Gluteal region

Anatomy of gluteal region for medical students

1. 5 differences between human superior and inferior extremity

2. INFERIOR EXTREMITY GLUTEAL REGION Maj Rishi Pokhrel NAIHS [email protected] www.slideshare.net

3. Anatomical regions Thigh Leg Foot Gluteal region

4. Compartments

5. Compartmental nerve supply

6. Gluteal region T ransitional between trunk & lower extremity. Anatomically – trunk Functionally - lower extremity I ncludes rounded posterior buttocks & lateral hip

7. Boundaries Superiorly : iliac crest L4 Medially : intergluteal cleft, Laterally : Greater trochanter Inferiorly : gluteal fold G luteal muscles form prominent majority

8. Skeleton

9. Key muscles

10. Key ligament

11. Key? Structures undercover of gluteus maximus Structures passing through GSF above Pyriformis below Pyriformis Structures passing through LSF

12. Gluteus maximus Origin Outer surface of ilium behind posterior gluteal line Posterior surface of sacrum, coccyx and sacrotuberous ligament. Insertion 75% of fibres into ilio -tibial tract – 25%(deep) into gluteal tuberosity Largest muscle responsible for the prominence of the ‘buttocks’

13. Gluteus maximus Nerve supply - inferior gluteal nerve Action Extensor & lateral rotator of thigh at hip joint. Helps to maintain extension at knee through the ilio -tibial tract Paralysis of muscle – inability to raise the trunk from sitting or stooping positions. Largest muscle responsible for the prominence of the ‘buttocks’

14.                   Iliotibial tract &Tensor fascia lata Tensor fascia lata Origin : anterior part of iliac crest, ASIS and notch below Insertion : inserts into the iliotibial tract. Nerve : Superior gluteal nerve Action : Assists gluteus maximus in keeping knee in extended position

15. Structures undercover of gluteus maximus Muscles Vessels Nerves Bones & Joints Ligaments B ursae

16. Structures undercover of gluteus maximus Muscles Gluteus Medius , Gluteus Minimus , Reflected Head of the Rectus Femoris, Obturator Internus with 2 Gemelli , Obturator Externus, Pyriformis, Quadratus Femoris, origin of the four hamstring muscles from the ischial tuberosity Insertion of the upper fibres of the adductor magnus,

17. Structures undercover of gluteus maximus Vessels superior gluteal vessels, inferior gluteal vessels, internal pudendal vessels, ascending branch of the medial circumflex femoral artery, trochanteric anastomoses , cruciate anastomoses, first perforating artery

18. Structures undercover of gluteus maximus Nerves Superior gluteal nerve (L4,L5,S1) , Inferior gluteus nerve (L5,S1, S2), Pudendal Nerve (S2,S3,S4) , Posterior Cutaneous Nerve of thigh (S1,S2,S3), Perforating Cutaneous Nerve (S2,S3), Sciatic Nerve (L4,L5,S1,S2,S3), Nerve to Quadratus Femoris (L4,L5,S1), Nerve to Obturator Internus (L5,S1,S2)

19. Structures undercover of gluteus maximus Bones & Joints Illium , Ischium with the ischial tuberosity, hip joint, sacroilliac joint, sacrum and coccyx, upper end of the femur with the greater trochanter Ligaments Sacrotuberous , Sacrospinous, ischiofemoral

20. Structures undercover of gluteus maximus Bursae trochanteric bursa of the glut max, bursa above the ischial tuberosity , bursa between the gluteus maximus and the vastus lateralis

21. Gluteus medius Posterior part covered by gluteus maximus Origin Outer surface of ilium b/w iliac crest above & posterior gluteal line behind and middle gluteal line below. Insertion Lateral surface of greater trochanter Nerve – superior gluteal nerve Action With G minimus and tensor fascia lata -powerful abductor at hip. Anterior fibres medially rotate the thigh Walking and running Holds opposite side of pelvis horizontally when foot is off the ground.

22. Gluteus minimus Origin Outer surface of ilium b/w middle & inferior gluteal lines Insertion - Anterior surface of greater trochanter Nerve -superior gluteal nerve Action With G minimus and tensor fascia lata -powerful abductor at hip. Anterior fibres medially rotate the thigh

23.                   Iliotibial tract &Tensor fascia lata Tensor fascia lata Origin: anterior part of iliac crest, ASIS and notch below Insertion: inserts into the iliotibial tract. Nerve: Superior gluteal nerve Action: Assists gluteus maximus in keeping knee in extended position

24. Short Lateral Rotators of Thigh

25. Piriformis Key muscle of gluteal region Origin Pelvic surface of sacrum 2 nd ,3 rd & 4 th pieces Sacrotuberous ligament Insertion Upper border of greater trochanter Leaves the pelvis through greater sciatic foramen and separates gleuteal vessels and nerves to superior and inferior Nerve S1 2 anterior rami Short Lateral Rotators of Thigh

26. Structures through greater sciatic foramen Above piriformis - superior gluteal vessels and nerves Below piriformis Sciatic N posterior femoral cutaneous nerves Inferior gluteal vessels & nerves PIN structures P udendal nerve I nternal pudendal vessels N erve to obturator internus Nerve to quadratus femoris

27. Structures through lesser sciatic foramen PIN structures P udendal nerve I nternal pudendal vessels N erve to obturator internus

28. Origin : from pelvic surfaces of Body of ischium Ischial tuberosity Ischio -pubic ramus Obturator membrane & fascia. Insertion : tendon passes out of the pelvis through the lesser sciatic foramen and enters gluteal region >> upper border of greater trochanter. Obturator Internus Nerve : Nerve to obturator internus L5 S1 2 One ½ of muscle in pelvis other ½ in perineum Tendon in gluteal region Short Lateral Rotators of Thigh

29. Gamellus superior Origin-spine of ischium Insertion-tendon of OBT int Nerve- to OBT internus Gamellus inferior Origin- ischial tuberosity Insertion-tendon of OBT internus Nerve-to Quadratus femoris Quadratus femoris Origin- ischial tuberosity Insertion-quadrate tubercle Nerve-sacral plexus Short Lateral Rotators of Thigh

30. Trendlenberg test??