Gluteal Region Flashcards
What are the Superior and Inferior Boundaries of the Gluteal Region?
Superior: Iliac Crests
Inferior: Gluteal Sulcus (groove beneath gluteal fold)
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What Nerve Roots supply the Superior Cluneal Nerve?
Dorsal Rami of L1-L3
What nerve roots supply the Middle Cluneal Nerve?
Dorsal Rami of S1-S3
What Nerve Roots supply the Inferior Cluneal Nerve?
Ventral Rami of S1-S3
Posterior Femoral Cutaneous Nerve
What would happen if the superior or medial cluneal nerves are impinged?
Nerve impingement in Lumbar Spine
-Can result in pain over distribution of cluneal nerves
In the gluteal region, when does the superficial gluteal structures drain into the deeper gluteal structures?
The external iliac nodes (superficial) drain into common iliac nodes (deep).
What ligament is on top of the greater sciatic foramen?
Sacrotuberous Ligament
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Posterior Sacrum to Ischial Tuberosity
What structures exit the Greater Sciatic Foramen?
Nerves:
- Sciatic Nerve
- Superior Gluteal Nerve
- Inferior Gluteal Nerve
- Pudendal Nerve
- Posterior Femoral Cutaneous N.
- Nerve to Quadratus Femoris
- Nerve to Obturator Internes
Vessels
- Superior Gluteal Artery and Vein
- Inferior Gluteal Artery and Vein
- Internal Pudendal Artery and Vein
Piriformis Muscle
- Greater Sciatic Foramen is a gateway to the _____.
- Lesser Sciatic Foramen is a gateway to the _____.
- What divides the Greater Sciatic Notch from the Lesser Sciatic Notch?
- Greater Sciatic Foramen is a gateway to the* pelvis.
- Lesser Sciatic Foramen is a gateway to the* perineum.
The Sacrospinous Ligament
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What structures enter the Lesser Sciatic Foramen?
- Tendon of Obturator Internus Muscle
- Pudendal Nerve
- Internal Pudendal Artery and Vein
- Nerve to Obturator Internus
What structures go through both Greater and Lesser Sciatic Foramen?
- Pudendal Nerve
- Internal Pudendal Artery and Vein
- Nerve to Obturator Internus
Basically PIN Structures
Gluteus Maximus Muscle
What are its attachments?
Origin: Posterior gluteal line
Insertion: Lateral Condyle of Tibia via Iliotibial Tract; Gluteal Tuberosity
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Gluteus Maximus Muscle
What is its action?
- Extension of Thigh
- Lateral Rotation of Hip
- Helps rise from seated position
Gluteus Maximus Muscle
What is its innervation and blood supply?
Innervation: Inferior Gluteal Nerve (L5-S2)
Blood Supply: Superficial Branch of Superior Gluteal Artery and Inferior Gluteal Artery
Gluteus Medius Muscle
What are its attachments?
Origin: External Surface of Ilium between Anterior and Posterior Gluteal Lines
Insertion: Lateral Surface of Greater Trochanter of Femur
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Gluteus Medius Muscle
What is its action?
- Abducts thigh
- Medially rotate thigh
- Keeps hip level when ipsilateral limb is weight-bearing and advancing the opposite limb during the swing phase
Gluteus Medius Muscle
What is its innervation and blood supply?
Innervation: Superior Gluteal Nerve (L5, S1)
Blood Supply: Deep Branch of Superior Gluteal Artery
Gluteus Minimus Muscle
What are its attachments?
Origin: External Surface of Ilium between Anterior and Inferior Gluteal Lines
Insertion: Anterior Surface of Greater Trochanter of Femur
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Gluteus Minimus Muscle
What is its action?
- Abduction of Hip
- Medial Rotation of Hip
- Keeps hip level when ipsilateral limb is weight-bearing and advancing the opposite limb during the swing phase
Gluteus Minimus Muscle
What is its innervation and blood supply?
Innervation: Superior Gluteal Nerve (L5, S1)
Blood Supply: Deep Branch of Superior Gluteal Artery
Tensor Fascia Lata Muscle
What are its attachments?
Origin: ASIS
Insertion: IT Tract and Lateral Condyle of Tibia
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Tensor Fascia Lata Muscle
What is its action?
- Abducts Hip
- Medial Rotation of Hip
- Keeps hip level when ipsilateral limb is weight-bearing and advancing the opposite limb during the swing phase
Tensor Fascia Lata Muscle
What is its innervation and blood supply?
Innervation: Superior Gluteal Nerve (L5, S1)
Blood Supply: Lateral Circumflex Artery and Deep Branch of Superior Gluteal Artery
What muscles abduct and medially rotate thigh?
- Gluteus Medius Muscle
- Gluteus Minimus Muscle
- Tensor Fascia Lata Muscle
What nerve roots supply the Superior Gluteal Nerve?
L4-S1
What nerve roots supply the Inferior Gluteal Nerve?
L5-S2
What vessel gives rise to both the Superior and Inferior Gluteal Artery?
Internal Iliac Artery
What muscles are supplied by the Superior Gluteal Artery, and by what branch for each?
Superficial Branch:
- Gluteus Maximus
Deep Branch:
- Gluteus Medius
- Gluteus Minimus
- Tensor Fascia Lata
What muscles are supplied by the Inferior Gluteal Artery?
Gluteus Maximus
Small Lateral Rotators
Superior Hamstrings
What muscles laterally rotate and extend the thigh?
- Piriformis Muscle
- Obturator Internus Muscle
- Superior Gemelli Muscle
- Inferior Gemelli Muscle
- Quadratus Femoris
Piriformis Muscle
What is its attachments?
Origin: Anterior Surface of Sacrum and Sacrotuberous Ligament
Insertion: Superior Border of Greater Trochanter of Femur
Goes through Greater Sciatic Foramen
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Piriformis Muscle
What is its action?
- External Rotation of Thigh
- Abduction of Flexed thigh
- Stabilize Femoral Head in Acetabulum
Piriformis Muscle
What is its innervation and blood supply?
Innervation: Nerve to Piriformis (Branches of anterior rami of S1, S2)
Blood Supply: Superior and Inferior Gluteal Arteries
Obturator Internus Muscle
What is its attachments?
Origin: Pelvic Surface of Obturator Membrane
Insertion: Medial Surface of Greater Trochanter of Femur
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Obturator Internus Muscle
What is its action?
- Laterally Rotation of Extended Thigh
- Abducts flexed thigh
- Steady femoral head in acetabulum
Obturator Internus Muscle
What is its innervation and blood supply?
Innervation: Nerve to Obturator Internus (L5,S1)
Blood Supply: Inferior Gluteal Artery
Superior Gemelli Muscle
What is its attachments?
Origin: Ischial Spine
Insertion: Medial Surface of Greater Trochanter of Femur
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Superior Gemelli Muscle
What is its action?
- Lateral Rotation of Extended Thigh
- Abduct Flexed Thigh
Superior Gemelli Muscle
What is its innervation and blood supply?
Innervation: Nerve to Obturator Internus
Blood Supply: Inferior Gluteal Artery
Inferior Gemelli Muscle
What is its attachments?
Origin: Ischial Tuberosity
Insertion: Medial Surface of Greater Trochanter of Femur
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Inferior Gemelli Muscle
What is its action?
- Lateral Rotation of Extended Thigh
- Abduct Flexed Thigh
Inferior Gemelli Muscle
What is its innervation and blood supply?
Innervation: Nerve to Quadratus Femoris (L5, S1)
Blood Supply: Inferior Gluteal Artery
Quadratus Femoris Muscle
What is its attachments?
Origin: Lateral Border of Ischial Tuberosity
Insertion: Quadrate Tubercle on Femur
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Quadratus Femoris Muscle
What is its action?
Lateral Rotation of Thigh
Quadratus Femoris Muscle
What is its innervation and blood supply?
Innervation: Nerve to Quadratus Femoris (L5,S1)
Blood Supply: Medial Circumflex Artery and Inferior Gluteal Artery
What is piriformis syndrome?
Pathology of piriformis muscle can innervate sciatic nerve
What ligament do the PIN structures run underneath?
Sacrotuberous Ligament
What are the PIN structures?
- Pudendal Nerve
- Internal Pudendal Artery
- Nerve to Obturator Internus
What arteries participate in the Cruciate Anastomosis?
Collateral Blood Supply to Femoral Head
- Inferior Gluteal Artery
- Transverse Branch of Medial Circumflex Femoral Artery
- Terminal Part of the Transverse Branch of Lateral Circumflex Femoral Artery
- First Perforating Brach of Deep Femoral Artery
What structure can be damaged in some people when the Ligament of the Head of the Femur is damaged?
A Branch of the Obturator Nerve
What is the most common direction for dislocation of the Femur?
Posterior Dislocations
How does the lower extremity present when the femur (head or neck) is posteriorly dislocated?
Shortened and internally rotated
What nerves are part of the lumbosacral plexus?
- Cluneal Nerves
- Superior and Inferior Gluteal Nerves
- Sciatic Nerves
- Nerve to Quadratus Femoris
- Posterior Cutaneous Nerve of Thigh
- Pudendal Nerve
- Nerve to Obturator Internus
What happens in a Gluteal Crush injury?
Arteries which supply the Sciatic Nerve become compressed, leading to Sciatic Nerve Damage
The nerve that innervates the Obturator Internus also innervates what other muscle?
The Superior Gemellus
The nerve that innervates the Quadratus Femoris also innervates what other muscle?
The Inferior Gemellus
What three muscles are supplied by the Superior Gluteal Nerve?
Gluteus Medius
Gluteus Minimus
Tensor Fascia Lata
What is the Trendelenburg Sign (Duchenne’s Limp)?
Lesion of Superior Gluteal Nerve that leads to weakness of Gluteus Medius and Minimus muscles
- Pelvis drops on opposite side of injury
- Foot cannot go into swing phase
What nerve supplies the largest cutaneous segment in the body?
The Posterior Femoral Cutaneous Nerve
What line in the gluteal region must you be sure to be superior to when performing a gluteal injection?
The line between the PSIS and the Superior Border of the Greater Trochanter of the Femur
Which quadrant of the gluteal region should you perform injections?
Superolateral Quadrant