Gluteal Region/Thigh Flashcards
boundaries of gluteal region
superior- iliac crest
inferior - gluteal fold
laterally - greater trochanter
medially - intergluteal cleft
*covered by thick layer of fascia
greater and lesser sciatic foramina
formed by greater and lesser sciatic notches, sacrotuberus,
and sacrospinous II
transmits muscles, nerves, arteries and veins from pelvis to gluteal region and gluteal region to pelvis1
hip joint type
synovial , ball and socket
articulations of hip joint
head a femur and acetabulum
movements of hip joint
flexion/extension , ADD/ABD, MR/LR, circumduction
acetabular labrum
attached to margin of acetabulum
increases articular area
hip extension
winds spiraling ll. tightly
pulls femoral head into acetabulum
limits extension
hip flexion
unwinds spiraling ll.
permits considerable flexion
transverse acetabuluar l.
continuation of acetabular labrum
bridges acetabular notch
most common type of hip dislocation
posterior
causes of hip dislocation
most commonly car accidents
limb position when hip dislocation happnes
flexed, ADD, and MR
knees strike dash
femoral head in hip dislocation
head is pushed out of acetabulum
limb position after hip dislocation
semi flexed and MR
sciatic nerve in hip dislocation
weakness/paralysis of hamstrings and everything distal to knee
sensation loss in dislocation of hip
posterolateral leg and much of foot
anterior dislocation of hip
result from violent injury
limb forced into extension, ABD and LR
femoral head in anterior hip dislocation
inferior to acetabular margin
femoral n. in anterior dislocation of hip
weakness/paralysis to sartorius and quadriceps mm
sensation in anterior dislocation of hip
medial leg and foot
what muscles exit the greater sciatic foramen? lesser?win
piriformis/ obturator internus m
do ligaments of hip wind of unwind with extension?
wind
what direction of hip dislocation is most common
posterior
what nerve might be damaged with posterior dislocation of hip? anterior?
sciatic/ femoral
superficial layer of gluteal muscles
gluteus maximus
gluteus medius
gluteus minimus
tensor fascia latae (located anteriorly but innervated by superior gluteal n)
deep layer of gluteal muscles
*lateral rotators
piriformis
gemellus superior
obturator internus
gemellus inferior
obturator externus
quadratus femoris
gluteus maxiumus
covers other gluteal muscles
moves superiorly when sitting (sit on ischial tuberosity)
actions of gluteus maximus
extension of thigh
LR of thigh
extension of trunk
innervation of gluteus maxiumus
inferior gluteal n.
gluteus medius
palpable just inferior to iliac crest posteriorly
gluteus medius actions
ABD of thigh
MR of thigh
keeps pelvis level when ipsilateral leg is weight bearing and unsupported side is in swing phase
gluteus medius innervation
superior gluteal n.
gluteus minimus
deep to gluteus medius
has shiny white fan shaped tendon
actions of gluteus medius
ABD of thigh
MR of thigh
keeps pelvis level when ipsilateral leg is weight bearing and unsupported side is in swing phase
gluteus minimus innervation
superior gluteal n.
tensor fascia latae
located more anteriorly
enclosed between layers of fascia lata
actions of tensor fascia latae
flexion of thigh
ABD of thigh
MR of thigh
helps knee extend by tensing IT band
tensor fascia latae innervation
superior gluteal n.
piriformis
has intra and extrapelvic parts
exits greater sciatic foramen
piriformis superior and inferior vasculature
pass above and below this muscle respectively
*other contents leaving GSF exit below
piriformis actions
LR of extended thigh
ABD of flexed thigh
steadies femoral head
innervation of piriformis
ventral rami S1 and S2
gemellus superior
*sometimes absent
acts as extrapelvis reinforcement of obturator internus m
gemellus superior action
LR of extended thigh
ABD of flexed thigh
steadies femoral head
gemellus superior innervation
N. to obturator internus
obturator internus
triceps coxae formed by this muscle and gemelli
fills gaps between piriformis and quadratus femoris
incapable of independent action
path of obturator internus
leaves pelvis via lesser sciatic foramen
makes 90 degree turn inferior to ishcial spine
obturator internus actions
LR of extended thigh
ABD of flexed thigh
steadies femoral head
obturator internus innervation
N to obturator internus
gemellus inferior
also serves as extrapelvic reinforcement of obturator internus m
gemellus inferior actions
LR of extended thigh
ABD of flexed thigh
steadies femoral head
gemellus inferior innervation
N. to quadratus femoris
obturator externus (not on lab exam)
obturator canal opens superiorly to this
deep in superomedial part of thigh
obturator externus path
tendon passes under acetabulum and neck of femur
visible deep to quadratus femoris
obturator externus actions
LR of thigh
steadies femorial head
innervation of obturator externus
obturator n.
quadratus femoris
inferior to inferior gemellus
sciatic nerve lies over it
may look small depending on how thigh is rotated
quadratus femoris actions
LR of thigh
steadies femoral head
quadratus femoris innervation
N. to quadratus femoris
superior gluteal n. VPR
VPR L4-S1
superior gluteal n. innervates
gluteus medius
gluteus minimus
tensor fascia latae
inferior gluteal n. VPR
VPR L5- S2
inferior gluteal n. innervates
gluteus maximus
sciatic n. VPR
VPR L4-S3
sciatic n. innervates
nothing in gluteal region
what two nerves is the sciatic nerve?
common fibular
tibular
N to quadratus femoris VPR
N to quadratus femoris VPR
VPR L4-S1
N to quadratus femoris innervates
gemellus inferior
quadratus femoris
N to obturator internus orgin
VPR L5-S2
N to obturator internus innervates
gemellus superior
obturator internus
pudendal n. orgin
VPR S2- 4
pudendal n. innervates
nothing in gluteal region
leaves GSF and enters LSF
injury to superior gluteal n. caused by
pelvic fracture
wound to gluteal region
compression by fetal head
injury to superior gluteal n. muscles impaired
gluteus minimus and medius
injury to superior gluteal n. sign
Positive Trendelenburg Sign
when asked to stand on one leg pelvis descends on unsupported side
tilts toward undamaged side
indicates mm on supported side are weakened or not fully functional
results of injury to superior gluteal n.
gluteal gait - list of body to weakened side; raises pelvis and allows foot room to clear ground
cause of injury to sciatic nerve
intragluteal injections
posterior dislocation of hip
muscles affected in injury to sciatic nerve
hamstrings
all muscles of leg and foot
* would maintain extension of leg (femoral nerve), rest of leg useless
sensory loss in injury to sciatic nerve
all areas below knee (exception medial leg and foot - saphanous n.)
sciatica
compression of sciatic nerve or related roots
causes of sciatica
piriformis syndrome (muscle pinches
spinal tumors/injections
pregnancy
lumbar herniated discs
lumbar spinal stenosis