Anatomy of the gluteal region and hip

Question 1

Describe the deep fascia

Answer 1

• Fascia lata in thigh
• Changes name in the leg
• Limits outward expansion of muscles,
  aids venous return
• Extensions divide leg into
  compartments

Fascia lata is thickened
laterally as the iliotibial
tract
* Encloses tensor fasciae
latae
* Gluteus maximus inserts
onto IT

Question 2

Gluteus maximus

Answer 2

Origin – external ilium posterior
to posterior gluteal line, dorsal
sacrum, coccyx and
sacrotubeous ligament
* Insertion – gluteal tuberosity
and iliotibial tract
* Innervation – Inferior gluteal
nerve (L5, S1, S2)
* Action – powerful hip extensor,
abducts and laterally rotates
thigh, stabilizes hip

Question 3

Gluteal burase

Answer 3

Trochanteric – between Gmax
and greater trochanter
* Ischial – between Gmax and
ischial tuberosity
* Gluteofemoral – between
Gmax and vastus lateralis
tendon

Question 4

Tensor fasciae latae

Answer 4

Origin – lateral iliac crest
between ASIS and tubercle
* Insertion – iliotibial tract
* Innervation – superior gluteal
nerve (L4, L5, S1)
* Action – stabilizes knee and hip

Question 5

Gluteus medius

Answer 5

• Origin – external ilium between
  posterior and anterior gluteal lines
• Insertion – greater trochanter
• Innervation – superior gluteal nerve
  (L4, L5, S1)
• Action – abducts and medially rotates
  femur; most posterior fibres can
  laterally rotate

Question 6

Gluteus minimus

Answer 6

Origin – external ilium between
anterior and inferior gluteal lines
* Insertion – greater trochanter
* Innervation – superior gluteal
nerve (L4, L5, S1)
* Action – abducts and medially
rotates femurc

Question 7

Deep muscles- piriformis

Answer 7

• Origin – anterior sacrum
• Insertion – greater trochanter
• Innervation – nerve to piriformis
  (L5, S1, S2)
• Action – laterally rotates
  (extended) and abducts (flexed)
  femur

Question 8

Deep muscles- quadratus femoris

Answer 8

Quadratus femoris
* Origin – lateral aspect of ischium
to ischial tuberosity
* Insertion – quadrate tubercle and
intertrochanteric crest
* Innervation – nerve to quadratus
femoris (L5, S1)
* Action – laterally rotates femur

Question 9

Deep muscles- obturator internus

Answer 9

• Origin – obturator membrane and
  surrounding bones
• Insertion – greater trochanter
• Innervation – nerve to obturator
  internus (L5, S1)
• Action – laterally rotates (ext

Question 10

Superior and inferior gemellus

Answer 10

Origin – ischial spine (superior) and
ischial tuberosity (inferior)
* Insertion – greater trochanter and
tendon of obturator internus
* Innervation – nerve to obturator
internus (superior) and nerve to
quadratus femoris (inferior)
* Action – laterally rotates (extended)
and abducts (flexed) femur

Question 11

What are the major arteries supplying the gluteal region

Answer 11

Femoral artery –
– Major artery of thigh
– Gives off deep artery of thigh
(=profunda femoris)&raquo_space; lateral
and medial circumflex arteries

• Lateral and medial circumflex
  contribute to cruciate
  anastomosis around the hip
• Medial circumflex is the most
  important source of blood to
  the femoral head in adults

Question 12

Superior and inferior gluteal artery

Answer 12

Branches of internal iliac
– Pass through greater sciatic
foramen
– Supply adjacent muscles and
contribute to cruciate
anatomosis

Question 13

Obturator artery

Answer 13

Branch of internal iliac
– Passes through obturator
canal, divides into anterior
and posterior branches
– Joins cruciate anastomosis
– Posterior branch>acetabular
branch to head of femur

Question 14

Lumbosacral plexus basics

Answer 14

Ventral rami of L1 – S4
* Nerves to the limb are
from L1 – S3 - limbs are
multi-segmental
* Developmentally dorsal
muscles innervated by
dorsal divisions
* Developmentally ventral
muscles innervated by
ventral divisions

Question 15

Nerves of lumbosacral plexus

Answer 15

Femoral nerve (L2 – L4) –
through subinguinal gap,
all muscles of anterior
thigh, obturator externus,
cutaneous to anterior
thigh, medial
knee/leg/foot

• Obturator nerve (L2 – L4)
  – through obturator canal,
  all muscles of medial
  thigh except part of
  adductor magnus and
  pectineus, cutaneous to
  upper medial thigh

Superior (L4 – S1) and inferior
(L5 – S2) gluteal nerves –
through greater sciatic
foramen, GMax (inferior),
GMed, Gmin and tensor fasciae
latae (superior)

SCIATIC NERVE (L4-S3)
* All muscles in
posterior thigh, part
of adductor magnus,
all muscles of leg
and foot, skin of
lateral leg and foot
* Common fibular
(posterior L4 – S2)
* Tibial (anterior L4 –
S3)

Question 16

How are intergluteal injections performed

Answer 16

Intragluteal injections –
Should be performed in the upper
lateral quadrant of the gluteal
region so as not to damage the
sciatic nerve or structures passing
through the sciatic foramina