Gluteal Region

Question 1

Describe the anatomical location of the gluteal region

Answer 1

-Lies between the back and the posterior thigh
-Posterior to the pelvis
- Bounded superiorly by the iliac crests and inferiorly by the gluteal fold/sulcus
- The intergluteal cleft lies between the buttocks
- The greater trochanter of the femur marks its lateral extent

Question 2

Where is the superficial muscle layer found? Name its actions

Answer 2

• Deep to the skin, superficial and deep fascia
• Abduct and extend the lower limb at the hip joint
• Helps to define the gluteal fold

Question 3

What is the most superficial and largest gluteal muscle?

Answer 3

Gluteus maximus

Question 4

Name the proximal and distal attachments of the gluteus maximus

Answer 4

• Proximal: iliac crest, sacrum, sacrotuberous ligament and coccyx
• Distal: iliotibial tract

Question 5

What is the action of the gluteus maximus

Answer 5

Most powerful extensor of the hip

Question 6

What innervates the gluteus maximus?

Answer 6

Inferior gluteal nerve (L5-S2)

Question 7

Name the proximal and distal attachments of the gluteus medius

Answer 7

• Proximal: external ileum between anterior and posterior gluteal lines
• Distal: lateral surface of greater trochanter of femur

Question 8

What is the action of the gluteus medius

Answer 8

Abduct and medially rotate the thigh at the hip joint

Question 9

What innervates the gluteus medius?

Answer 9

Superior gluteal nerve (L4-S1)

Question 10

Name the proximal and distal attachments of the gluteus minimus

Answer 10

• Proximal: external ileum between anterior and inferior gluteal lines
• Distal: superior surface of greater trochanter of femur

Question 11

What is the action of the gluteus minimus?

Answer 11

Abduct and medially rotate the thigh at the hip joint

Question 12

What innervates the gluteus minimus?

Answer 12

Superior gluteal nerve (L4-S1)

Question 13

Name the actions of the deep muscle layer and what it is innervated by

Answer 13

• Lateral rotators of the thigh and hip stabilises
• Innervated by nerves from the sacral plexus

Question 14

Name the proximal and distal attachments of the piriformis

Answer 14

• Proximal: anterior surface of sacrum
• Distal: superior surface of greater trochanter of femur
• Also divides the greater sciatic foramen into suprapiriform and infrapiriform foramina
• Innervation: anterior ramus of S1, S2

Question 15

Name the actions of the pirifomis

Answer 15

-Laterally rotates the extended thigh
-Abducts the flexed thigh
-Also divides the greater sciatic foramen into suprapiriform and infrapiriform foramina

Question 16

What is the piriformis innervated by?

Answer 16

Anterior ramus of S1, S2

Question 17

Name the proximal and distal attachments of the superior and inferior gemelli

Answer 17

Proximal: ischial spine
Distal: ischial tuberosity

Question 18

Name the actions of the superior and inferior gemelli

Answer 18

-Laterally rotates the extended thigh
-Abducts the flexed thigh

Question 19

What is the superior and inferior gemelli innervated by?

Answer 19

• Superior: nerve to obturator internus
• Inferior: nerve to quadratus femoris

Question 20

Name the proximal and distal attachments of the obturator internus

Answer 20

-Proximal: internal surface of obturator membrane,
-Distal: trochanteric fossa

Question 21

Name the actions of the obturator internus

Answer 21

-Laterally rotates the extended thigh
-Abducts the flexed thigh

Question 22

What is the obturator internus innervated by?

Answer 22

Nerve to obturator internus

Question 23

Name the proximal and distal attachments of the obturator femoris

Answer 23

-Proximal: ischial tuberosity
-Distal: intertrochanteric crest (quadrate tubercle)

Question 24

Name the action of the obturator femoris

Answer 24

Laterally rotates the thigh

Question 25

What is the obturator femoris innervated by?

Answer 25

Nerve to quadratus femoris

Question 26

What does the inferior gluteal neurovascular bundle contain? What does it supply? Where is it located

Answer 26

-Contains the inferior gluteal artery, vein and nerve (L5, S1, S2)
- Supplies gluteus maximus
- Located deep to gluteus maximus

Question 27

What does the superior gluteal neurovascular bundle contain? What does it supply? Where is it located

Answer 27

• Contains the superior gluteal artery, vein and nerve (L4, L5, S1)
• Supplies the gluteus medius and minimus muscles
• Located deep to gluteus medius

Question 28

Damage to what results in the clinical sign identified in the ‘Trendelenburg Test’…

Answer 28

Damage to the gluteus medius/gluteus minimus or their nerve supply (superior gluteal nerve)

Question 29

What does a positive Trendelenburg sign indicate?

Answer 29

Gluteal muscle weakness e.g. if the left gluteal muscles are weak, the right side of the pelvis will drop when the patient stands on their left leg (with the right leg unsupported)