Gluteal Region and Posterior Thigh

Question 1

What four general motions are performed by the gluteal and posterior thigh muscles?

Answer 1

Extension, abduction, medial, and lateral rotation of the leg at the hip

Question 2

What is the purpose of the sacrospinous and sacrotuberous ligaments?

Answer 2

These stabilize the sacrum so that the sacrum does not pivot forward due to the weight of the upper body transmitting down the spine.

Question 3

What ligament separates the greater sciatic foramen and the lesser sciatic foramen? What forms the medial border of these foramen?

Answer 3

The sacrospinous ligament separates the two and the sacrotuberous ligament forms the medial border.

Question 4

What is the most superficial gluteal muscle and what innervates it? What does the muscle do?

Answer 4

Gluteus maximus, innervated by the inferior gluteal nerve. It extends the leg at the hip, laterally rotates the leg, and assists in abduction.

Question 5

Name six muscles that are immediately deep to the gluteus maximus.

Answer 5

1. Gluteus medius
2. Gluteus minimus
3. Piriformis
4. Quadratus femoris
5. Obturator internus
6. Gemelli

Question 6

What is the importance of the piriformis muscle?

Answer 6

It marks the border of the superior gluteal muscles.

Question 7

Where does the piriformis muscle originate and what is its insertion? What does the muscle do?

Answer 7

The piriformis arises from the anterior aspect of the second to the fourth segments of the sacrum, emerges through the greater sciatic foramen, and passes inferolaterally to attach to the greater trochanter of the femur. It is a lateral rotator of the leg at the thigh and helps hold the femoral head into the acetabulum.

Question 8

Name six structures that emerge to the gluteal region through the greater sciatic foramen along the inferior border of the piriformis muscle.

Answer 8

1. Inferior gluteal vessls
2. Inferior gluteal nerve
3. Sciatic nerve
4. Posterior femoral cutaneous nerve
5. Pudendal nerve
6. Internal pudendal vessels

Question 9

What do the gluteus minimus and medius muscles do?

Answer 9

Abduct the thigh and stabilize the pelvis during walking.

Question 10

What can happen if someone has an injury to the superior gluteal nerve? What test is used clinically to spot this?

Answer 10

The superior gluteal nerve innervates the gluteus medius and minimus. If injured the patient’s hips will be abnormally pushed upwards on the side of the grounded foot while walking. If this is seen then it is called a “positive Trendelenburg test.”

Question 11

Where in relation to the piriformis are the gluteus medius and minimus?

Answer 11

Superior and lateral

Question 12

What happens to the nerves and vessels that enter the glut region superior to the piriformis?

Answer 12

They continue laterally in the fascial plane between the gluteus medius and minimus to supply the tensor fascia lata muscle.

Question 13

How does the sciatic nerve enter the gluteal region?

Answer 13

Through the greater sciatic foramen inferior to the piriformis muscle.

Question 14

The sciatic nerve is composed of two major nerves. At the popliteal fossa the medial component turns into the _______ nerve and the lateral component turns into the ______ _______ nerve.

Answer 14

medial - tibial

lateral - common peroneal

Question 15

What muscles do the sciatic nerve innervate?

Answer 15

Hamstring muscles and all the muscles below the knee, including the sole of the foot

Question 16

The quadratus femoris muscle passes from the ________ _______ to the femur.

Answer 16

ischial tuberosity

Question 17

What nerve innervates the gluteus maximus?

Answer 17

Inferior gluteal nerve

Question 18

What is the major cutaneous sensory nerve for the posterior thigh? How does it enter the gluteal region?

Answer 18

Posterior femoral cutaneous nerve. Enters through the greater sciatic foramen.

Question 19

Where does the sciatic nerve arise from? How does it enter the gluteal region?

Answer 19

Ventral primary rami of L4 through S3. Enters glut region through the greater sciatic foramen inferior to the piriformis.

Question 20

Which nerve innervates the hamstring muscles? What is the exception?

Answer 20

The tibial (medial) division of the sciatic nerve - except for the short head of the biceps femoris, a hamstring muscle, is innervated instead by the common peroneal nerve (lateral division).

Question 21

Describe how damage to the sciatic nerve would change a person’s gait. What is a common term for this?

Answer 21

It would cause someone to lift the swing leg excessively high at the hip due to the inability to dorsiflex the foot - an attempt to keep the foot from dragging. Called “foot drop.”

*Note, an injury more distally in the peroneal nerve would have the same effect.

Question 22

From what artery does the superior gluteal artery arise from and through what does it enter the gluteal region?

Answer 22

Arises from the internal iliac artery and enters the glut region through the greater sciatic foramen superior to the piriformis (hence the name superior glut artery)

Question 23

What happens to the superior gluteal artery after it enters the gluteal region?

Answer 23

It runs deep to the gluteus maximus muscle and divides into a superficial branch that supplies the gluteus maximus and a deep branch which supplies the gluteus medius, minimus, and the tensor fascia lata.

Question 24

From what artery does the inferior gluteal artery arise from and through what does it enter the gluteal region?

Answer 24

It arises from the internal iliac aftery and enters the gluteal region through the greater sciatic foramen inferior to the piriformis.

Question 25

What does the inferior gluteal artery supply?

Answer 25

Gluteus maximus, the lateral rotators of the hip, and the hamstrings

Question 26

The iliotibial tract is a thickening of the ______ ______ that stretches on the lateral leg from the ________ of the ________ to the ______ ______ ______.

Answer 26

the IT tract is a thickening of the fascia lata that stretches from the crest of the ileum to the lateral tibial condyle.

Question 27

What is the gluteal aponeurosis?

Answer 27

A thickening of the fascia lata that extends distally from the iliac crest

Question 28

In which quadrant of the gluteal region should you give an injection?

Answer 28

Superolateral quadrant.

Question 29

What is piriformis syndrome?

Answer 29

When the piriformis muscle irritates and puts pressure on the sciatic nerve, causing pain in the buttocks or along the course of the nerve (from the lower back radiating down the posterior thigh).
“Fat wallet syndrome”

Question 30

Name the four hamstring muscles.

Answer 30

1. Semimembranosus
2. Semitendinosus
3. Biceps femoris (2 heads)
4. Ischiocondylar portion of the adductor magnus muscle

Question 31

Where do the hamstring muscles arise from? What is the exception?

Answer 31

From the ischial tuberosity except for the short head of the biceps femoris

Question 32

What do the hamstring muscles do?

Answer 32

Extend the thigh and flex the knee

Question 33

What supplies blood to the hamstring muscles?

Answer 33

Three perforating branches of the deep femoral artery.

Question 34

What makes up the roof of the popliteal fossa?

Answer 34

The overlying skin, superficial fascia, and fascia lata

Question 35

What forms the superior, lateral, medial, and inferior boundaries of the popliteal fossa?

Answer 35

The hamstring muscles make up the superior boundary.

Biceps femoris forms the lateral boundary.

Semitendinosis and semimembranosus muscles form the medial boundary.

The two gastrocnemius heads form the inferior boundary.

Question 36

To what bones does the popliteus muscle connect?

Answer 36

Lateral femoral condyle and posterior medial aspect of the tibia.

Question 37

Name the five major branches of the popliteal artery.

Answer 37

1. Superior lateral genicular artery
2. Superior middle genicular artery
3. Middle genicular artery (enters into the knee joint)
4. Inferior lateral genicuar artery
5. Inferior medial genicular artery

Question 38

List the contents of the popliteal fossa (6).

Answer 38

1. Popliteal artery
2. Popliteal vein (small saphenous vein empties into it)
3. Tibial nerve
4. Peroneal nerve
5. Medial sural cutaneous nerve (a branch of the tibial nerve that runs alongside the small saphenous vein)
6. Lateral sural cutaneous nerve (a branch of the peroneal nerve)

Question 39

What is bursitis and what are two common locations in the hip region?

Answer 39

Inflammation of the bursae sacs due to repeated friction, stress, and inflammation. Commonly seen in the trochanteric bursa and ischial bursa.

Question 40

What syndrome causes compression of the sciatic nerve?

Answer 40

Piriformis syndrome. Piriformis muscle spasms, compressing the nerve.

Question 41

Weakening or loss of the popliteal pulse is a sign of _____?

Answer 41

Femoral artery obstruction.

Question 42

What two serious injuries are possible in the popliteal artery?

Answer 42

1. Popliteal aneurysm (can be diagnosed by abnormal sounds heard with a stethoscope).
2. Arteriovenous fistula (communication between artery and vein caused by an injury to one or both).

Question 43

What effect would injury to the tibial nerve have?

Answer 43

Loss of plantarflexion of the foot, loss of plantar sensation, and loss of flexion of the leg.