Download Gluteal Region, Posterior Thigh and Popliteal Fossa

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
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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