Download Gluteal Region (17).

Gluteal Region (17)
Description
Pelvis
-Os coxae
*(2) ilium, (2) ischium, (2) pubis
-Sacrum
*5 fused sacral vertebrae
-Coccyx
*fused coccygeal vertebrae (~3, variable
in number)
Pelvic
ligaments
-iliolumbar
-anterior sacroiliac
-sacrotuberous
-sacrospinous
-pubic symphysis
-inguinal
-ALL (anterior longitudinal ligament)
-obturator membrane
-sacrospinous & sacrotuberous important
b/c define the greater & lesser sciatic
foramina
Pictures
Description
Pictures
Description
Sciatic
foramina
Hip joint
-greater foramen:
*greater sciatic notch, sacrospinous
ligament
*piriformis m, superior & inferior gluteal
nn & aa, sciatic n, pudendal n & a
-lesser foramen:
*lesser sciatic notch, sacrospinous &
sacrotuberous ligaments
*obturator internus m, pudendal n & a
-acetabulum of os coxae, acetabular
labrum, articular cartilages, synovium,
joint capsule ligaments & muscles all form
the joint
-joint capsule strengthened by 3 ligaments
(arising from the 3 bones of the os coxae
and named for their bone of origin):
*iliofemoral
*pubofemoral
*ischiofemoral
-iliofemoral ligament
*Y-shaped
*very strong
*prevents hyperextension of thigh
*anterior & superior to joint capsule
-pubofemoral ligament
*anterior & inferior to joint capsule
*prevents over abduction of thigh
*blends with iliofemoral ligament
*this ligament can be trained to stretch
further over time!
-ischiofemoral ligament
*weakest of the 3 ligaments
*posterior to joint capsule
Pictures
Description
*helpful in preventing hyperextension
Pictures
Description
Femur
-greater trochanter, lesser trochanter,
intertrochanteric line & crest, head, neck,
fovea, linea aspera, gluteal tuberosity
-most muscles will distally attach to the
femur
-ligament of the head of the femur
*not a major structural player
*carries artery of head of the femur
(artery is inside the ligament!)
*damage = avascular necrosis of femoral
head
Pictures
Description
Gluteal
bursae
-reduce friction & permit free movement
-trochanteric bursa:
*largest
*separates superior fibers of glut. max.
from greater trochanter
-ischial bursa:
*separates inferior part of glut. max.
from ischial tuberosity
*often absent
-gluteofemoral bursa:
*separates iliotibial tract from superior
part of proximal attachment of vastus
lateralis
Pictures
Description
Muscles
Pictures
-superficial layer
*tensor fascia latae (TFL)
*glutei muscles: maximus, medius,
minimus
*mainly extend, abduct and medial
rotate thigh
-deep layer
*piriformis, obturator internus, superior
& inferior gemelli, quadratus femoris
*mainly lateral rotators of thigh
*help stabilize head of femur in
acetabulum
Piriformis
syndrome
-peripheral neuritis of the sciatic nerve d/t
impingement by the piriformis muscle
-often caused by sitting on a wallet, falls,
overuse in sitting activities
-estimated that at least 6% of patients
who are dx as having low back pain
actually have this syndrome
-tx  stretching, NSAIDs, muscle
relaxants, analgesics, steroid injections,
OMT, PT, surgery
***sciatic nerve usually emerges from greater sciatic foramen inferior to piriformis
 Could also divide before exiting greater sciatic foramen- common fibular nerve passing
though piriformis; less common- common fibular division could pass over piriformis
Description
Gait cycle
-abductors of the hip (gluteus medius &
minimus, TFL) contract to keep pelvis level
when opposite foot is lifted
-medial rotators (same as above) swing
pelvis & body forward during swing phase
of gait
-lateral rotators (piriformis, OI, both
gemelli, quadratus femoris) keep moving
foot in line during swing phase
-Trendelenburg test  person who has
suffered a lesion of the superior gluteal
nerve is asked to stand on one leg, the
pelvis on the unsupported side descends
indicating that the gluteus medius &
minimus on the supported side are weak
or non-functional
*other causes of this sign  fx of greater
trochanter (distal attachment of gluteus
medius) & dislocation of the hip joint
Pictures
Description
innervation CLUNIAL NERVES
-cutaneous nerves supplying skin of
gluteal region (clunes = buttocks)
-vulnerable to injury when bone is taken
from ilium for grafting
-superior  supply skin of superior
buttock as far as tubercle of iliac crest
-middle  supply skin over sacrum &
adjacent area of bittock
-inferior  supplies skin of inferior half of
buttock as far as greater trochanter
LUMBAR PLEXUS
-femoral nerve (L2-L4)  innervates the
iliacus & passes deep to the inguinal
ligament/iliopubic tract to the anterior
thigh, supplying the flexors of the hip &
extensors of the knee
-obturator nerve (l2-L4)  passes into the
lesser pelvis, inferior to the superior pubic
ramus (through the obturator foramen) to
the medial thigh, supplying the adductor
muscles
SCIATIC NERVE
-largest nerve in the body
-formed as the large ventral rami of spinal
nerves L4-S3 converge on the anterior
surface of the piriformis
-passes through greater sciatic foramen
Pictures
Description
-supplies posterior thigh, entire leg &
foot  articular branches to hip joint;
muscular branches to flexors of knee in
thing & all muscles in leg & foot
PUDENDAL NERVE
-main nerve of the perineum, chief nerve
of the external genitalia
-leaves the pelvis through the greater
sciatic foramen between the piriformis &
coccygeus muscles
-S2, S3, S4 origin
-distribution: structures of the perineum
 sensory to genitalia; muscular branches
to perineal muscles, external urethral
sphincter, & eternal anal sphincter
SUPERIOR & INFERIOR GLUTEAL NERVES
-superior gluteal nerve leaves pelvis
through greater sciatic foramen
*origin  L4, L5, S1
*distribution  gluteus medius &
gluteus minimus muscles
-inferior gluteal nerve leaves pelvis
through greater sciatic foramen,
superficial to sciatic nerve, accompanying
inferior gluteal artery
*origin  L5, S1, S2
*distribution  gluteus maximus
Pictures
Description
Vasculature VEINS
-gluteal veins are tributaries of the
internal iliac veins that rain blood from
the gluteal region
-superior & inferior gluteal veins
accompany the corresponding arteries
through the greater sciatic foramen,
superior and inferior to the piriformis,
respectively
*communicate with tributaries of the
femoral vein, providing alternative routes
for the return of blood from the lower
limb if the femoral vein is occluded or has
to be ligated
-internal pudendal veins accompany the
arteries and join to form a single vein that
enters the internal iliac vein
*drain blood from the external genitalia
or pudendum
LYMPHATICS
-lymph from the deep tissues of the
buttocks follows the gluteal vessels to the
superior and inferior gluteal lymph nodes
and from them to the internal, external,
and common iliac lymph nodes  from
there to the lateral lumbar (aortic/caval)
lymph nodes
-lymph from the superficial gluteal
tissues enters the superficial inguinal
lymph nodes, which also receive lymph
from the thigh
-all of the superficial inguinal nodes send
efferent lymphatic vessels to the external
iliac lymph nodes
Pictures
ARTERIES