gluteal region Flashcards
where does the gluteal region lie?
between the back and posterior thigh and is posterior to the pelvis
bounded superiorly by the iliac crests and inferiorly by the gluteal fold/sulcus
what marks the lateral extend of gluteal region
greater trochanter or femur
3 gluteal muscles
gluteus maximus, medius, minimus
most superficial gluteal muscle
gluteus maximus
gluteus maximus and attachments
largest, attaches to iliac crest, sacrum, sacrotuberous ligament and coccyx proximally and distally onto iliotibial tract (some fibres attach distally to gluteal tuberosity of femur)
what helps define the gluteal fold
gluteus maximus and supercial fascia overlying it
most powerful extensor of the hip
gluteus maximus
gluteus medius and minimus both attach to
external/posterior/gluteal aspect of plum and the anterolateral aspect of the greater trochanter of the femur
gluteus medius and minimus do what?
abduct and medially rotate the thigh and hip joint
nerve supply to gluteus medius and minimus
superior gluteal nerve (spinal nerve root values L5, S1 and 2); damage to these can resent in the sign “Trendelenburg”
what is the inferior neuromuscular bundle?
contains inferior gluteal artery, vein, and nerve (spinal nerve root L5, S1 and 2) and supplies gluteus maximus, located deep to this muscle
superior gluteal neuromuscular bundle?
contains superior artery, vein, and nerve and supplies the gluteus medius and minimus muscles
located deep to gluteus medius
what lies deep to the gluteal muscles?
the lateral rotators of the hip (including piriformis)
these small muscles are arranged in strips running approximately transversely from medial to lateral between the sacrum, ilium, and ischial spine and tuberosity medially and mainly greater trochanter of femur laterally
lateral rotators of the hip action?
external rotation of the lower limb at the hip joint, although they also play a role in stabilizing the head of the femur in acetabulum
what is the iliotibial tract?
thickening of the deep fascia of the thigh (fascia lata)
runs from ASIS to lateral aspect of lateral tibial condyle at Gerdy tubercle
iliotibial tract supports…
the knee joint
what is the tensor fascia lata
muscular part of fascia lata, enclosed within the proximal portion of the tract
sciatic nerve?
L4-S3, forms the sacral plexus of the pelvis and emerges into the middle of the gluteal region then descends and leaves the region to enter the posterior compartment of the thigh
sciatic nerve branches path…
descend though popliteal fossa and posterior and lateral compartments of the leg into the foot
largest nerve in the body? how is it usually affected?
sciatic nerve, lumbar slipped discs (sciatica)
how does piriformis cause sciatica?
hypertrophy or tightness of the muscle which may compress the sciatic nerve
pudenal nerve?
S2-4, forms sacral plexus within the pelvis, emerges into the middle of the gluteal region and supplies the muscles, skin + fascia of much of the perineum
posterior cutaneous nerve of thigh
(PCNT- posteriorr femoral cutaneous nerve: S1-3) forms in sacral plexus, emerges into middle of gluteal region and supplies the skin over the posterior aspect of the thigh
somatic nerve - sensory and sympathetic
reason for a lumbar puncture
conditions affecting brain, spinal cord, or other parts of the nervous system
pressure measurements are recorded and CSF is taken from subarachnoid space
how does lumbar puncture work
patient on left side and knees to chin. iliac crests identified, L3/4, spinal fluid between
what does insertion at this point for lumbar puncture avoid?
injury to the terminal part of the spinal cord (L1/2) - conus medullaris
gluteus medius attachments, nerve supply, action
prox: external ilium between anterior and posterior gluteal lines
distal: lateral surface of greater trochanter of femur
nerve: superior gluteal
action: abduct and medially rotate thigh
gluteus minimus attachments, nerve, action
prox: external ilium between anterior and inferior gluteal lines
distal: superior surface of greater trochanter
nerve: superior gluteal
action: abduct and medially rotate thigh
piriformis attach, nerve, action
prox: anterior surface of sacrum
distal: superior surface of greater trochanter
nerve: anterior rams of S1/2
action: laterally rotate and extend thigh and abducts flexed thigh
superior and inferior gemelli attach, nerve, action
prox: sup-ischial spine inf- ischial tuberosity
distal: trochanteric fossa
nerve: sup- nerve to obturator internus, inf- quad femoris
action: same as piriformis
obturator internus attach, nerve, action
prox: internal surface of obturator membrane
distal: trochanteric fossa
nerve: nerve to obturator internus
action: same as piriformis
quadrates femoris attach, nerve, action
prox: ischial tuberosity
distal: intertrochanteric crest (quad tubercle)
nerve: nerve to quad femoris
action: lateral rotate thigh
sciatic nerve course and action
enters gluteal region through infra-piriform foramen and deep to gluteus maximus, supplies nothing in gluteal region but supplies posterior compartment of thigh and all of leg
posterior cutaneous nerve of the thigh
enters gluteal region through infra-piriform foramen, medial to sciatic nerve, supplies skin of inferior half of butt and skin of posterior thigh and popliteal fossa
inferior gluteal nerve
enters gluteal region through infra-piriform foramen, divides into many branches before piercing the gluteus maximus, supplies gluteus maximus
nerve to quadrates femoris
enters gluteal region through the infra-piriform foramen, deep to sciatic nerve, supplies hip joint, inferior femellus and quad femoris
nerve to obturator internus
enters gluteal region through infra-piriform foramen, posterior to sacrospinous ligament to enter pelvis through lesser sciatic foramen, supplies superior gemellus and obturator internus
pudenal nerve
enters gluteal region through infra-piriform foramen, posterior to sacrospinous ligament to enter pelvis through lesser sciatic forament, supplies perineum
