Download Anatomy of the gluteal region

Gluteal region
D.Rania Gabr
D.Sama.
D.Elsherbiny
Objectives
• Identify the bony landmarks of the pelvis and hip on the
articulated skeleton and bones.
• Enlist the prominent bony features of the femur.
• Identify the muscles of the gluteal region in terms of their
origin, insertion, nerve supply and actions.
• Identify the superior gluteal and inferior gluteal nerves in
relation to Piriformis muscle.
• Explain how the anatomical position affects the muscle
function.
Gluteal region
Popliteal fossa
The Gluteal Region
 It extends from the iliac crest (waist) above to
the gluteal fold below.
 Buttock: The lower part of the gluteal region
which presents a rounded bulge due to fat is
called buttock.
Gluteal fold indicates the lower border of the
gluteus maximus muscle (gluteal sulcus/crease
is a skin crease for the hip joint)
A deep midline groove, the natal (intergluteal)
cleft separates the buttocks from each other.
 Hip: It is the anterosuperior part of the gluteal
region.
Bony Pelvis
Hip Bone
Femur
Femur
Femur
Femur
Movements at Hip Joint
Movements at Hip Joint
Ligaments of the Gluteal Region
1.
2.
Sacrospinous: connecting
sacrum to ischial spine
Sacrotuberous: connecting
sacrum to ischial tuberosity
Function :
 Stabilize the sacrum
 Prevent its posterior rotation
at the sacroiliac joint
N.B: They convert the greater &
lesser sciatic notches into
greater & lesser sciatic foramina
Gluteus medius
Gluteus minimus
Piriformis
Superior gemillus
Tendon of obturator internus
Inferior gemillus
Quadratus femoris
Adductor magnus
Gluteus maximus
Muscles of the Gluteal Region
Gluteus Maximus
ilium
S
C
Most powerful & the bulkiest
muscle of the body (Antigravity muscle)
Nerve supply
Inferior gluteal nerve (L5, S1,
S2)
Actions:
 Chief extensor and lateral
rotator of thigh at hip.
 Helps in rising from sitting,
bending
or
squatting
positions and in climbing
upstairs & cycling.
 Extend
knee
through
iliotibial tract
Gluteus Maximus (Chief
extensor)
Iliac tubercle
Tensor fasciae
lata
Ilio-tibial tractr
Gluteus Medius
Origin: outer surface of ilium
Insertion: Lateral surface of
greater trochanter
Nerve supply: Superior
gluteal nerve (L4,5, S1)
Action:
 Powerful abductor and
Medial rotator of thigh.
 Steadies the pelvis,
prevents the opposite
side of the pelvis from
tilting downwards as in
walking & running
Gluteus Minimus
Origin:
outer surface of ilium
Insertion:
Anterior surface of greater
trochanter
Nerve supply:
Superior gluteal nerve (L4,5,
S1)
Action:
Abduction & medial
rotatation of the thigh
Tensor Fascia Lata
Origin: Outer edge of iliac crest
Insertion: iliotibial tract
Nerve supply:
Superior gluteal nerve (L4,5,
S1)
Action:
Extension of the knee
Piriformis
Origin:
Anterior surface of S2,3,4
Insertion: Upper border
of greater trochanter
Nerve supply: Nerve to
Piriformis (S1,2)
Action:
Lateral rotator of
thigh
Obturator Internus
Origin: Inner surface of
obturator membrane
Insertion: medial border of
greater trochanter
Nerve supply: nerve to
obturator internus (L4,S1)
Action:
Lateral rotator of thigh
Superior & Inferior
Gemelli
Origin:
 Superior: from ischial spine
 Inferior: from ischial tuberosity
Insertion: tendon of obturator
internus
Nerve supply:
Superior: nerve to obturator
internus (L4, S1)
Inferior: nerve to quadratus
femoris (L4, S1)
Action:
Lateral rotators of thigh
Quadratus Femoris
Origin: Lateral border of
ischial tuberosity
Insertion: Quadrate tubercle
of femur
Nerve supply: nerve to
quadratus femoris (L4,S1)
Action:
Lateral rotator of thigh
Greater and Lesser Sciatic Foramen
Structures passing through greater sciatic
foramen
1. Piriformis Muscle
2. Above Piriformis:
 Superior gluteal nerve
 Superior gluteal vessels
3. Below Piriformis:
 Inferior gluteal nerve
 Inferior gluteal vessels
 Sciatic nerve
 Post. Cutaneous nerve of
thigh
 Nerve to quadratus femoris
 Nerve to obturator internus
 Pudendal nerve
 Internal Pudendal vessels
Structures passing through lesser sciatic
foramen
1. Nerve to obturator
internus
2. Pudendal nerve
3. Internal Pudendal vessels
4. Tendon of obturator
internus
Site for
Intramuscular
Injection
Trendelenburg Test
Observe patient from behind,
ask him/her to stand on one foot
and then the other
Negative test: Pelvis ‘tilts up’ on
contralateral side
Positive test: Pelvis ‘sags’ on
contralateral side as in:
1. Fracture neck of femur
2. Dislocation of hip joint
3. Nonfunctioning gluteus
medius and minimus due
to:
 Neurological damage (L4 –
5 disc herniation)
 Any disease affecting
muscles (myopathy)