the normal side, the pelvis falls on that side. A congenital dislocation of the hip or nonunion of a fracture of the femoral neck can also produce this limp. The supporting mechanism fails and the pelvis sinks when an attempt is made to stand on the affected limb
A lateral rotator, originates on the pelvic surface of the sacrum, the sacrotuberous ligament and the ilium below the PIIS. It leaves the pelvis through the greater sciatic foramen and inserts on the upper border of the greater trochanter.
piriformis muscle
Sciatica
a neuritis (inflammation of the nerve) of the sciatic nerve characterized by intense pain at the back of the leg and/or thigh; can also be caused by pressure on a root of the nerve, e.g., from a herniated disc
Piriformis syndrome
individuals involved in sports (ice skaters, cyclists, rock climbers) and women are more likely to develop this syndrome. In 50% of cases, trauma in the buttock is associated with hypertrophy and spasm of the piriformis which compresses the sciatic nerve.
Pudendal nerve
The pudendal nerve (S2,3,4) innervates the structures in the perineum. It is the most medial structure crossing the sacrospinous ligament, possibly under cover of the sacrotuberous ligament.
Posterior dislocation of hip can injure ___
sciatic nerve
Anterior compartment thigh
Hip flexors
Knee extensors
Femoral nerve
Medial compartment thigh
Thigh adductors, medial rotators
Obturator nerve
Posterior compartment thigh
Hip extensors, knee flexors
Tibial and fibular nerves
Posterior thigh muscles
Hamstrings –>
biceps femoris
semitendinosus
semimembranosis
biceps femoris
Long head - tibial portion of sciatic nerve
Short head - common fibular portion of sciatic nerve
Semitendonosus
tibial portion of sciatic nerve
Semimembranosus
tibial portion of sciatic nerve
Hamstring injuries
are common in individuals who run and kick hard (baseball, basketball, football and soccer). Parts of the proximal attachment to the ischial tuberosity may tear (avulsion). Hamstring injuries are twice as common as quadriceps strains.
Charley horse
contusion and tearing of muscle fibers enough to result in a thigh hematoma (collection of blood); pain and stiffness
Blood supply to posterior thigh
perforating branches of deep femoral artery
Sciatic nerve
L4,5
S1,2,3
Largest nerve in body, no branches in gluteal region
Pudendal nerve
S2,3,4
Supplies structures in perineum
Posterior Femoral cutaneous Nerve
S1,2,3
Cutaneous to skin of lower buttock and skin of posterior compartment of thigh
Superior Gluteal nerve
L4,5 S1
To gluteus medius, minimus and Tensor Fasciae latae
Inferior Gluteal nerve
L5, S1,2
To gluteus Maximus
Other muscular nerve branches
To quadratus femoris, obturator internus and piriformis
