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Lower Extremity Anatomy > Gluteal Region > Flashcards

Gluteal Region Flashcards

1
Q

Gluteal region

A
  • Posterior to pelvis
  • Inferior to iliac crest
  • Transition point between trunk and lower extremity
  • Gluteal muscles define the region
  • Gluteal fold is inferior boundary
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2
Q

Hip region

A
  • Area over greater trochanter
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3
Q

Cutaneous nerves of gluteal region

A
  • Cluneal nerves
  • Perforating cutaneous (S2, 3)
  • Iliohypogastric nerve
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4
Q

Cluneal nerve branches

A
  • Superior
  • Middle
  • Inferior
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5
Q

Superior cluneal nerve

A
  • Branches of posterior rami of L1-3
  • Susceptible to entrapment passing through fascia
  • Can be injured during iliac crest bone harvesting
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6
Q

Middle cluneal nerve

A
  • Branches of posterior rami S1-3
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7
Q

Inferior cluneal nerve

A
  • Branches of posterior femoral cutaneous (S1-3)
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8
Q

Perforating cutaneous nerve level/pathway

A
  • S2,3

- Pierce sacrotuberous ligament

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9
Q

Perforating cutaneous nerve supplies

A
  • Small area at the inferior/medial gluteal region
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10
Q

Superficial tissue lymph drainage of gluteal region

A
  • Horizontal (superior) superficial inguinal nodes

- Lateral group

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11
Q

Deep tissue lymph drainage of gluteal region

A
  • Gluteal nodes

- Drain into internal iliac nodes

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12
Q

All gluteal muscles attach to

A
  • Hip bone/sacrum (proximal)

- Femur (distal)

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13
Q

Superficial layer gluteal muscles attach to

A
  • Posterolateral ala of ilium

- Mostly hip extensors, abductors, medial rotators

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14
Q

Deeper layer gluteal muscles attach to

A
  • Mostly hip lateral rotators, hip stabilizers
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15
Q

Fascia over gluteus maximus

A
  • Thin

- Thicker superior to gluteus maximus over gluteus medius (gluteus aponeurosis)

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16
Q

Gluteus maximus origin

A
  • External ala of ilium behind posterior gluteal line
  • Posterior iliac crest
  • Sacrotuberous ligament
  • Dorsolateral sacrum/coccyx
  • Gluteal aponeurosis
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17
Q

Gluteus maximus insertion

A
  • Iliotibial tract (superior fibers)

- Gluteal tuberosity (inferior fibers)

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18
Q

Gluteus maximus innervation

A
  • Inferior gluteal nerve (L5-S2)
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19
Q

Gluteus maximus blood supply

A
  • Superior & inferior gluteal arteries

- Perforating branches of profunda femoris

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20
Q

Gluteus maximus function

A
  • Primary thigh (hip) extensor
  • Also thigh lateral rotator
  • Trunk extension
  • (Especially when more force is needed)
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21
Q

Gluteus medius

A
  • Primary thigh abductors

- Deep to gluteus maximus

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22
Q

Gluteus medius origin

A
  • External ala between posterior and anterior gluteal lines

- Gluteal aponeurosis (fascia)

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23
Q

Gluteus medius insertion

A
  • Lateral part of greater trochanter
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24
Q

Gluteus medius innervation

A
  • Superior gluteal nerve (L4-S1)
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25
Q

Gluteus medius blood supply

A
  • Superior gluteal artery
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26
Q

Gluteus medius function

A
  • Abduction of thigh

- Medial rotation and lateral rotation of thigh

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27
Q

Gluteus minimus

A
  • Deepest gluteal muscle

- Deep to glut medius

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28
Q

Gluteus minimus origin

A
  • External ala between anterior and inferior gluteal lines

- Superior edge of greater sciatic notch

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29
Q

Gluteus minimus insertion

A
  • Anterior part of greater trochanter

- Hip joint capsule

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30
Q

Gluteus minimus innervation

A
  • Superior gluteal nerve
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31
Q

Gluteus minimus blood supply

A
  • Superior gluteal artery
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32
Q

Gluteus minimus function

A
  • Abduction, medial and lateral rotation of thigh
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33
Q

Piriformis muscle

A
  • Exits pelvis through greater sciatic foramen

- Important landmark for identifying superior and inferior gluteal vessels/nerves

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34
Q

Piriformis origin

A
  • Pelvic surface of sacrum
  • Superior margin of greater sciatic notch
  • SI joint capsule
  • Sacrotuberous ligament
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35
Q

Piriformis insertion

A
  • Superior greater trochanter
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36
Q

Piriformis innervation

A
  • Nerve to piriformis (S1, S2)
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37
Q

Piriformis blood supply

A
  • Gluteal arteries
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38
Q

Piriformis function

A
  • Lateral rotation of thigh

- Helps with abduction (when thigh is flexed)

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39
Q

Superior gemellus origin

A
  • Ischial spine

- Superior margin of lesser sciatic notch

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40
Q

Superior gemellus insertion

A
  • Medial part of greater trochanter (with OI and Inf. Gem tendons)
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41
Q

Superior gemellus innervation

A
  • Nerve to obturator internus (L5-S2)
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42
Q

Superior gemellus blood supply

A
  • Inferior gluteal artery
43
Q

Superior gemellus function

A
  • Lateral rotator
44
Q

Inferior gemelli origin

A
  • Superior ischial tuberosity

- Inferior margin of lesser sciatic notch

45
Q

Inferior gemelli insertion

A
  • Medial greater trochanter (with Sup Gem and OI)
46
Q

Inferior gemelli innervation

A
  • Nerve to quadratus femoris (L4-S1)
47
Q

Inferior gemelli blood supply

A
  • Medial femoral circumflex artery

- Inferior gluteal artery

48
Q

Inferior gemelli function

A
  • Lateral rotation of thigh
49
Q

Obturator internus

A
  • Leaves pelvis through lesser sciatic foramen

- Gemelli muscles usually cover tendon of OI

50
Q

Obturator internus origin

A
  • Pelvic surface of obturator foramen and membrane
51
Q

Obturator internus insertion

A
  • Same as the gemelli

- Greater trochanter of femur

52
Q

Obturator internus innervation

A
  • Nerve to obturator internus (L5-S2)
53
Q

Obturator internus blood supply

A
  • Inferior gluteal artery

- Internal pudendal artery

54
Q

Obturator internus function

A
  • Lateral rotator of thigh

- Abduct thigh (when flexed)

55
Q

Quadratus femoris

A
  • Most inferior gluteal region muscle
56
Q

Quadratus femoris origin

A
  • Ischial tuberosity
57
Q

Quadratus femoris insertion

A
  • Quadrate tubercle of intertrochanteric crest
58
Q

Quadratus femoris innervation

A
  • Nerve to quadratus femoris (L4-S1)
59
Q

Quadratus femoris blood supply

A
  • Inferior gluteal artery

- Medial femoral circumflex

60
Q

Quadratus femoris function

A
  • Lateral rotator of thigh

- Adductor of thigh

61
Q

Obturator externus

A
  • Tendon is deep to the quadratus femoris muscle from posterior view
  • Deep to pectineus from anterior view
62
Q

Obturator externus origin

A
  • External surface of obturator foramen/membrane
63
Q

Obturator externus insertion

A
  • Trochanteric fossa of femur (passes below neck of femur)
64
Q

Obturator externus innervation

A
  • Obturator nerve (L2-4)

- This is unique for a lateral thigh rotator

65
Q

Obturator externus blood supply

A
  • Obturator artery

- Medial femoral circumflex artery

66
Q

Obturator externus function

A
  • Lateral rotator of thigh

- Also helps with adduction

67
Q

Nerves of gluteal region and posterior thigh location

A
  • All exit greater sciatic foramen

- Most pass inferior to piriformis

68
Q

Nerves of gluteal region and posterior thigh location (names)

A
  • Superior Gluteal (L4-S1)
  • Inferior Gluteal (L5-S2)
  • Nerve to Quadratus Femoris (L4-S1)
  • Nerve to Obturator Internus (L5-S2)
  • Posterior Cutaneous Nerve of Thigh (S1-3)
69
Q

Superior gluteal nerve (L4-S1) innervates

A
  • Gluteus medius
  • Gluteus minimus
  • TFL
  • Passes superior to piriformis
70
Q

Inferior gluteal nerves (L5-S2) innervates

A
  • Gluteus maximus
71
Q

Nerve to quadratus femoris (L4-S1) innervates

A
  • Quadratus femoris

- Inferior gemellus

72
Q

Nerve to obturator internus (L5-S2) innervates

A
  • Obturator internus

- Superior gemellus

73
Q

Nerve to obturator internus (L5-S2) passes

A
  • Lateral to pudendal nerve as it passes over sacrospinous ligament
  • Passes through lesser sciatic foramen
74
Q

Posterior cutaneous nerve of thigh (S1-3)

A
  • Usually medial to sciatic nerve

- Travels deep to fascia lata

75
Q

Posterior cutaneous nerve of thigh (S1-3) branches supply

A
  • Posterior thigh
  • Perineum
  • Gluteal region (Inferior cluneal nerves, pass around inferior edge of glut max)
76
Q

Sciatic nerve (L4-S3) passes midway between

A
  • PSIS and ischial tuberosity

- Greater trochanter and ischial tuberosity

77
Q

Sciatic nerve (L4-S3) pathway

A
  • Travels deep to long head of biceps femoris

- Usually separates in the distal thigh/popliteal fossa

78
Q

Sciatic nerve (L4-S3) separates in

A
  • Distal thigh/popliteal fossa
  • Tibial nerve (L4-S3)
  • Common fibular (L4-S2)
79
Q

Tibial nerve (L4-S3)

A
  • To the posterior leg
80
Q

Common fibular (L4-S2)

A
  • Passes below biceps femoris tendon

- Around head of fibula (palpable)

81
Q

Sciatic nerve (L4-S3) innervation

A
  • Posterior thigh, leg, and foot muscles

- Cutaneous innervation of most leg/foot

82
Q

Sciatic nerve (L4-S3)

A
  • Largest nerve (2cm wide)

- Variation in relationship to piriformis

83
Q

Piriformis syndrome

A
  • Compression of sciatic nerve due to spasm, fibrosis or hypertrophy of piriformis
84
Q

Arteries of gluteal region and posterior thigh

A
  • Gluteal arteries are branches of internal iliac

- Exit out greater sciatic foramen

85
Q

Arteries of gluteal region and posterior thigh (names)

A
  • Superior gluteal
  • Inferior gluteal
  • Internal pudendal
  • Perforating arteries
86
Q

Superior gluteal artery supplies branches to

A
  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimis
  • TFL
87
Q

Inferior gluteal artery

A
  • Inferior to piriformis

- Gives off artery to the sciatic nerve

88
Q

Inferior gluteal artery supplies branches to

A
  • Gluteus maximus

- Deep gluteal muscles

89
Q

Internal pudendal artery pathway

A
  • Inferior to piriformis
  • Travels with pudendal nerve
  • Usually between nerve to OI and pudendal nerve
  • Passes over (posterior) sacrospinous ligament
  • Enters lesser sciatic foramen
90
Q

Perforating arteries

A
  • Branches off deep artery of thigh
  • Pierce adductor magnus
  • Supplies posterior thigh compartment
91
Q

Superior gluteal nerve entrapment/injury can be caused by

A
  • Trauma (fall on buttocks, intragluteal injection)
  • Entrapment between glut medius and minimus, superior border of piriformis
  • Hip surgery
92
Q

Superior gluteal nerve entrapment/injury symptoms

A
  • Weak hip abductors (gluteus medius and minimus, TFL)

- Trendelenburg gait

93
Q

Trendelenburg Test purpose

A
  • Test the hip abductors (gluteus medius and minimus, TFL) innervated by the superior gluteal nerve
94
Q

Trendelenburg Test is performed by

A
  • Having the patient stand on one leg

- This is the leg being tested

95
Q

Negative Trendelenburg Test

A
  • The pelvis remains level
  • Muscle contraction of the gluteus medius/minimus/TFL on the unsupported (stance) side pulls the pelvis down
  • This keeps the unsupported side from dropping
96
Q

Positive Trendelenburg Test (Trendelenburg sign)

A
  • Single leg standing on involved side
  • Pelvis drops on unsupported (swing) side
  • Test can also be positive with hip frx or dislocation
97
Q

Trendelenburg gait (lurch)

A
  • Excessive lateral lean to keep center of gravity over supported leg while walking
98
Q

Intragluteal injections

A
  • Safe area
  • Superolateral quadrant
    above line from PSIS to greater trochanter tip
  • Triangular area between ASIS, tubercle of crest, greater trochanter
99
Q

Inferiorgluteal nerve entrapment/injury caused by

A
  • Hip surgery

- Injection related injury

100
Q

Inferiorgluteal nerve entrapment/injury symptoms

A
  • Weak hip extension

- Gluteus maximus gait (gluteal lurch or lurch gait)

101
Q

Gluteal lurch or lurch gait

A
  • During gait, the trunk lurches backwards at heel-strike on the affected side
  • Keep center of gravity behind the hip
102
Q

Normally the gluteus maximus contracts at heels-strike, which

A
  • Slows the forward motion of the trunk and the flexion movement caused by the hip flexors
  • Keeps you upright as your center of gravity moves anterior to the hip
  • (Hamstrings are primary hip extensors during walking)
103
Q

Content passing through greater sciatic foramina

A 
- Piriformis muscle
Above piriformis
- Superior gluteal artery, vein, nerve
Below pirifromis:
- Inferior gluteal artery, vein, nerve
- Internal pudendal artery and vein
- Pudendal nerve
- Sciatic nerve
- Posterior femoral cutaneous nerve
- Nerve to obturator internus
- Nerve to quadratus femoris
104
Q

Content passing through lesser sciatic foramen

A
  • Internal pudendal artery and vein
  • Pudendal nerve
  • Nerve to obturator internus
  • Tendon of obturator internus

Lower Extremity Anatomy (35 decks)

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