Gluteal Region Flashcards
What enters and exits the Greater Sciatic Nerve?
all nerves exit the Greater Sciatic Foramen:
- Gluteal neurovascular bundle
- Piriformis m.
- Sciatic nerve
- Posterior femoral cutaneous n.
- pudendal and internal pudendal a.
- obturator internus/superior gemellus
What ligaments form the greater/less sciatic foramen?
Sacrotuberous ligament (Greater sciatic) Sacrospinous ligament (lesser sciatic)
What enters/exits the lesser sciatic foramen?
- Pudendal n and internal pudendal artery (enter)
- Obturator internus and superior gemellus nerve (enter)
- obturator internus (exit)
Cluneal Nerves
cutaneous nerves of the gluteal region
- Superior - lateral branches of dorsal rami
- middle - dorsal rami 2/3
- lower - ventral rami
Super gluteal nerve
leaves pelvis superior to periformis with superior gluteal artery
runs between gluteus medius and minimus
supplies those + tensor fasciae latae
Inferior gluteal nerve
Leaves pelvis inferior to periformis with inferior gluteal artery
supplies gluteus maximus
Sciatic Nerve
Leaves pelvis inferior to periformis
runs deep to gluteus maximus
usually divides half down into tibial and common fibular nerves
no gluteal region innervated
Posterior femoral cutaneous nerve
s1-s3
supplies more skin than any other cutaneous nerve
Obturator Internus/Superior Gemellus Nerve
Leaves pelvis through greater sciatic and re-enters through lesser sciatic nerve
Pudendal nerve
most medial structure exiting greater sciatic nerve, re-enters via lesser sciatic foramen to supply perineal structures
Arteries of gluteal region
Branches arise from internal iliac
- superior gluteal artery
- inferior artery
- internal pudendal artery
Superior Gluteal artery
Largest internal iliac artery branch
Deep/superficial branch
Superficial branch: gluteus maximus
Deep branch: gluteus medius, minimus, tensor
fascia lata
Deep branch of the superior gluteal artery
gluteus medius, minimus, tensor fascia lata
Inferior gluteal artery
gluteus maximus
small lateral rotators
superior hamstrings
participate in cruciate anastomoses
Cruciate anastomoses includes
- transverse branch of medial circumflex femoral artery
- terminal part of transverse branch of lateral circumflex
- femoral artery
- first perforating artery
- inferior gluteal artery
Internal pudendal artery
reenters pelvis via lesser sciatic
supplies perineal muscles and ext genitalia
NO GLUTEAL structures
Gluteal injections should
- be made in superio-lateral part of gluteal region
Chief extensor muscle of the thigh and lateral rotation
gluteus maximus
inferior gluteal nerve
attachment site: posterior gluteal line
Thigh abduction and medial rotation, and supplied by
superior gluteal nerve
gluteus minimus and medius
My function is abduction, medial rotation of the thigh as well as flexion. I also assist in slight extension of the knee
tensor fascia lata
Iliotibial tract: where and function
runs from iliac tubercle to gerdy’s
reinforced by tensor fascia latae and gluteus maximus
functionL decelerating adduction of thigh, extends leg, compensate for quadriceps paralysis via gluteus maximums flexion
pulls patella laterally
Pulls patella laterally and stretch to treat chondromalacia patella
ilitibial tract
Positive Trendelenburg : signs
gluteal gait/limp
superior gluteal nerve injury
a patient loses steadying action, what has been lost?
gluteus stabilizing actions
superior gluteal nerve has been effected
Duchennes’s limp
loss of gluteus stabilizing function, superior gluteal nerve injury
Deep to gluteus maximus, medial to gluteus medius
periformis
Occludes or stops up
obturator internus
“Extrapelvic parts of obturator internus”
superior/inferior gemelli
Triceps Coxae
Superior/Inferior Gemelli + obturator internus
Inserts in trochanteric fossa
origin is ischial spine+ lesser sciatic notch
inferior/superior gemellus
Attachments:
external margins of obturator foramen
trochanteric fossa
obturator externus
deep to pectineus
Attachments:
trochanteric crest and iliac below acetabulum
Quadratus femoris
Lateral rotation muscles of hip
Obturator externus Obturator internus Triceps Coxae Piriformis Quadratus femoris Gluteus maximus
Oh, Orion
The child’s
palaces Quake
for guilty men
Oh, Orion
The child’s
palace Quakes
for guilty men
Obturator externus Obturator internus Triceps Coxae Piriformis Quadratus femoris Gluteus maximus
lateral rotation of hip
Medial rotation of hip
Tensor fasciae latae
gluteus medius
gluteus minimus
The faces leave
Gray medows
gutted and meager
Which of the lateral rotatores is least effective when thigh is flexed?
piriformis
The faces leave
meager
Gray medows
gutted
Tensor fasciae latae
gluteus medius
gluteus minimus
medial rotators
