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Gross Anatomy Block 3 > Gluteal Region > Flashcards

Gluteal Region Flashcards

1
Q

Boundaries of the gluteal region

  1. Superior
  2. Inferior
  3. Medial
  4. Lateral
A
  1. Iliac crest
  2. Gluteal fold
  3. Natal cleft (cleft between right and left buttocks)
  4. Line connecting ASIS to greater trochanter
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2
Q

What is the gluteal fold

A

Fold of skin that separates gluteal region from posterior thigh

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3
Q

Superior clunial nerves

  1. Come from which spinal level
  2. Innervates?
A
  1. Dorsal rami of L1-L3

2. Skin of superior part of gluteal region

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4
Q

Medial clunial nerves

  1. Come from which spinal level
  2. Innervates?
A
  1. Dorsal rami of S1-S3

2. Skin of medial part of gluteal region

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5
Q

Inferior clunial nerves

  1. Come from?
  2. Innervates?
A
  1. Branches of posterior cutaneous nerve of thigh

2. Curves around inferior border of gluteus maximus to supply skin of inferior part of gluteal region

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6
Q

Lateral cutaneous branch

  1. Come from
  2. Innervates?
A
  1. Iliohypogastric nerve

2. Skin of superolateral part of gluteal region

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7
Q

What does the lateral cutaneous nerve of thigh innervate

A

Skin of inferolateral part of gluteal region

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8
Q

9 muscles of the gluteal region

A

Gluteus maximus, medius, minimus; tensor fascia lata, piriformis, obturator internus, superior gemellus, inferior gemellus and quadratus femoris

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9
Q

What do the gluteal lines do

A

Mark the boundaries between the attachments of the gluteus max, med, and minims muscles

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10
Q

Gluteus maximus

  1. Origin
  2. Insertion
  3. Innervation
  4. Action
A
  1. Ala of ilium (behind posterior gluteal line), sacrotuberous ligament, and posterior surface of sacrum/coccyx
  2. Iliotibial tract and deeper fibers insert into gluteal tuberosity of femur
  3. Inferior gluteal nerve
  4. Extension of thigh at hip joint, lateral rotation of thigh at hip joint, stability to extended knee
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11
Q

How do the fibers of the gluteus maximus run?

A

Inferiorly and laterally

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12
Q
  1. What is the iliotibial tract

2. Where does IT band extend from

A
  1. Thickening of deep fascia of thigh (fascia lata)

2. From tubercle of iliac crest to anterolateral aspect of lateral condyle of tibia

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13
Q

Gluteus medius is partly covered by

A

Gluteal aponeurosis

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14
Q

Gluteus maximus muscle is important in which two everyday actions

A

Climbing stairs and getting up from a sitting position

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15
Q

Gluteus medius

  1. Shape/covered by?
  2. Origin
  3. Insertion
A
  1. Fan shaped/covered by glut max and gluteal aponeurosis
  2. Outer gluteal surface of ala of ilum (between anterior and posterior gluteal lines)
  3. Lateral surface of greater trochanter of femur
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16
Q

Gluteus minimus

  1. Shape/location
  2. Origin
  3. Insertion
A
  1. Fan shaped/deep to glut med
  2. Right below origin of glut med (but also between anterior and posterior gluteal lines)
  3. Same as glut med
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17
Q

Glut medius AND minimus

  1. Innervation
  2. Action
A
  1. Superior gluteal nerve

2. Abduction/medial rotation of thigh at hip

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18
Q

Action of glut medius and minimus when walking ?

A

When foot of opposite side is taken off ground and is going forward, these muscles steady pelvis on supporting limb (not one moving) to prevent pelvis from tilting down on unsupported side
~so these muscles will tilt the pelvis slightly to their side to prevent downward tilting~

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19
Q

What happens if gluteus medius and minimus is paralyzed?

When this happens, what is called?

A

When patient stands on the side of lower limb with the paralysis, pelvis sinks on opposite, unsupported side

This is called a positive Trendelenburgs sign

~so if left side is paralyzed, when lifting right leg when walking, pelvis will tilt down to the right

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20
Q

Paralysis of gluteal medius and minimus is most commonly caused by

A

Lesion of the superior gluteal nerve

21
Q

Tensor fasciae latae

  1. How is this muscle enclosed
  2. Origin
  3. Insertion
  4. Innervation
  5. Action

~can be seen more anteriorly

A
  1. Fascia lata splits to enclose this muscle
  2. Outer edge of iliac crest between ASIS and tubercle of iliac crest
  3. Iliotibial tract
  4. Superior gluteal nerve
  5. Flexion, abduction and medial rotation of thigh at hip joint; provides stability to extended knee
22
Q

~ action of anything that is going to insert into IT band

A

These muscles will provide stability to extended knee

23
Q

Where is the tubercle of iliac crest in relation to ASIS

A

Posterior (when looking from front)

24
Q

Piriformis

  1. Origin
  2. Insertion
  3. Innervation
  4. Action
A
  1. Within pelvis, from anterior sacrum, lateral to anterior sacral foramina
  2. Exits pelvis via greater sciatic foramen to insert into greater trochanter
  3. Nerve to piriformis - contains ventral rami from S1 and S2(supplies piriformis inside pelvis, does not enter gluteal region)
  4. Lateral rotation of thigh at hip joint, steadies femoral head in acetabulum (same as obturator internus)
25
Q

Why is the piriformis an important landmark in gluteal region

A

All vessels/nerves that originate in the pelvis and pass from pelvic cavity to gluteal region via greater sciatic foramen are related to either superior or inferior borders of piriformis

26
Q

Obturator internus

  1. Origin
  2. Insertion
  3. Innervation
  4. Action
A
  1. Pelvic surface of obturator membrane and bony margins of obturator foramen
  2. Enters gluteal region thru lesser sciatic foramen, joined by sup/inf gemelli in gluteal region to all insert into greater trochanter
  3. Nerve to obturator internus
  4. Lateral rotation of thigh at hip joint, steadies femoral head in acetabulum (same action as piriformis)
27
Q

Where are the gemelli muscles located in relation to obturator internus

A

Gemellus superior is on top; gemellus inferior is on bottom

28
Q

Superior gemellus

  1. Origin
  2. Insertion
  3. Innervation
  4. Action
A
  1. Posterior part of ischial spine
  2. With tendon of obturator internus into greater trochanter
  3. Nerve to obturator internus
  4. Same as obturator internus/piriformis
29
Q

Inferior gemellus

  1. Origin
  2. Insertion
  3. Innervation
  4. Action
A
  1. Upper part of ischial tuberosity
  2. With tendon of obturator internus into greater trochanter
  3. Nerve to quadratus femoris
  4. Same as obturator internus/piriformis
30
Q

Quadratus femoris

  1. Origin
  2. Insertion
  3. Innervation
  4. Action
A
  1. Upper lateral border of ischial tuberosity
  2. Into quadrate tubercle of femur
  3. Nerve to quadratus femoris
  4. Same as obturator internus/piriformis/gemelli
31
Q

Sciatic nerve - largest nerve in body

  1. Branch of
  2. Emerges from
  3. How does it run
  4. Does it give branches to the gluteal region?
A
  1. Sacral plexus
  2. Greater sciatic foramen of pelvis, inferior to piriformis
  3. Runs inferiorly in gluteal region, passes deep to long head of biceps femoris as it leaves gluteal region and enters posterior part of thigh
  4. No
32
Q

When the sciatic nerve is running in the gluteal region, what is anterior and posterior to it

A

Anterior to sciatic nerve is obturator internus, superior/inferior gemelli, and quadratus femoris
Posterior is gluteus maximus

33
Q
  1. Two divisions of sciatic nerve
  2. Where are they from
  3. Where does the sciatic nerve usually divide into these branches
A
  1. Tibial nerve and common fibular (peroneal) nerve
  2. Tibial= ventral rami of L4-S3
    Peroneal= ventral rami of L4-S2
  3. Usually in the lower 1/3 of thigh- sometimes in the upper thigh or gluteal region though
34
Q

Posterior cutaneous nerve of thigh (posterior femoral cutaneous nerve)

  1. Branch of/formed by
  2. How does it leave the pelvis
  3. How does it run
  4. Three branches
    ~starts as similar course to sciatic nerve except more medial
A
  1. Sacral plexus/anterior ventral rami of S2 and S3 and posterior ventral rami of S1 and S2
  2. Through greater sciatic foramen, inferior to piriformis
  3. Deep to glut max, medial to sciatic nerve-passes superficial to long head of biceps femoris- continues superficial to hamstring muscles and deep to fascia lata
  4. Inferior clunial nerves, perineal branches, and cutaneous branches to back of thigh and upper leg
35
Q

Inferior clunial nerves

  1. Branch of
  2. Run?
  3. Supply
A
  1. Posterior cutaneous nerve of thigh
  2. Curve around inferior border of gluteus maximus
  3. Skin of inferior part of gluteal region
36
Q

Perineal branches of posterior cutaneous nerve of thigh supply?

Where do they run

A

Skin of superomedial thigh and adjacent perineum

Between perineum and medial aspect of thigh

37
Q

Superior gluteal nerve

  1. Branch of/comes from
  2. How does it leave pelvis
  3. Runs between
  4. Branches?
A
  1. Sacral plexus/ventral rami of L4-S1
  2. Thru greater sciatic foramen, superior to piriformis with superior gluteal vessels
  3. Gluteus medius and minimus
  4. Muscular branches to gluteus medius, minimus and TFL; articular branch to hip joint
38
Q

Inferior gluteal nerve

  1. Branch of/ comes from
  2. How does it leave pelvis
A
  1. Sacral plexus/ventral rami of L5-S2
  2. Thru greater sciatic foramen, inferior to piriformis with inferior gluteal vessels
    ~only gluteus maximus
39
Q

Pudendal nerve

  1. Branch of/comes from
  2. How does it leave pelvis/how does it enter perineum
A
  1. Sacral plexus/ventral rami of S2-S4
  2. Leaves thru greater sciatic foramen, inferior to piriformis, with internal pudendal vessels, curves around posterior ischial spine and passes through lesser sciatic foramen to enter perineum
40
Q

Nerve to obturator internus

  1. Branch of/comes from
  2. How does it leave pelvis
A
  1. Sacral plexus/ventral rami of L5-S2 spinal nerves
  2. Leaves thru greater sciatic foramen, inferior to piriformis and lateral to pudendal nerve/vessels, gives branch to sup gemellus then passes thru lesser sciatic foramen to supply obturator internus
41
Q

Nerve to quadratus femoris

  1. Branch of/comes from
  2. How does it leave pelvis
A
  1. Sacral plexus/ventral rami of L4-S1
  2. Thru greater sciatic foramen, inferior to piriformis, descends deep (aka anterior) to obturator internus/gemelli

~also provides sensory innervation to hip joint

42
Q

Difference in course between sciatic nerve and posterior cutaneous nerve of thigh

A

They run similar except sciatic nerve is more lateral. Difference is that sciatic nerve runs deep to biceps femoris and posterior cutaneous nerve of thigh runs superficial to biceps femoris

43
Q

~What is the only nerve that passes superiorly to piriformis

A

Superior gluteal nerve (hence the name)

44
Q

What is the most medial nerve that emerges from the pelvis and passes through the greater sciatic foramen

A

Pudendal nerve

45
Q

Superior and inferior gluteal arteries

  1. Branches of
  2. How do they enter gluteal region
A
  1. Internal iliac artery (originate within pelvis)

2. Thru greater sciatic foramen (with corresponding nerves)

46
Q

Internal pudendal artery

  1. Branch of
  2. Where does it go
A
  1. Internal iliac artery
  2. With pudendal nerve through gluteal region into perineum
    ~no important branches in gluteal region
47
Q

Superior and inferior gluteal and internal pudendal veins accompany arteries; where do they drain into

A

Internal iliac vein

48
Q

9 structures that pass through the greater sciatic foramen (6 are nerves)

A

Piriformis, superior and inferior gluteal vessles, superior and inferior gluteal nerves, sciatic nerve, posterior cutaneous nerve of thigh, nerve to obturator internus, nerve to quadratus femoris, pudendal nerve, and internal pudendal vessels

*remember only superior gluteal nerve/vessels pass superior to piriformis; all others pass inferior to piriformis

49
Q

4 structures passing through lesser sciatic foramen

A

Obturator internus muscle, nerve to obturator internus, pudendal nerve and internal pudendal vessels

Gross Anatomy Block 3 (8 decks)

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