Gluteal Flashcards
Glute borders
The gluteal region lies posterior to the pelvis and is bounded superiorly by the iliac crests and inferiorly by the gluteal sulcus created by the Gluteus Maximus muscles.
Label the X ray of pelvis
Lecture Slide
Glute ligaments
- Sacrotuberous ligament is continuous with the posterior sacroiliac ligament. It extends across the sciatic notch and along with the
2.sacrospinous ligament, converts the notch into Greater and Lesser Sciatic Foramina.
Label the areas of pelvis (no ligaments)
Lecture Slide
Label pelvis with ligaments
Lecture Slide
Gluteal Muscles:
*Gluteus Maximus
*Gluteus Medius
*Gluteus Minimus
Piriformis
Obturator internus
Superior and inferior gemelli
Quadratus femoris
*Tensor fascia lata
- origin
-insertion
-action
-Nerve supply
Lecture Slide
*Gluteus Maximus
Origin:
Upper portion of ilium, posterior sacrum, coccyx, sacrotuberous lig
Insertion:
ITB, gluteal tuberosity of femur
Action:
Extends and
laterally rotates thigh
Extends hip
Nerve Supply
Inferior Gluteal L5,S1,S2
*Gluteus Medius
Origin: Ilium between posterior and middle gluteal lines
Insertion: Greater trochanter
Action: Abducts and internally rotates thigh, steadies pelvis when walking
Nerve Supply
Superior Gluteal L4-S1 and artery
*Gluteus Minimus
Origin: Ilium between middle and inferior gluteal lines
Insertion: Greater trochanter
Action:’Abducts and internally rotates thigh, stabilise pelvis when walking
Nerve Supply
Superior Gluteal L4-S1 and artery
Tensor fascia lata
Origin: ASIS, iliac crest
Insertion: ITB
Action: Abducts thigh, dynamic stabilizer. When raising leg to take a step, weight of body shifts to standing leg. To prevent pelvis tilting to side of raised leg the opposite side abductors need to be very powerful
Nerve Supply
Superior Gluteal L4-S1
Label where abductors and extensors and rotators are
Lecture Slide
Label where all muscles are on glute
Lecture Slide
Posterior Thigh Muscles:
Label diagram
Lecture Slide
Muscles of Posterior Thigh Muscles:
*Biceps femoris
*Semitendinosus
*Semimembranous
Adductor magnus
-origin
-insertion
-action
-nerve supply
LEcture Slide
*Biceps femoris
Origin
Long Head: ischial tuberosity Short Head: linea aspera
Insertion
Head of fibula
Action
Flexes and externally rotates leg at knee; extends thigh at hip
Nerve supply
Sciatic
Long Head: Tibial
Short Head: Peroneal (L5, S1)
*Semitendinosus
Origin: Ischial tuberosity
Insertion
Superior part of medial tibia
(Pes Anserinus)
Action
Flexes and internally rotates leg; extends thigh/hip
Nerve supply
Sciatic (Tibial L5, S1, S2)
*Semimembranous
Origin: Ischial tuberosity
Insertion
Medial condyle of tibia
Action
Flexes and internallyrotates leg; extends thigh/hip
Nerve supply
Sciatic (Tibial L5, S1, S2)
Nerves and Vessels of the Gluteal Region
describe the flow and label diagram
The gluteal arteries arise from the Internal Iliac Arteries.
The Superior Gluteal and Inferior Gluteal arteries leave the pelvis through the Greater Sciatic Foramen and, along with their corresponding nerves, pass superior and inferior to Piriformis.
The Internal Pudendal Artery also leaves the pelvis via the Greater Sciatic Foramen, but then hooks around the Ischial spine to enter the pelvis via the Lesser Sciatic Foramen.
The Superior and Inferior Gluteal Arteries anastomose then further anastomose with the circumflex arteries (branches of the Profunda Femoris).
Lecture Slide
Sciatic nerve
-size
-continuation of
-divides into
The Sciatic Nerve is the largest nerve in body and is a continuation of main part of sacral plexus.
It exits under the gluteal region under Gluteus Maximus, inferior to Piriformis.
It is large enough to have own artery- a branch of the Inferior Gluteal- called the artery to Sciatic Nerve.
The Sciatic Nerve divides into Tibial and Peroneal components
Tilt of bony pelvis and ASIS is in same plane as ?
The bony pelvis
is tilted upwards
ASIS is in same plane as symphysis pubis
Acetabulum:
At site of fusion of what 3 bones?
-how does it change as you age? and at what age for each sex does it fuse
illium, ischium and pubis
Initially cartilaige and then becomes bones and then fuse (Age 14 –for girls and Age 16 for boys)
Label the hip bone front and back (side profile)
Pelvis comprises of 2 hip bones (+ ischium, ilium, pubis) + the sacrum + coccyx
Lecture Slide
Where is the Sacrospinous ligament and Sacrotuberous ligament on diagram
Lecture Slide
describe location of Sacrospinous ligament
- attaches to?
Located from the sacrum to the ischial spine
describe location of Sacrotuberous ligament
- attaches to?
- continous with?
-converts notch into?
Located from The sacrum to the ischial tuberosity
Attaches to ischium spine to saccrum
Sacrotuberous ligament is continuous with the posterior sacroiliac ligament
*It extends across the sciatic notch and along with the sacrospinous ligament, converts the notch into Greater and Lesser Sciatic Foramina
Greater and Lesser sciatic foramen
- Purpose
-Example
The Greater Sciatic Foramen
* Allows passage to all the lower limb arteries and nerves OUT from the pelvis and into the gluteal region e.g. Sciatic Nerve (7 nerves, 3 arteries, 1 muscle)
The Lesser Foramen
Is the passage way for structures entering or leaving the perineum. e.g. Pudendal Nerve
what does externally rotating hip look like?
Point toes outward
Nerves and Vessels of Gluteal region in relation to piriformis
Arteries and nerves arising above piriformis = superior gluteal A+N
Arteries and nerves arising below piriformis = inferior gluteal A+N
Summary:
Nerves and what they supply to and their nerve supply
Nerves to gluteal region
Sup gluteal nerve
Inferior gluteal nerve
Post femoral cutaneous n
Sciatic N
Pudendal nerve
- Nerves to gluteal region are from sacral plexus (L4-S4)
- Sup gluteal nerve supplies gluteus medius and minimus
- Inferior gluteal nerve supplies gluteus maximus
- Other muscles have own nerves (quad femoris,
obturator internus, piriformis) - Post femoral cutaneous n S1-3. supplies skin of lower buttock and post compartment of thigh
- Sciatic N (L4,5,S1,2,3) has no branches in gluteal region
- Pudendal nerve supplies perineal structures
Arteries of the gluteal region
-superior and inferior flow
The gluteal arteries arise from the Internal Iliac arteries
The Superior and Inferior Gluteal arteries leave the pelvis through the Greater Sciatic Foramen and, along with their corresponding nerves, pass superior and inferior to Piriformis
Gluteal Superior and inferior arteries anatomse with what
The Superior and Inferior Gluteal Arteries anastomose then further anastomose with the circumflex arteries (branches of the Profunda Femoris that supply femoral head)
Clinical Applications: Hamstring injuries
Usually due to kicking or running sports.
Muscle sstrains or tears or can avulse the ischail tuberosity
Where can you give injections in the butt?
With respect to the Sciatic nerve, the buttock has a ‘safe’ side; the lateral side.
The safe area to give these injections is therefore the superolateral part of the buttock.
Trendelenburg gait
-caused by?
-affects of this?
-how to diagnose
Gluteus Medius has an important role in pelvic stabilization, particularly when walking
Injury to this muscle (or the the Superior Gluteal Nerve) results in a characteristic stance and gait pattern. Thigh abduction on the affected side is weakened and the resulting gait is referred to as a Gluteal or Trendenlenburg gait
Causes: Avulsion of insertion of gluteus medius
Diagnosis:
When a person with a non-functioning
Gluteus Medius stands on the affected leg, the pelvis will titl down on the unaffected
side (the ‘sound side sags’). As this person walks, to clear the leg on the unaffected side they must lean over to the side with the Glut Med insufficiency- giving the characteristic Trendelenburg gait.
