Gluteal Region

Question 1

What is the gluteal region?

Answer 1

Borders;
Superiorly by iliac crest
Inferiorly by gluteal fold
Laterally by greater trochanter of femur
Medially by intergluteal cleft

Superficial layer - Gluteus Maximus, medius, minimus and tensor fascia lata
Deep layer - lateral rotators
Innervated by branches of the sacral plexus
Blood supply from branches of internal iliac artery:

Question 2

Describe the Tensor Fascia Lata:

Answer 2

Originates at Iliac tubercle and inserts at the Iliotibial tract
Iliotibial tract = thickening of fascia lata, inserts on lateral tibial condyle
Function - flex hip, stabilise knee
Innervated by superior gluteal nerve
Blood supply - superior gluteal artery and femoral artery

Question 3

Describe the Gluteus Maximus:

Answer 3

Originates at;
Sacrum,
Sacrotuberous ligament
Ilium posterior to post. gluteal line
Inserts at;
Iliotibial tract
Gluteal tuberosity

Function - extend and laterally rotate the hip,
Innervated by inferior gluteal nerve

Question 4

Describe the gluteus medius and gluteus minimus:

Answer 4

G. Medius originates at ilium between post. & ant. gluteal lines
G. Minimus originates at ilium between ant. & inf. gluteal lines
Both insert at the greater trochanter
Function - abduct and medially rotate hip
Innervated by the superior gluteal nerve

Question 5

Describe the sacral plexus and its components:

Answer 5

Plexus of nerves formed by L4-S4 anterior rami
Located anterior to piriformis

Superior gluteal (L4-S1) - Gluteus medius, minimus, tensor fascia lata
Inferior gluteal (L5 - S2) - gluteus maximus
Sciatic (L4 - S3) - hamstrings, legs
Posterior femora cutaneous (S1 - S3) - sensory to posterior thigh
Pudenal (S2 - S4) - perineum, penis, clitoris

Question 6

How do nerves and vessels reach gluteal region?

Answer 6

Nerves & vessels exit the pelvis via the greater sciatic notch to reach the gluteal region

Question 7

Describe the Piriformis:

Answer 7

Originates at anterior surface of sacrum
Inserts at the grater trochanter
Function: Laterally rotate extended hip, Abduct flexed hip
Innervated by nerve to piriformis arising from sacral plexus

Question 8

Describe the Superior Gemellus:

Answer 8

Originates from ischial spine of pelvis
Inserts at the greater trochanter via tendon of obturator internus
Innervated by the nerve to obturator internus
Function - Laterally rotate extended hip, Abduct flexed hip

Question 9

Describe the Obturator Internus

Answer 9

Originates from the internal (posterior) surface of the obturator membrane
The muscle’s fibres converge into a tendon that passes through the lesser sciatic notch
Inserts at medial surface of the greater trochanter of the femur
Function - Laterally rotate extended hip, Abduct flexed hip
Innervated by the nerve to obturator internus

Question 10

Describe the Inferior Gemellus

Answer 10

Originates from the ischial tuberosity
Inserts onto the medial surface of the greater trochanter via the tendon of the obturator internus
Function: Laterally rotate extended hip, Abduct flexed hip
Innervated by the nerve to quadratus femoris

Question 11

Describe the Quadratus Femoris

Answer 11

Originates from the lateral border of the ischial tuberosity
Inserts greater trochanter (specifically on the quadrate tubercle on the intertrochanteric crest)
Most inferior off lateral abductors
Function: Laterally rotate extended hip, Abduct flexed hip
Innervated by nerve to quadratus femoris

Question 12

Describe the blood supply to the lateral rotators of the hip:

Answer 12

Piriformis - superior gluteal + inferior gluteal arteries

Superior gemellus - inferior gluteal artery + internal pudendal artery

Obturator internus - inferior gluteal artery + Internal pudendal artery

Inferior gemellus - inferior gluteal artery + Medial circumflex femoral arter

Quadratus Femoris - Medial circumflex femoral artery + inferior gluteal artery

Question 13

What is Trendelenburg Gait?

Answer 13

Gluteus medius abducts hip but it also keeps pelvis level when contralateral limb is off the ground
If impaired (e.g. superior gluteal nerve injury) we see a characteristic Trendelenburg gait - right hip drops when right leg off the ground

Question 14

What are the 2 ligaments in the gluteal region?

Answer 14

Sacrospinous Ligament: Connects the sacrum to the ischial spine, converting the greater sciatic notch into the greater sciatic foramen.
Sacrotuberous Ligament: Extends from the sacrum to the ischial tuberosity, stabilizing the pelvis and creating the lesser sciatic foramen by closing off the lesser sciatic notch.