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Anatomy - Lower limb > L14: Musculo-neuro-vascular systems of gluteal region (hip and buttock) > Flashcards

L14: Musculo-neuro-vascular systems of gluteal region (hip and buttock) Flashcards

1
Q

gluteal surface anatomy :
bony landmarks:

A
  • anterior superior iliac spine ASIS
  • pubic tubercle
  • posterior superior iliac spine PSIS
  • iliac crest
  • greater trochanter
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2
Q

gluteal surface anatomy:
soft tissue features:

A
  • gluteal cleft
  • gluteal fold
  • gluteal maximus
  • gluteal medius
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3
Q

ligaments of pelvis

A

sacrospinous ligament:
- from sacrum to ischial spine
- stabilises sacroiliac joint

sacrotuberous ligament:
- from sacrum to ischial tuberosity
- stabilises sacroiliac joint

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4
Q

sacrospinous ligament and sacrotuberous ligament form

A

these ligaments from part of the perimeter the greater sciatic foramen and lesser sciatic foramen

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5
Q

movements of hip joint

A

Flexion and Extension
Abduction and Adduction
External and Internal Rotation
Circumduction

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6
Q

gluteal muscles (9)
superficial (4)=

A
  1. gluteus maximus
  2. gluteus medius
  3. gluteus minimus (deep to gluteus medius)
  4. tensor fasciae latae
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7
Q

gluteal muscles (9)
deep muscles (5) =

A
  1. piriformis
  2. superior gemellus
  3. obturator internus
  4. inferior gemellus
  5. quadratus femoris
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8
Q

gluteus maximus
origin:
insertion:

A
  • most superficial muscle. covers most of other muscles. Usually covered by a thick layer of adiposity

Origin=
- ilium posterior to posterior gluteal line
- lateral part of posterior sacrum and coccyx
- sacrotuberous ligament

insertion=
- illiotibial tract
- gluteal tuberosity on posterolateral femur

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9
Q

gluteus maximus
innervation=
actions=

A

innervation:
- inferior gluteal nerve (L5, S1, S2)

Actions:
- inferior part: extends thigh at hip joint
- external (lateral) rotation of femur at hip joint

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10
Q

gluteus medius
origin=
insertion=

A

lies deep to gluteus maximus

origin:
- external iliac surface, between anterior and posterior gluteal lines

insertion:
- lateral surface of greater trochanter of femur

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11
Q

gluteus medius
innervation=
actions=

A

innervation:
- superior gluteal nerve (L5, S1)

actions:
- abducts femur at hip joint
- internally rotates femur at hip joint
- stabilises pelvis in coronal plane

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12
Q

gluteus minimus
origin=
insertion=

A

lies deep to gluteus maximus

origin:
- external iliac surface, between anterior and inferior gluteal lines

insertion:
- anterior surface of greater trochanter

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13
Q

gluteus minimus
innervation=
actions=

A

innervation:
- superior gluteal nerve (L5, S1)

actions:
- abducts femur at hip joint
- internally rotates femur at hip joint
- stabilises pelvis in coronal plane

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14
Q

trendelenburg sign

A

caused by a weakness of hip abductors

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15
Q

Tendelenburgs gait

A

*When standing on one leg, hip abductors are unable to counteract gravity.
*Opposite side of pelvis tilts inferiorly.
*This means the other leg does not have sufficient clearance to swing forward for next step.
*In order to compensate and provide additional clearance for leg swing, patient leans to same side as the weak hip abductors.
*This elevates the pelvis and allows the leg clearance to swing for next step.
*In addition, often patients will swing their leg out and forward in order to achieve greater clearance.

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16
Q

Tensor Fasciae Latae
origin=
insertion=

A

Origin: ASIS + Anterior Iliac crest

Insertion: illiotibial tract (which inserts into lateral tibial condyle)

17
Q

Tensor Fasciae Latae
Innervation=
Actions=

A

Innervation: Superior Gluteal Nerve (L5-S1)

Actions:
- abduct, flexes, internally rotates thigh at hip joint
- tightens iliotibial tract which stabilises knee while leg is extended
- keeps pelvis level when standing on ipsilateral limb

18
Q

Piriformis
Origin=
insertion=

A

origin:
- anterior surface of sacrum
- sacrotubureous ligament

Insertion:
- exits pelvis through greater sciatic foramen
- superior border of greater trochanter

19
Q

Piriformis
innervation=
actions=

A

innervation:
- nerve to piriformis (S1/S2)

Actions:
- externally rotates an extended thigh
- abducts a flexed thigh
- stabilises femoral head in acetabulum

20
Q

Superior Gemellus
origin=
insertion=

A

origin: ischial spine

insertion: medial surface of greater trochanter of femur

21
Q

Superior Gemellus
Innervation=
Actions=

A

innervation: nerve to obturator internus (L5,S1)

Actions:
- externally rotates an extended thigh
- abducts a flexed thigh
- stabilises femoral head in acetabulum

22
Q

Obturator internus
origin=
insertion=

A

Forms triceps coxae with gemelli muscles

Origin: inner surface of obturator membrane and its bony boundaries

Insertion: medial surface of greater trochanter of femur

23
Q

Obturator internus
Innervation=
Actions=

A

innervation: Nerve to obturator internus (L5,S1)

Actions:
- externally rotates an extended thigh
- abducts a flexed thigh
- stabilises femoral head in acetabulum

24
Q

Inferior Gemellus
origin=
insertion=

A

origin: ischial tuberosity

insertion: medial surface of greater trochanter of femur

25
Q

Inferior Gemellus
innervation=
actions=

A

Innervation: nerve to quadratus femoris (L5,S1)

Actions:
- externally rotates an extended thigh
- abducts a flexed thigh
- stabilises femoral head in acetabulum

26
Q

Quadratus Femoris
origin=
insertion=

A

Origin: lateral border of ischial tuberosity

Insertion: quadrate tubercle on intertrochanteric crest of femur

27
Q

Quadratus femoris
innervation=
actions=

A

innervation: nerve to quadratus femoris (L5,S1)

Actions:
- external rotation of thigh at hip joint
- stabilises femoral head in acetabulum

28
Q

Cutaneous Nerves of the gluteal region

A

superior, middle and inferior clunial (cluneal) nerves:
- superior: posterior rami of L1-3
- middle: posterior rami of S1-3
- inferior: anterior rami of S2-3

lateral branch of the iliohypogastric Nerve also supplies part of the lateral buttocks

29
Q

The sciatic nerve

A
  • is the continuation of the lumbrosacral plexus and is the major nerve of the lower limb
  • carries motor signals to muscles
  • carries sensory signals from skin
  • is vulnerable to compression which causes sciatica
30
Q

Sciatica

A

can be understood as sciatic nerve impingement (compression)

patients will report a shooting pain that shoots down the back of their leg

Treated with:
generally with rest, anti-inflammatories, muscle relaxants

31
Q

Sciatic nerve - anatomical variation

A
  • sciatic nerve spits into tibial and fibular nerves before exiting the greater sciatic foramen
  • 12.2% of people have common fibular nerve passing through piriformus
  • 0.5% of people have common fibular nerve passing superior to piriformis - vulnerable to injury
32
Q

arterial supply to lower limb

A

Heart,
Descending Aorta,
Common Iliac Artery
- internal iliac artery > supplies gluteal region and pelvis region
- external iliac artery > goes on to become femoral artery and supply thigh, leg, foot

33
Q

arterial supply to gluteal region

A

heart,
descending aorta,
common iliac artery,
internal iliac artery,
- superior gluteal artery
- inferior gluteal artery

superior and inferior gluteal arteries supply the superior / inferior gluteal region respectively

34
Q

Venous drainage of the lower limb

A

right atrium of heart
^
inferior vena cava
^
common iliac vein
^ ^
internal iliac vein external iliac vein
^^ ^
superior gluteal common femoral
vein and inferior vein (main thigh
gluteal vein vein)

35
Q

venous drainage of the gluteal region

A

The gluteal region is drained by the Superior and Inferior Gluteal Veins.
These run beside the Superior and Inferior Gluteal Arteries but carry deoxygenated blood in the opposite direction.
The Superior and Inferior Gluteal veins pass through the greater sciatic foramen on either side of piriformis and drain into the Internal Iliac Vein.
The Internal Iliac Vein drains into Common Iliac Vein which subsequently drains into the Inferior Vena Cava.

Anatomy - Lower limb (6 decks)

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