The Gluteal Region Flashcards
Greater Sciatic Foramen (all exit)
Gluteal neurovascular bundles Piriformis m. Sciatic nerve Posterior Femoral Cutaneous n. Pudendal n. and internal pudendal a. Obturator internus/superior gemellus nerve
Lesser sciatic foramen
Pudendal n. and internal pudendal artery (enter) Obturator internus/superior gemellus nerve (enter) Obturator internus (exit)
Ligaments that form the greater sciatic foramen and lesser sciatic foramen
Sacrospinous ligament
Sacrotuberous ligament
Nerves of the Gluteal Region
Cluneal nerves (cutaneous) Deep nerves (Sacral plexus branches -- leave pelvis via greater sciatic foramen)
Superior and Middle Cluneal Nerves
Lateral branches of dorsal rami
Supply superior 2/3; Sacrum and adjacent area
Inferior Cluneal Nerve
Gluteal branches of posterior femoral cutaneous nerve (S1-S3 ventral rami branches)
Supply inferior 1/3
Superior Gluteal Nerve Location
Leaves pelvis superior to piriformis with superior gluteal artery.
Runs between gluteus medius and gluteus minimus
What does the Superior Gluteal Nerve innervate?
Supplies gluteus medius, gluteus minimus, and tensor fasciae latae
Inferior Gluteal Nerve Location
Leaves pelvis inferior to piriformis with inferior gluteal artery
What does the Inferior Gluteal Nerve innervate?
Supplies gluteus maximus
Largest nerve in the body
Sciatic Nerve
L4-S3 ventral rami
Where does the sciatic nerve leave the pelvis?
Inferior to piriformis
Where does the sciatic nerve run?
Runs inferiorly deep to gluteus maximus
Where does the Sciatic nerve divide? What does the sciatic nerve divide into?
Divides about half way down thigh.
Divides into tibial and common fibular nerves
Posterior Hip Dislocation
Can cause damage to the sciatic nerve.
May result in paralysis of hamstrings and muscles distal to the knee.
Sensory change may occur in skin over the posterolateral aspects of leg and most of foot
Posterior Femoral Cutaneous Nerve
S1-S3
Supplies more skin than any other cutaneous nerve
Quadratus Femoris/Inferior Gemellus Nerve
L4-S1 Ventral Rami
Obturator Internus/Superior Gemellus Nerve
L5-S2 Ventral Rami
Leaves pelvis via greater sciatic foramen
Reenters pelvis via lesser sciatic foramen
Pudendal Nerve
Anterior divisions of S2-S4 ventral rami
Most medial structure exiting greater sciatic foramen.
Reenters pelvis via lesser sciatic foramen to supply perineal structures.
Arteries of the Gluteal Region (Branches arise from the internal iliac artery)
Superior gluteal art.
Inferior gluteal art.
Internal pudendal art.
Superior gluteal artery
Largest internal iliac artery branch
Superficial branch: Gluteus maximus
Deep branch: Gluteus medius, minimus, tensor fascia lata
Inferior Gluteal Artery Supplies:
Gluteus maximus
Small lateral rotators
Superior hamstrings
Cruciate anastomosis components:
Transverse branch of the medial circumflex femoral artery.
Terminal part of the transverse branch of the lateral circumflex femoral artery.
First perforating artery
The inferior gluteal artery
Internal Pudendal Artery
Reenters pelvis via lesser sciatic foramen with pudendal nerve.
Supplies perineal muscles and ext. genitalia.
Does not supply any gluteal structures.
Where should intragluteal injections be made?
In the supero-lateral part of gluteal region in order to avoid the sciatic nerve and other gluteal nerves and vessels
Largest Gluteal Muscle
Gluteus Maximus
Actions of Gluteus Maximus
Chief extensor of the thigh and lateral rotation
Slight extension of leg when working with tensor fascia lata
Innervation of Gluteus Maximus
Inferior gluteal nerve (L5-S1)
The gluteus maximus partially covers what two muscles?
Gluteus medius and minimus (medius over minimus)
Actions of the Gluteus Medius and Minimus
Thigh abduction and medial rotation (particularly gluteus minimus)
Innervation of Gluteus Medius and Minimus
Superior gluteal nerve (L5-S1)
Tensor Fascia Lata is enclosed by:
Fascia lata
Innervation of Tensor Fascia Lata
Superior Gluteal Nerve (L5-S1)
Actions of Tensor Fascia Lata
Abducts, medially rotates, and flexes thigh
Slight extension of knee along with the gluteus maximus
Where does the Iliotibial tract run?
Runs from iliac tubercle to a tubercle (Gerdy’s) on lateral tibial condyle
What reinforces the Iliotibial tract?
Tendinous fibers from tensor fasciae latae and gluteus maximus
Functions of the Iliotibial tract
Assists in decelerating adduction of thigh.
Laterally stabilizes knee.
Extends leg, compensates for quadriceps paralysis via gluteus maximus flexion.
Pulls patella laterally, antagonist of vastus medialis, and synergist with flexing vastus lateralis for this action.
What can be treated by stretching the iliotibial tract?
Chondromalacia patella
Causes of Gluteal gait or limp/Positive Trendelenburg’s sign
Superior gluteal nerve injury
Effect of gluteal gait or limp/Positive Trendelenburg’s sign
Patient loses steadying action of gluteus medius and minimus
Where is the Piriformis in regards to the Gluteus Maximus and Gluteus Medius?
Deep to Gluteus Maximus
Medial to Gluteus Medius
The Piriformis demarcates:
Gluteal blood vessels and nerves
Where does the Obturator Internus leave the pelvis?
Through the lesser sciatic foramen
Superior and Inferior Gemelli
“Twins”
“Extrapelvic parts of obturator internus”
With obturator internus, form the “triceps coxae”
Where is the Obturator Externus
Deep to pectineus
Attachments of the Obturator Externus
External margins of obturator foramen
Trochanteric fossa
Innervation of Obturator Externus
Obturator nerve (L3, L4)
Short rotator muscles of the hip
Piriformis Superior gemellus Obturator internus Inferior gemellus Quadratus femoris
Which of the small lateral rotators is least effective when the thigh is flexed?
Quadratus femoris
Bursae of the Gluteal Region
Ischial bursa
Trochanteric bursa
Gluteofemoral bursa
