The Gluteal Region

Question 1

Greater Sciatic Foramen (all exit)

Answer 1

Gluteal neurovascular bundles
Piriformis m.
Sciatic nerve
Posterior Femoral Cutaneous n.
Pudendal n. and internal pudendal a. 
Obturator internus/superior gemellus nerve

Question 2

Lesser sciatic foramen

Answer 2

Pudendal n. and internal pudendal artery (enter)
Obturator internus/superior gemellus nerve (enter)
Obturator internus (exit)

Question 3

Ligaments that form the greater sciatic foramen and lesser sciatic foramen

Answer 3

Sacrospinous ligament

Sacrotuberous ligament

Question 4

Nerves of the Gluteal Region

Answer 4

Cluneal nerves (cutaneous)
Deep nerves (Sacral plexus branches -- leave pelvis via greater sciatic foramen)

Question 5

Superior and Middle Cluneal Nerves

Answer 5

Lateral branches of dorsal rami

Supply superior 2/3; Sacrum and adjacent area

Question 6

Inferior Cluneal Nerve

Answer 6

Gluteal branches of posterior femoral cutaneous nerve (S1-S3 ventral rami branches)
Supply inferior 1/3

Question 7

Superior Gluteal Nerve Location

Answer 7

Leaves pelvis superior to piriformis with superior gluteal artery.
Runs between gluteus medius and gluteus minimus

Question 8

What does the Superior Gluteal Nerve innervate?

Answer 8

Supplies gluteus medius, gluteus minimus, and tensor fasciae latae

Question 9

Inferior Gluteal Nerve Location

Answer 9

Leaves pelvis inferior to piriformis with inferior gluteal artery

Question 10

What does the Inferior Gluteal Nerve innervate?

Answer 10

Supplies gluteus maximus

Question 11

Largest nerve in the body

Answer 11

Sciatic Nerve

L4-S3 ventral rami

Question 12

Where does the sciatic nerve leave the pelvis?

Answer 12

Inferior to piriformis

Question 13

Where does the sciatic nerve run?

Answer 13

Runs inferiorly deep to gluteus maximus

Question 14

Where does the Sciatic nerve divide? What does the sciatic nerve divide into?

Answer 14

Divides about half way down thigh.

Divides into tibial and common fibular nerves

Question 15

Posterior Hip Dislocation

Answer 15

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

Question 16

Posterior Femoral Cutaneous Nerve

Answer 16

S1-S3

Supplies more skin than any other cutaneous nerve

Question 17

Quadratus Femoris/Inferior Gemellus Nerve

Answer 17

L4-S1 Ventral Rami

Question 18

Obturator Internus/Superior Gemellus Nerve

Answer 18

L5-S2 Ventral Rami
Leaves pelvis via greater sciatic foramen
Reenters pelvis via lesser sciatic foramen

Question 19

Pudendal Nerve

Answer 19

Anterior divisions of S2-S4 ventral rami
Most medial structure exiting greater sciatic foramen.
Reenters pelvis via lesser sciatic foramen to supply perineal structures.

Question 20

Arteries of the Gluteal Region (Branches arise from the internal iliac artery)

Answer 20

Superior gluteal art.
Inferior gluteal art.
Internal pudendal art.

Question 21

Superior gluteal artery

Answer 21

Largest internal iliac artery branch
Superficial branch: Gluteus maximus
Deep branch: Gluteus medius, minimus, tensor fascia lata

Question 22

Inferior Gluteal Artery Supplies:

Answer 22

Gluteus maximus
Small lateral rotators
Superior hamstrings

Question 23

Cruciate anastomosis components:

Answer 23

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

Question 24

Internal Pudendal Artery

Answer 24

Reenters pelvis via lesser sciatic foramen with pudendal nerve.
Supplies perineal muscles and ext. genitalia.
Does not supply any gluteal structures.

Question 25

Where should intragluteal injections be made?

Answer 25

In the supero-lateral part of gluteal region in order to avoid the sciatic nerve and other gluteal nerves and vessels

Question 26

Largest Gluteal Muscle

Answer 26

Gluteus Maximus

Question 27

Actions of Gluteus Maximus

Answer 27

Chief extensor of the thigh and lateral rotation | Slight extension of leg when working with tensor fascia lata

Question 28

Innervation of Gluteus Maximus

Answer 28

Inferior gluteal nerve (L5-S1)

Question 29

The gluteus maximus partially covers what two muscles?

Answer 29

Gluteus medius and minimus (medius over minimus)

Question 30

Actions of the Gluteus Medius and Minimus

Answer 30

Thigh abduction and medial rotation (particularly gluteus minimus)

Question 31

Innervation of Gluteus Medius and Minimus

Answer 31

Superior gluteal nerve (L5-S1)

Question 32

Tensor Fascia Lata is enclosed by:

Answer 32

Fascia lata

Question 33

Innervation of Tensor Fascia Lata

Answer 33

Superior Gluteal Nerve (L5-S1)

Question 34

Actions of Tensor Fascia Lata

Answer 34

Abducts, medially rotates, and flexes thigh | Slight extension of knee along with the gluteus maximus

Question 35

Where does the Iliotibial tract run?

Answer 35

Runs from iliac tubercle to a tubercle (Gerdy's) on lateral tibial condyle

Question 36

What reinforces the Iliotibial tract?

Answer 36

Tendinous fibers from tensor fasciae latae and gluteus maximus

Question 37

Functions of the Iliotibial tract

Answer 37

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.

Question 38

What can be treated by stretching the iliotibial tract?

Answer 38

Chondromalacia patella

Question 39

Causes of Gluteal gait or limp/Positive Trendelenburg's sign

Answer 39

Superior gluteal nerve injury

Question 40

Effect of gluteal gait or limp/Positive Trendelenburg's sign

Answer 40

Patient loses steadying action of gluteus medius and minimus

Question 41

Where is the Piriformis in regards to the Gluteus Maximus and Gluteus Medius?

Answer 41

Deep to Gluteus Maximus | Medial to Gluteus Medius

Question 42

The Piriformis demarcates:

Answer 42

Gluteal blood vessels and nerves

Question 43

Where does the Obturator Internus leave the pelvis?

Answer 43

Through the lesser sciatic foramen

Question 44

Superior and Inferior Gemelli

Answer 44

"Twins" "Extrapelvic parts of obturator internus" With obturator internus, form the "triceps coxae"

Question 45

Where is the Obturator Externus

Answer 45

Deep to pectineus

Question 46

Attachments of the Obturator Externus

Answer 46

External margins of obturator foramen | Trochanteric fossa

Question 47

Innervation of Obturator Externus

Answer 47

Obturator nerve (L3, L4)

Question 48

Short rotator muscles of the hip

Answer 48

``` Piriformis Superior gemellus Obturator internus Inferior gemellus Quadratus femoris ```

Question 49

Which of the small lateral rotators is least effective when the thigh is flexed?

Answer 49

Quadratus femoris

Question 50

Bursae of the Gluteal Region

Answer 50

Ischial bursa Trochanteric bursa Gluteofemoral bursa