Lecture 5 - gluteal region and posterior thigh Flashcards
Fascia lata
Deep fascia
Superiorly continuous with the abdominal wall fascia
Inferiorly continuous with the deep fascia of the leg (crural).
Thinnest medially over the adductor muscles of the leg
Saphenous opening in the fascia lata
Just below the inguinal ligament
Where the saphenous vein (drains femoral vein) and lymphatics which drain into the inguinal lymph nodes enter
Iliotibial tract
Thickening of the fascia lata laterally
Runs from the iliac crest to the lateral tibial condyle at knee
Tensor fascia lata origins, insertions, innervation and action
Origin: ASIS
Inserts: between the two layers of the iliotibial tract at upper middle 2/3rds of thigh
Innervated: superior gluteal nerve (L5,S1, S2)
Action: - Stabalise hip during extension
- Help stabalise knee by steadying condyles
when standing
-Assist abduction of hip joint
- Hoists fascia lata up, improving venous return
Superficial gluteal muscles
- Gluteus maximus
- Gluteus medius
- Glutues minimus
- Tensor fascia lata
Deep gluteal muscles
Piriformis Gemellus superior Obturator internus Gemellus inferior Quadratus femoris
Gluteus maximum origin, insertion, action and innervation
Origin: gluteal surface of the ilium, saxrum and coccyx
Insertion: Superficial- iliotibial tract
Deep - Gluteal tuberosity of the femur
Action: Main extensor of the thigh
Assists with lateral rotation
Assists extension of knee via iliotibial tract
- Walking up the stairs
- Running
Innervation - Inferior gluteal nerve (L5, S1, S2)
Glutues Medius origin, insertion, action and innervation
Origin: gluteal surface of the ileum
Insertion: Lateral surface of the greater trochanter
Action: Abduction of the hip
Medial rotation
Secures pelvis in horizontal alignment when
walking
Innervation: Superior gluteal nerve (L4, L5, S1)
Gluteus minimus origin, insertion, action and innervation
Origin: Ilium
Insertion: Anterior surface of the greater trochanter
Action: Abduction of the hip
Medial rotation
Secures the pelvis in horizontal alignment when
walking
Innervation: Superior gluteal nerve (L4, L5, S1)
When can a superior gluteal nerve injury occur
During hip surgery
Fracture of the greater trochanter
Injections in the buttocks
Dislocation of the hip joint
Trendelenberg sign
When stood on one foot, the pelvis tilts towards the unsupported side.
The side opposite the weak muscle tilts
Piriformis origin, insertion, action and innervation
Origin: anterior sacrum
(through the greater sciatic foramen)
Insertion: Posterosuperior aspect of the greater trochanter
Action: Lateral rotation
Abduction of the lower limb
Innervation: Nerve to piriformis
Obturator internus origin, insertion, action and innervation
Origin: Medial surface of the obturator membrane and adjacent pubis and ischium
(travels through the lesser sciatic foramen)
Insertion: Posterior aspect of the greater trochanter
(below the insertion of the piriformis and Superior gemellus)
Action: Lateral rotation
Abduction of the lower limb
Innervation: Nerve to the Obturater Internus
Superior gemellus origin, insertion, action and innervation
Origin: Ischial spine
Insertion: Posterior surface of the greater trochanter below the piriformis muscle
Action: Lateral rotation
Abduction of the lower limb
Innervation: Nerve to obturator internus
Inferior gemellus origin, insertion, action and innervation
Origin: Ischial tuberosity
Insertion: Posterior aspect of the greater trochanter below the Obturator internus insertion
Action: Lateral rotation
Abduction of the lower limb
Innervation: Nerve to quadratus femoris
Quadratus femoris origin, insertion, action and innervation
Origin: Lateral aspect of the ischial tuberosity
Insertion: Quadrate tubercle (intertrochanteric crest)
Action: Lateral rotation
Innervation: Nerve to the quadratus femoris
Obturator externus origin, insertion, action and innervation
Deep gluteal muscle and in medial compartment of the thigh
Origin: External surface of the obturator membrane and adjacent pubis and ischium
(passes posterior to the femoral neck)
Insertion: Posterior aspect of the greater trochanter
Action: Adduction
Lateral rotation
Innervation: Obturator nerve (L2, L3, L4)
Hamstrings (posterior thigh muscles)
Semitendinosus
Semimembranosus
Biceps femoris long head and short head
Small hamstring component of the adductor magnus
- Extend thigh at hip and flex leg at the knee
- Innervated by the tibial part of the sciatic nerve except the short head of the biceps femoris = common peroneal part of the sciatic nerve
Biceps femoris origin, insertion, action and innervation
Origin: Long head - ischial tuberosity
Short head - linear aspera on the femur
Insertion: Head of the fibula
Action: Flex leg at the knee
Extend the thigh at the hip
Lateral rotation
Innervation: Long head - tibial aspect of the sciatic nerve
short head - common peroneal aspect of
the nerve
Semitendinosus origin, insertion, action and innervation
Origin: Ischial tuberosity
(medial to biceps femoris + superficial to semimembranosus)
Insertion: Pes anserinus (upper medial tibia)
Action: Flex leg at the knee
Extension of the thigh at the hip
Medially rotates the thigh at hip and leg at knee
Innervation: Tibial part of the sciatic nerve
Semimembranosus origin, insertion, action and innervation
Origin: Ischial tuberosity
(deep to semitendinosus)
Insertion: Medial tibial condyle
Action: Flex leg at the knee
Extends the thigh at the hip
Internal rotation of thigh at hip and leg at knee
Innervation: Tibial aspect of the sciatic nerve
Pulled hamstring
Cause: Sudden onset muscle exertion causing stretching of hamstrings
- sudden tension
- muscle sprain
- partial tear
- complete tear
- complete tear with avulsion of a fragment of bone
