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Gross Anatomy of the GLUTEAL REGION, M1 - Gross and Developmental Anatomy 8:00 AM, October 29, 2008 Dr. Milton M. Sholley Professor of Anatomy and Neurobiology 1 Grant’s Atlas, 10th ed. Fig. 5.23, pp. 327 Lateral view Grant’s Atlas, 10th ed. Fig. 5.24, pp. 328 Posterior view Grant’s Atlas, 10th ed. Fig. 5.41, pp. 344 2 Posterior view Iliac crest Anterior superior iliac spine Posterior superior iliac spine Greater trochanter Greater trochanter Gluteal tuberosity Ischial tuberosity Grant’s Atlas, 12th ed. Fig. 5.22A, p. 380 Grant’s Atlas, 12th ed. Fig. 5.22C, p.3381 Posterior view Anterior view Grant’s Atlas, 12th ed. Fig. 5.25A, p. 384 Posterior view Gluteal Region and Posterior Thigh 4 Posterior view Posterior view Location and Attachments of Gluteus Maximus Muscle Gluteus maximus Iliotibial tract Hamstrings Semitendinosus Biceps femoris, long head Semimembranosus Tibial nerve Common peroneal nerve Gastrocnemius, medial head Grant’s Atlas, 12th ed. Fig. 5.25B, p. 384 Gastrocnemius, lateral head Grant’s Atlas, 512th ed. Fig. 5.25C, p. 385 Grant’s Atlas, 12th ed. Fig. 5.24B, p. 383 Lateral view 6 Posterior view Gluteal Muscles Gluteus maximus Gluteus medius Layering of Gluteal Muscles Grant’s Atlas, 12th ed. p. 386 Gluteus minimus Min Maximus Medius Minimus Med Head of femur Lateral views of gluteal region-right side Max Nerve: Inferior gluteal Nerve: Superior gluteal Nerve: Superior gluteal 7 Lateral views of gluteal region-right side Frontal view of gluteal region-right side Grant’s Atlas, 11th ed. 8 p. 368 Gluteus Medius/Minimus Muscle Complex Actions of Gluteal Muscles Gluteus maximus- Gluteus medius Powerful hip extension Gluteus minimus (as in standing-up from a sitting position or climbing stairs) Gluteus medius/minimus muscle complexHip abduction (or the opposite action - lateral balance of pelvis) Lateral views of gluteal region-right side Paralysis of the Gluteus Medius/Minimus Muscle Complex causes a Other actions like those of the deltoid muscle (the “deltoid of the hip”) 9 Location and Attachments of Tensor Fascia Lata Muscle Trendelenburg's Sign 10 The sacrotuberous and sacrospinous ligaments close off the greater and lesser sciatic notches to form the Greater and Lesser Sciatic Foramina Tensor fascia lata muscle Iliotibial tract Nerve: Superior gluteal Lateral view 11 Anterior view Posterior view 12 Short Rotator Muscles (Syllabus-Topic E, page 193) Piriformis-”the key to the gluteal region” Grant’s Atlas, 12th ed. Fig. 5.28A, p. 390 Posterior views From: Hollinshead’s Text, 5th ed. 14 Fig.18-18, p. 364 th Grant’s Atlas, 12 13 ed. Fig. 5.28C, pp. 391 Structures leaving the greater sciatic foramen: Above piriformis Superior gluteal n, a & v Below piriformis Inferior gluteal n, a & v Sciatic n Posterior femoral cutaneous n N to sup. gemellus & obturator int. Internal pudendal a & v Pudendal n Structures entering the lesser sciatic foramen: Grant’s Atlas, 12th ed. Fig. 5.28A, p. 390 N to obturator internus Internal pudendal a & v Pudendal n 15 Posterior views Structures leaving the greater sciatic foramen: 16 Sciatic nerve 87% Two divisions Tibial -medial position Common peroneal (fibular) -lateral position Both divisions usually pass inferior to piriformis. 12% Below piriformis, but deep to tendon of obturator int. and gemelli What might happen to a person who has this variation and hypertrophies his/her piriformis because of repeated lateral rotation? Say, for example, from playing a lot of racketball. N to inf. gemellus & quadratus fem. Structures entering the lesser sciatic foramen: N to obturator internus Internal pudendal a & v Pudendal n 17 1% Grant’s Atlas, 12th ed. Fig. 5.28B, pp. 390 18 Don’t stick needles into the sciatic nerve! Bursa - A closed sac lined with synovial membrane and containing fluid, usually found in an area subject to friction; e.g., where a tendon passes over a bone. Ischial bursa (Gluteus maximus slides over ischial tuberosity) 19 Gross Anatomy Trochanteric bursa (Gluteus maximus slides over greater trochanter) 20 Compartmentalization of the Thigh of the POSTERIOR THIGH and POPLITEAL FOSSA M1 Gross and Developmental Anatomy 9:00 AM, October 29, 2008 Dr. Milton M. Sholley Professor of Anatomy and Neurobiology 21 22 179 Syllabus page Hamstring Muscles Medial Lateral Semimembranosus Semitendinosus Biceps femoris Posterior views 23 From: Hollinshead’s Text, 5th ed. 24 Fig.18-18, p. 364 Compartmental Innervations and Actions of Contained Muscles 25 184 Syllabus page 26 Dynamic Stabilizers of the Knee Joint Pes anserinus Combined tendons of: Sartorius Pes anserinus Iliotibial tract Gracilis Semitendinosus 12th Grant’s Atlas, ed. Fig. 5.21A&B, p. 379 27 Medial view Anterior view 28 Lateral side Medial side Cutaneous nerves arising in the popliteal fossa Popliteal fossa Biceps tendon Popliteal v Tibial n Popliteal a Medial Peroneal communicating n Lateral Medial sural cutaneous n Semitendinosus tendon Common peroneal n Lateral sural cutaneous n Grant’s Atlas, 12th ed. Fig. 5.36B, p. 402 29 Posterior views 30 Cutaneous nerves arising in the popliteal fossa High origin of sural nerve Major Segmental Innervation of Muscles Crossing Lower Extremity Joints Peroneal communicating n Medial sural cutaneous n Joint Sural n Muscles crossing joint Anteriorly Muscles crossing joint Posteriorly Action Segments Action Segments Hip: Flexion L2, L3 Extension L4, L5 Knee: Extension L3, L4 Flexion L5, S1 Ankle: Dorsiflexion L4, L5 Plantar flexion S1, S2 Grant’s Atlas, 12th ed. Fig. 5.37, p. 403 31 32 The Anastomosis around the Hip Geniculate Anastomosis (Anterior view) Cruciate Anastomosis (Posterior view) Medial Lateral 33 Posterior views Femoral/Popliteal Artery Angiograms Normal Bilateral occlusion of femorals 35 LAT. MED. 34