Gluteal Region

Question 1

Pathology

Answer 1

Damage the normal and assess effect

Identify effected systems in injury and assess effect

Question 2

Comparison

Answer 2

Compare human normal condition to normal condition in organisms with different configurations of the same structures

Question 3

Structural differences that effect gait

Answer 3

Vertebral column, femoral angle, foot, pelvis
quadrupeds- vertebral column doesn’t bear weight
Apes- vertebra bent over, ilium longer
humans- successively larger vertebrae, lordosis and kyphosis

Question 4

Joint wear from bipedal motion

Answer 4

Lumbar spine, hips, knees, feet. All starts at the feet and goes up.

Question 5

Greater sciatic foramen

Answer 5

All exit: 
Gluteal neurovascular bundles
Piriformis m.
-sciatic nerve
-posterior femoral cutaneous n.
-pudendal n and internal pudendal n
-obturator internus/superior gemellus nerve

Question 6

Lesser sciatic foramen

Answer 6

pudendal n and internal pudendal artery (enter)
obturator internus/superior gemellus nerve (enter)
Obturator internus muscle (exit)

Question 7

Sacrospinous ligament

Answer 7

Forms greater sciatic foramen

Question 8

Sacrotuberous ligament

Answer 8

Forms lesser sciatic foramen

Question 9

Cluneal nerves

Answer 9

Superior (L1-L3) and Middle (S1-S3):
-Lateral branches of dorsal rami
-Supply superior 2/3 of sacrum and adjacent area
Inferior (S1-S3):
-Gluteal branches of posterior femoral cutaneous nerve
-supply inferior 1/3

Question 10

Superior Gluteal Nerve

Answer 10

Leaves pelvis superior to performs with superior gluteal artery
Runs between gluteus menus and gluteus minimum
Supplies gluteus medius, gluteus minimus, tensor fasciae latae

Question 11

Inferior gluteal nerve

Answer 11

Leaves pelvis inferior to piriformis with inferior gluteal artery
Supplies gluteus maximus

Question 12

Sciatic Nerve

Answer 12

L4-S3 ventral Rami
Largest nerve in the body
Leaves pelvis inferior to piriformis
Runs inferior and deep to gluteus maximus
Usually divides half way into tibial and common fibular nerves
Doesn’t supply gluteal structures
Posterior hip dislocations main cause of damage

Question 13

Posterior Femoral cutaneous nerve

Answer 13

Supplies more skin than any other cutaneous nerve

Basically entire hamstring into popliteal surface

Question 14

Obturator internus/superior Gemellus nerve

Answer 14

nerve of small lateral rotators
Leaves pelvis via greater sciatic foramen
Reenters via lesser sciatic foramen

Question 15

Pudendal nerve

Answer 15

Nerve of small lateral rotators
Anterior divisions of S2-S4 Ventral rami
Most medial structure exiting greater sciatic foramen
Reenters pelvis via lesser sciatic foramen to supply perineal structures

Question 16

Superior Gluteal Artery

Answer 16

Largest internal iliac artery branch
Superficial branch: gluteus maximus
Deep branch: Gluteus medius, minimus, tensor fascia lata

Question 17

Inferior Gluteal Artery

Answer 17

Supplies: Gluteus Maximus, Small lateral rotators, superior hamstrings
Involved in cruciate anastomosis of the thigh:
-transverse branch of medial circumflex femoral artery
- Terminal part of transverse branch of lateral circumflex femoral artery
-first perforating artery
-inferior gluteal artery

Question 18

Internal Pudendal Artery

Answer 18

Reenters pelvis via lesser sciatic foramen with pudendal nerve
Supplies perineal muscles and external genitalia
Does not supply gluteal structures

Question 19

Gluteus Maximus

Answer 19

Largest Gluteal muscle
A: Chief extensor of the thigh and lateral rotation.
-Slight extension when working with tensor fascia late
N: inferior gluteal nerve

Question 20

Gait Cycle

Answer 20

Heel strike (Gluteus Maximus, Tibialis Anterior)
Loading Response (Quadriceps Femoris)
Midstance (Triceps Surae)
Terminal Stance (Triceps Surae)
Preswing (Rectis Femoris, Iliopsoas)
Terminal Swing (Quadriceps Femoris, Tibialis anterior, hamstrings)
Heel Strike (Gluteus maximus, tibialis anterior)

Question 21

Duchenne’s Limp

Answer 21

Insert Picture

Question 22

IT Band

Answer 22

Runs from iliac tubercle to Gerdy’s tubercle
Reinforced fibers from tensor fasciae late and gluteus maximus
assists with abduction
Laterally stabilizes the knee
Extends leg. Can compensate for quad paralysis

Question 23

Glutea Gait or Duchenne’s Limp

Answer 23

Positive Trendelenburg sign (Hip drop)
Caused by Superior gluteal nerve injury
Effect: patient loses steadying action of gluteus medius and minimum
-Lean toward effected side during stance phase of gait