gluteal region Flashcards
what is different in terms of timing when it comes to lower and upper limb development
lower limb develops a week after upper (4th and 5th week)
where do you begin to see the lower limb buds? upper limb buds? what is located on the superior aspect of these buds?
lower limb- L2-S2
upper- C5-T1
big toes and the thumbs
what occurs to the upper and lower limbs in the 7th week of gestation?
- upper limb rotates laterally around its axis
- lower rotates medially- continues even post birth-explains why baby feet meet sole to sole
what accounts for the barber-pole pattern of the cutaneous innervation (dermatome pattern) of the limbs?
the rotation of the limbs in utero
where do the hip bones meet anteriorly and posteriorly
anteriorly at the pubic symphysis and posteriorly at the sacroiliac joint (meets with sacrum)
when do the ilium, ischium and pubis fuse
at the end of teen yrs
what two bones the hip bones articular with
sacrum and femur
what comprises the pelvic girdle? how does the bony pelvis differ?
- the pelvic girdle is the two hip bones together
- bony pelvis includes sacrum and coccyx
what it the largest of the three parts of the hip and describe some of its characteristics
- ilium
- ala- wing, attachment side for gluteal muscles laterally and iliacus on the medial side
what part of the acetabulum does the ilium make up?
the superior 2/5
what part of the lumbar spines does the line between the anterior superior iliac spine to the posterior superior iliac spines go thru?
L4-5
what is the attachment site for the posterior sacroiliac ligament
posterior inferior iliac spine
what comprises the posterior 2/5 of the acetabulum
the ischium
what are the two parts of the ischium
-body (consists of all the good stuff IT’s etc) and the ramus(consists of just the ramus
at the bottom of the ischium, what two things come together to fuse the pubis with the ischium
the ichial ramus and the inferior ramus of the pubis to form the ischiopubic ramus
what fraction of the acetabulum does the pubis make up?? what are the three main parts of the pubis
- 1/5
- three parts- body, superior ramus and inferior ramus
what part of the pubis fuses with the ischium and the ilium within the acetabulum
superior ramus of the pubis
what is the greater sciatic foramen formed of? what is ita a passageway for?
- made up of the
1) sacrospinous ligament- ligament that goes from sacrum to the spine of the ischium
2) sacrotuberous ligament- ligament from the sacrum to the IT
3) greater sciatic notch
what muscles traverses the greater sciatic foramen? Nerves and vessels?
- piriformis
- internal pudendal vessels and nerve
- sciatic nerve
- posterior femoral cutaneous nerve
- nerve to quadratus femoris and inferior gemellus
- nerve to the obturator internus and superior gemellus
what makes up the lesser sciatic foramen?
- formed by lesser sciatic notch and the sacrospinous and sacrotuberous ligaments
what structures traverse the lesser sciatic foramen
1) the tendon of the obturator internus
2) internal pudendal vessels and pudendal nerve
3) nerve to the obturator internus
the gluteal muscles are split into superficial and deep. what are the superficial muscles comprised of? what are their primary fxn?
- gluteus max, med, min- mainly extensors and abductors of the thigh
gluteus max: origin insertion action nerve blood supply
origin- (CISS my gluteus max): coccyx, ilium, sacrotuberous ligament, sacrum
insertion- (TI loves butts) gluteal tuberosity and iliotibial tract
action-extend and laterally rotate thigh, rising from sitting position and running
nerve- inferior gluteal
blood supply- superior and inferior gluteal arteries
Gluteus medius origin insertion action nerve blood supply
origin- ilium between anterior and POSTERIOR gluteal line
insertion- greater trochanter
action- abduction and medial rotation of thigh; along with gluteus min, stops the hip from sagging on the unsupported side
nerve- superior gluteal
blood supply- superior gluteal
gluteus minimus origin insertion action nerve blood supply
origin- ilium between the anterior and INFERIOR gluteal lines
insertion- greater trochanter
action- abduction and medial rotation- stops the hip from sagging on unsupported side with the glut. med
nerve- superior gluteal
blood supply- superior gluteal
what’s a positive trendelenburg sign?
- damage to superior gluteal nerve
- would cause blockage of innervation to the glut med/min
- waddling gait, high stoppage gait and swing out gait
what comprises the deep layer of the gluteal muscles
4 things-
piriformis, obturator internus, inferior gemellus, quadratus femoris
piriformis origin- insertion- nerve- action- location-
origin-anterior surface of the sacrum insertion- greater trochanter (gluteal and pelvic regions) nerve-S1-2 action-lateral rotation of the thigh location is right under the glut min
obturator internus origin- insertion- nerve- action- location
origin- obturator membrane surrounding bone
insertion:-greater trochanter- LEAVES PELVIS THRU THE LESSER SCIATIC FORAMEN
nerve-nerve to the obturator internus (L5, S1-2)
action- lateral rotation of the thigh, extension, abduction of flexed thigh
location- right under the superior gemellus and over the inferior gemellus
superior gemellus origin- insertion- nerve- action- location
origin- ischial spine
insertion- tendon of obturator internus
nerve-nerve to the obturator internus (L5, S1-2) (same as obturator internus)
action-lateral rotation of thigh, extension,. abduction of flexed thigh (same as obturator internus)
location- above obturator internus
inferior gemellus origin- insertion- nerve- action- location
origin- ischial tuberocity
insertion-tendon to the obturator internus
nerve-nerve to the quadratus femoris (L5, S1) (like QF)
action- lateral rotate thigh (like QF)
location -under the obturator internus
quadratus femoris origin- insertion- nerve- action- location
origin- ischial tuberocity insertion- interotrocanteric crest nerve- nerve to the quadratus femoris (L5-S1) action-laterally rotate the thigh location- under the inferior gemellus
the sacral plexus is the lower part of the ____ and is covered by branches from what artery
lumbosacral plexus- ventral primary rami (L4-5,s1-4)
internal iliac artery
where does the major part of the plexus lie? what foramen does do the large branches of the sacral plexus pass thru to get to the gluteal regions
on top of the piriformis
they pass thru the greater sciatic foramen
what is the sacral plexus made up of
-ventral primary rami of the
where do the S1-4 nerves enter the pelvis thru?
the sacral formina
what do they nerves of the sacral plexus supply the muscles and skin of?
gluteal region
the posterior thigh and the entire leg and foot
__to__ divisions of the sacral plexus give rise to anterior and posterior divisions
L4-S4
*what are the posterior divisions of the sacral plexus?
posterior- common peroneal, superior gluteal, inferior gluteal, posterior femoral cutaneous, nerve to the piriformis
*what are the anterior divisions of the sacral plexus?
QPLOT:
- N. to quadratus femoris
- Pudendal n
- Nerve to the levator ani
- N. to obturator internus
- Tibial nerve
What is different about the superior gluteal nerve than all other nerves of the sacral plexus
- it exists the pelvis thru the greater sciatic foramen like all of them BUT DOES SO OVER THE PIRIFORMIS VS UNDER
what spinal levels is superior gluteal? what would injury to the superior gluteal cause?
L4-S1
injury- probs with tensor fasciae latae muscles and glut medius and minimus
inferior gluteal levels? injury?
L5-S2
injury gluteus max
sciatic nerve levels? what two nerves does it give rise to? what would injury to the sciatic nerve cause?
L4-S3
largest branch of the plexus
gives rise to Tibial and common peroneal
injury will not cause any injury to the gluteal region
what levels are the tibial and common peroneal
tibial L4-5, S1-4
common peroneal L4-5, S1-2
what levels are the posterior femoral cutaneous- nerve to quadratus femoris- nerve to the obturator internus- pudendal nerve-
posterior femoral cutaneous- S1-S3- post. div sacral plexus
nerve to quadratus femoris- L4-S1 -ant div
nerve to the obturator internus-L5-S2
pudendal nerve-(near superior gemellus) -S2-4
what does the cutaneous innervation of the gluteal region
superior cuneal- dorsal primary rami
medial cuneal- dorsal
inferior cuneal-ventral
what arteries supply the muscles of the gluteal region and what major artery do they stem off of and where do they enter the gluteal region
- they stem off of the internal iliac artery and enter the gluteal region via GREATER sciatic foramen
- superior gluteal artery- glut max, med, min plus tensor facia lata
- inferior gluteal- glut max and short lateral rotators of the thigh
- internal pudendal- supplies perineal region
what are the veins of the gluteal region? what do they drain into?
- superior and inferior gluteal veins as well as the internal pudental vein
- the internal iliac vein
what is the safe zone?
where you can do intragluteal injections
-near piriformis and glut med
