Part 3: Gluteal Region + Hip Joint

Question 1

What forms the buttock fold?

Answer 1

Crease of hip joint, with subcutaneous fat given it characteristic shape - panniculus adiposis is well developed in buttocks

Question 2

What is the cutaneous innervation over the buttock?

Answer 2

Cutaneous nerves of the buttock are derived from posterior and anterior rami (T12-L2)

Question 3

What is the blood supply of the cutaneous tissue of the buttocks?

Answer 3

Perforating branches of superior and inferior gluteal nerves

Question 4

What is the origin, insertion, action and innervation of Gluteus maximus?

Answer 4

O: Outer surface of ileum behind posterior gluteal line, posterior 3rd of iliac crest, lumbar fascia, lateral mass of sacrum, ST lig and coccyx.
I: Gluteal tuberosity of femur and remain fibres into IT tract
A: Extends and lat rotates hip (may aid in supporting extended knee with IT attachment.
N: Inferior gluteal nerve

Question 5

What is the origin, insertion, action and innervation of Gluteus medius

Answer 5

O: Outer upper surface of ilium between posterior and middle gluteal lines
I: Posterolateral surface of GT
A: Abduction and medially rotates hip. Tilts pelvis on walking.
N: Superior gluteal nerve

Question 6

What is the origin, insertion, action and innervation of Gluteus minimus

Answer 6

O: Outer surface of ilium between posterior and anterior gluteal lines
I: Anterior surface of GT
A: Abduction and medially rotates hip. Tilts pelvis on walking.
N: Superior gluteal nerve

Question 7

What is the origin, insertion, action and innervation of Piriformis

Answer 7

O: Arises 2,3,4 costotransverse bars of anterior sacrum
I: Anterior part of medial GT
A: Laterally rotates and stabilises hip
N: Anterior rami S1,S2

Question 8

Describe the path of superior gluteal nerve

Answer 8

L4,5,S1. Emerges from greater sciatic notch above piriformis, disappears beneath posterior border of gluteus medius. No cutaneous distribution.

Question 9

Describe the course of the superior gluteal artery

Answer 9

Largest branch of IIA. Emerges into pelvis from above piriformis (GSN). Gives a superficial branch to gluteus maximus and skin and a deep branch to which has upper (anastomosis at ASIS) and lower (joins trochanteric anastomosis)

Question 10

What arises through greater sciatic notch above piriformis?

Answer 10

Superior gluteal nerve and vessels

Question 11

What arises through greater sciatic notch below piriformis?

Answer 11

Inferior gluteal nerve and vessels
Pudendal nerve
Internal pudendal artery
Nerve to obturator internus
Sciatic nerve
Posterior femoral cutaneous nerve
Nerve to QF

Question 12

What does inferior gluteal artery supply?

Answer 12

Piriformis, obturator internus, gluteus maximus, anastomotic branches.

Question 13

Describe the path of sciatic nerve

Answer 13

emerges beneath piriformis lateral to inferior gluteal nerve and vessels, lying on ischium over posterior aspect of acetabulum then passes vertically down into posterior compartment of leg, lying deep to long head of biceps.

Question 14

What is the origin, insertion, action and innervation of Gemellus superior

Answer 14

O: Ischium spine
I: Tricipital tendon (superior and inferior gemellus and obturator internus) to middle part of medial GT
A: Lat rotates and stabilises hip
N: Nerve to obturator internus

Question 15

What is the origin, insertion, action and innervation of Obturator internus

Answer 15

O: Inner surface of obturator membrane and rim of pubis and ischuim bordering membrane
I: Tricipital tendon (superior and inferior gemellus and obturator internus) to middle part of medial GT
A: Lat rotates and stabilises hip
N: Nerve to obturator internus

Question 16

What is the origin, insertion, action and innervation of gemellus inferior

Answer 16

O: Upper border of ischial tuberosity
I: Tricipital tendon (superior and inferior gemellus and obturator internus) to middle part of medial GT
A: Lat rotates and stabilises hip
N: Nerve to QF

Question 17

What is the origin, insertion, action and innervation of Quadratus femoris

Answer 17

O: Lateral border of ischial tuberosity
I: Quadrate tubercle of femur and below
A: Lat rotates and stabilises hip
N: Nerve to QF

Question 18

Describe the trochanteric anastomosis

Answer 18

Main source of blood for head of femur. Formed by descending branch of superior gluteal, ascending branch of circumflex femoral and inferior gluteal artery.

Question 19

Describe the cruciate anastomosis

Answer 19

So called due to cross shape. At level of LT. Formed by transverse branch of both medial and lateral femoral circumflex arteries, ascending branch of perforating descending branch of inferior gluteal

Question 20

What is the central non-articular part of acetabulum covered with fat pad known as?

Answer 20

Haversians pad

Question 21

Hip capsule extends further down neck of femur posteriorly or anteriorly?

Answer 21

Anteriorly. Goes to intertrochanteric line anterior but only to beginning of femoral neck posterior.

Question 22

How is the femoral head supplied?

Answer 22

Retrograde supply. Reticular fibres of capsule are reflected along periosteum and with them are transported the nutrient vessels. These are damaged in intracapsular fractures

Question 23

What are the 3 supporting ligaments of the hip joint?

Answer 23

Iliofemoral: strongest, V shaped from AIIS/acetabular rim to intertrochanteric line
Pubofemoral: Iliopubic eminence + obturator crest to inferior capsule
Ischiofemoral: From acetabulum to capsule, weakest

Question 24

What is the nerve supply of the hip?

Answer 24

3 nerves of pelvic girdle and lower limb supply hip - femoral nerve (via nerve to rectus femoris), sciatic nerve (via nerve to QF), obturator nerve