Gluteal Region Flashcards
What can be found in the lesser sciatic foramen?
- pudental nerve
- internal pudental artery
- obturator internus
- sup. gemellus nerve
- obturator internus
What is the cutaneous nerve of the gluteal region?
-cluneal nerves
+sup. and middle (lateral branches of dorsal rami)
1. supply sup. 2/3, sacrum and adjacent area
+inferior
1. supply inferior 1/3
2. gluteal branches of post. femoral cutaneous nerve
Superior gluteal nerve
- leaves pelvis sup. to piriformis with sup. gluteal artery
- runs between gluteus medius and gluteus minimus
- supplies gluteus medius, minimus, tensor fasciae latae
Inferior gluteal nerve
- leaves pelvis inferior to piriformis with inferior gluteal artery
- supplies gluteus minimus
What is the largest nerve in the body?
sciatic nerve
sciatic nerve
- leaves pelvis inferior to piriformis
- runs inferiorly deep to gluteus maximus
- usually divides half way down thigh into tibial and common fibular nerves
- does not supply any gluteal structures
What is a posterior hip location?
- can cause damage to the sciatic nerve
- may result in paralysis of hamstrings and muscles distal to the knee
- sensory change may occur in skin over the posterolateral aspects of the leg and most of the foot
What nerve supplies more skin than any other cutaneous nerve?
posterior femoral cutaneous nerve
Innervation of quadratus femoris?
-inferior gemellus nerve
Innervation of obturator internus?
-superior gemellus nerve
+leaves pelvis via geater sciatic foramen
+reenters pelvis via sciatic foramen
Pudental nerve
- most medial structure exiting greater sciatic foramen
- reenters pelvis via lesser sciatic foramen to supply perineal structures
The arteries supplying the gluteal region
- sup. gluteal a
- inf. gluteal a
- internal pudental a
superior gluteal artery
- largest internal iliac artery branch
- superficial branch: gluteus maximus
- deep branch: gluteus medius, minimus, tensor fascia latae
Inferior gluteal artery
-supplies:
+gluteus maximus
+small lateral rotators
+superior hamstrings
-participates in cruciate anastomosis of thigh
+transverse branch of the medial circumflex femoral artery
+terminal part of the transverse branch of the lateral circumflex femoral artery
+first perforating artery
+inferior gluteal artery
What anastomosis comes into play if femoral artery is blocked?
-cruciate anastomosis \+inf. gluteal artery \+medial circumflex femoral artery \+perforating arteries \+lateral circumflex femoral artery
Internal pudental artery
- reenters pelvis via lasser sciatic foramen with pudental nerve
- supplies perineal muscles and ext. genitalia
- does not supply any gluteal structures
Where should intragluteal injections be made?
-supero-lateral part of gluteal region to avoid sciatic nerve and gluteal vessels
Innervation and actions of the GLUTEUS MAXIMUS
innervation: inferior gluteal nerve
actions: chief extensor of the thigh and lateral rotation, slight extension of leg with tensor fascia latae
Innervation and actions of GLUTEUS MEDIUS and MINIMUS, location
innervation: superior gluteal nerve
actions: thigh abduction and medial rotation
location: both partially covered by maximus, medius over minimus
Innervation, actions, and covering of TENSOR FASCIA LATA
innervation: superior gluteal nerve
covered by: fascia lata
actions: abducts, medially rotates, and flexes thigh, slight extension of thigh with maximus
What is a feature of the fascia lata?
-iliotibial tract
+runs from iliac tubercle and Gerdy’s on lateral tibial condyle
+reinforced by tendinous fibers
What are the functions of the IT tract?
- assists in decelerating adduction of thigh
- laterally stabilizes knee
- extends leg, compensate for quads, paralysis via gluteus maximus flexion
- pulls patella laterally, antagonist of vastus medialis, and synergist with flexing vastus lateralis
- stretch to treat chondromalacia patella
What are some causes and effects of positive Trendelenburg’s sign? (gluteal gait or limp)
causes:
- superior gluteal nerve injury
effect:
-patient loses steadying action of gluteus minimus and medius
What is Duchenne’s limp?
- issues with superior gluteal nerve
- it is the hip dropping gait
PIRIFORMIS
innervation: nerve to pirifomis
- deep to gluteus maximus and medial to gluteus medius
- sciatic nerve enters piriformis in different ways
OBTURATOR INTERNUS
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What can be found in the greater sciatic foramen?
- gluteal neurovascular bundles
- piriformis
- sciatic nerve
- post. femoral cutaneous nerve
- pudental nerve
- internal pudental artery
- obturator internus/sup. gemellus nerve
