Lecture 44: Gluteal Region Flashcards
when and from which regions does the upper limb develop?
4th week
C5-T1 levels
when and from which regions does the lower limb develop?
5th week
L2-S2 levels
where is the primitive great toe/thumb located?
superior aspect of the buds
which direction are the soles/palms directed?
medially
when does the opposite direction torsion of limbs occur?
7th week
the lower limbs rotate…
the upper limbs rotate….
lower: rotate medially
upper: rotate laterally
2 hip bones together
pelvic girldle
pelvic girdle, sacrum and coccyx bound together by ligmanents
bony pelvis
how far up does the iliiac crest reach on the spine
reaches superiorly up to the 4th lumbar vertebra (disc between 4th and 5th L) and extends from ASIS to PSIS
attachment site for posterior sacroiliac ligament
PIIS
location of articulation with sacrum
auricular surface
between the greater and lesser sciatic notches
ischial spine
formed by the greater sciatic notch and sacrospinous and sacrotuberous ligaments
greater sciatic foramen
passes through both the greater and lesser sciatic foramen
internal pudendal vessels and pudendal nerve
- goes out the greater and back in the lesser
structures that traverse greater sciatic foramen
- Piriformis muscle
- Superior gluteal vessels and nerve
- Inferior gluteal vessels and nerve
- Internal pudendal vessels and pudendal nerve
- Sciatic nerve
- Posterior femoral cutaneous nerve
- Nerve to quadratus femoris and inferior gemellus
- Nerve to obturator internus and superior gemellus
structures that traverse lesser sciatic foramen
- internal pudendal vessels and pudendal nerve
- tendon of obturator internus
- nerve to obturator internus
formed by the lesser sciatic notch and the sacrospinous and sacrotuberous ligaments
lesser sciatic foramen
ischial tuberosity to sacrum
sacrotuberous ligament
sacrospinous ligament
ischial spine to sacrum
gluteus maximus O
sacrotuberous ligament
ilium (behind posterior gluteal line)
sacrum
coccyx
gluteus maximus I
gluteal tuberosity iliotibial tract (IT band)
gluteus maximus A
extend and lateral rotate thigh
rise from sitting position
running
gluteus maximus N
inferior gluteal n.
gluteus maximus B
superior and inferior gluteal a.
gluteus medius O
ilium between anterior and posterior gluteal line (below iliac crest)
gluteus medius I
greater trochanter of femur
gluteus medius A
abduction and medial rotation thigh
stops hip from sagging on unsupported side
gluteus medius N
superior gluteal n.
gluteus medius B
superior gluteal a.
gluteus minimus O
ilium between anterior and inferior gluteal lines
gluteus minimus I
greater trochanter of femur
gluteus minimus A
abduction and medial rotation
gluteus minimus N
superior gluteal n.
gluteus minimus B
superior gluteal a.
positive trendelenburg sign
damage to superior gluteal n.
- observe waddling gait/ high steppage gait/ swing out gait
- side opposite of damage will sag down
piriformis O
anterior surface of sacrum (inside pelvis)
piriformis I
greater trochanter (located partly in pelvis and partly in gluteal region)
piriformis N
S1, S2
piriformis A
lateral rotation of thigh
obturator internus O
obturatior membrane and surrounding bone
obturator internus I
greater trochanter
obturator internus N
nerve to obturator internus (L5, S1, S2)
obturator internus A
lateral rotation, extension and abduction of flexed thigh
superior gemellus O
ischial spine
superior gemellus I
tendon of obturator internus
superior gemellus N
nerve to obturatior internus (L5,S1,S2)
superior gemellus A
lateral rotation, extension, and abduction of flexed thigh
inferior gemellus O
ischial spine
inferior gemellus I
tendon of obturator internus
inferior gemellus N
nerve to quadratus femoris (L5, S1)
inferior gemellus A
lateral rotation, extension, and abduction of flexed thigh
quadratus femoris O
ischial tuberosity
quadratus femoris I
intertrochanteric crest
quadratus femoris N
nerve to quadratus femoris (L5,S1)
quadratus femoris A
laterally rotate thigh
artery branches covering the sacral plexus
the plexus as a whole is covered by branches of the internal iliac a.
the major part of the sacral plexus lies on ….
the anterior surface of the piriformis muscle
how do the large branches of the sacral plexus enter the gluteal region?
pass through the greater sciatic foramen
spinal contribution to sacral plexus
L4-5 and S1-4
EVERY plexus in the body is ___________ primary rami
ventral
sympathetics in the sacral plexus?
each nerve contributing to sacral plexus receives postganglionic sympathetic fibers from the lower end of the sympathetic chain
nerves originating from the posterior division of the sacral plexus (5)
C-PINS
common peroneal n. posterior femoral cutaneous* n. inferior gluteal n. n. to piriformis superior gluteal n.
nerves origination from the anterior division of the sacral plexus (5)
TNNNP
tibial n. n. to obturator internus n. to quadratus femoris n. to levator ani pudendal n.
extensor nerves v. flexor nerves
extensor = posterior division of sacral plexus flexor = anterior division of sacral plexus
true or false: pelvic splanchnic n. (parasympathetics) are not a part of the sacral plexus
TRUE
where does the superior gluteal n. exit
through the greater sciatic foramen above the piriformis muscle
***ALL OTHER branches of the sacral plexus that leave the pelvis do so below the piriformis muscle
what muscles would be affected by injury to the superior gluteal n?
gluteus medius
gluteus minimus
tensor fasciae latae
injury to this nerve would affect gluteus maximus muscle
inferior gluteal n.
anterior division of sciatic nerve
tibial (L4-S3)
posterior division of sciatic nerve
common peroneal (L4-S2)
will injury to the sciatic nerve affect any muscles in the gluteal region?
No
what is the cutaneous innervation of the gluteal region?
cluneal n.
superior and medial cluneal nerves are branches of…. inferior cluneal is a branch of…
superior and inferior cluneal= dorsal primary rami
inferior cluneal = ventral primary rami (branch of post. femoral cutaneous)
gluteal arteries originate from
internal iliac a.
how do gluteal arteries enter the gluteal region
through the greater sciatic foramen
what a. supplies the gluteus maximus, medius, minimus and the tensor fasciae latae
superior gluteal a.
what a. supplies the gluteus maximus and the short lateral rotators of the thigh?
inferior gluteal
what a. supplies the perineal region?
internal pudendal
veins in the gluteal region are tributaries of what?
internal iliac vein
what area is best for intragluteal injections?
superior lateral portion of butt
