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Gluteal region

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Varun Walia
Varun Walia

The gluteal region contains important muscles, nerves and vessels. It is bounded by the ilium, sacrum and ischial tuberosity. The gluteal region contains nine muscles including the gluteus maximus, medius and minimus. The gluteal region receives its blood supply from the superior and inferior gluteal arteries and contains important nerves like the superior and inferior gluteal nerves. The piriformis muscle passes through the greater sciatic foramen along with blood vessels and nerves.

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GLUTEAL REGION Varun Walia (145)
Contents: Gluteal region and boundaries Cutaneous innervations Muscles of gluteal region Arteries of gluteal region Nerves of gluteal region Applied Aspect
Introduction: Transitional area b/w trunk and lower extremity Anatomically it is a part of trunk. Functionally it is a part of lower extremity Gluteal region includes rounded, posterior buttocks and laterally placed hip region
Boundaries:
Superficial fascia: Thick, dense, well developed, laden with large quantities of fat (specially in women) that: - Gives the characteristic convexity to the buttock - Forms a thick cushion over the ischial tuberosity It contains cutaneous innervations, vessels and lymphatics
Cutaneous innervations:
Cutaneous vessels & lymphatics: Blood supply: -branches of superior and inferior gluteal arteries Lymphatics: - lateral group of superficial inguinal lymph nodes
Deep Fascia Is continuation of the fascia lata (deep fascia of the thigh) At the lower border of the gluteus maximus, fascia lata splits to enclose the muscle Above the gluteus maximus, the deep fascia continues as one layer covering the gluteus medius & gets attached to iliac crest Laterally the fascia merges with the iliotibial tract Fascia over gluteus medius Tensor fascia lata Gluteal fascia Iliotibial tract
Gluteus maximus Gluteus medius Gluteus minimus Tensor fascia lata Piriformis Obturator internus Superior Gemellus Inferior Gemellus Quadratus femoris obturator externus Muscles of the Gluteal Region
Largest muscle in the body Forms the prominence of buttock ilium S C Gluteus Maximus
Origin: Outer surface of ilium behind the posterior gluteal line Lumbar fascia Posterior surface of sacrum & coccyx Sacrotuberous ligament Insertion: Most of the muscle (3/4th) inserted into the iliotibial tract Deeper fibers inserted to the gluteal tuberosity Nerve supply: Inferior gluteal nerve (L5, S1, 2)
Actions: Extends & laterally rotates the hip joint Extends the knee joint (through iliotibial tract) Gives simultaneous stability to the hip and knee joints through the iliotibial tract
Structures under the cover of gluteus maximus: gluteus Medius & minimus rectus femoris Piriformis obturator internus with two gemelli Quadratus femoris obturator externus Origin of four hamstring from ischial tuberosity Insertion of pubic fibers of ad. magnus Muscles:-
Superior gluteal vessels inferior gluteal vessels internal pudendal Medial femoral circumflex artery trochanteric & cruciate anastomosis Vessels:-
Superior gluteal inferior gluteal sciatic Post. cut. Nerve of thigh nerve to quadratus femoris pudendal nerve nerve to obturator internus perforating cutaneous nerves Nerves:-
Bones & joints- ilium, ischial tuberosity, upper end of femur with greater trochanter, sacrum, coccyx, hip joint &sacroiliac joint Ligaments- sacrotuberous, sacrospinous & ischiofemoral Bursa- trochanteric bursa of glut. maximus, of ischial tuberosity, & bet. glut. max, & vastus lateralis
Ligaments of gluteal region: 2 ligaments: Sacrospinous, connecting sacrum to ischial spine Sacrotuberous, connecting sacrum to ischial tuberosity They convert the greater & lesser sciatic notches into greater & lesser sciatic foramina Their main function is to: -Stabilize the sacrum -Prevent its posterior rotation at the sacroiliac joint
Origin: outer surface of ilium between the middle and posterior gluteal lines Insertion: Lateral surface of greater trochanter Nerve supply: Superior gluteal nerve (L4,5, S1) Action: Abducts & medially rotates the thigh Steady pelvis in walking Gluteus Medius
Origin: outer surface of ilium Insertion: Anterior surface of greater trochanter Nerve supply: Superior gluteal nerve (L4,5, S1) Action: Abducts & medially rotates the thigh Gluteus Minimus
Origin: Anterior surface of sacrum between the anterior sacrum foramina Insertion: Apex of greater trochanter Nerve supply: direct branch from L5, S1&S2 Action: lateral rotator of femur Piriformis
Origin: Deep surface of obturator membrane and surrounding bone Insertion: Medial side of greater trochanter above the trochanteric fossa Nerve supply: nerve to obturator internus Action: Lateral rotator of femur Obturator internus
Origin: Superior gemellus- external surface of ischial spine Inferior gemellus- Upper aspect of ischial tuberosity Insertion: Both Gemelli insert into the tendon of obturator internus Nerve supply: superior gemelli by nerve to obturator internus inferior gemelli by nerve to quadratus femoris Action: help in lateral rotation Superior & Inferior gemelli
Origin: Lateral border of ischial tuberosity Insertion: Quadrate tubercle of femur Nerve supply: nerve to quadratus femoris Action: lateral rotator of thigh Quadratus femoris
Origin: Obturator membrane Ramus of pubis Ramus of ischium Insertion: Trochanteric fossa on the medial aspect of greater trochanter Nerve supply: Obturator nerve Action: Lateral rotator of femur Obturator externus
Arteries Inferior gluteal artery Originates from the ant. Trunk of the internal iliac artery Supplies adjacent muscles and desends through the gluteal region into the posterior thigh Superior gluteal artery Originates form the post. Trunk of the internal iliac artery Divides into a superficial and a deep branch Internal pudendal artery Various anastomosis
Arterial anastomosis of the gluteal region Cruciate anastomosis: Present in the lower part of the gluteal region. Arteries taking part in anastomosis are inferior gluteal artery, first perforating artery and the lateral & medial Circumflex Femoral arteries. Trochanteric artery: Seen in relation to greater trochanter. Arteries taking part in anastomosis are superior gluteal artery and the medial & lateral circumflex femoral arteries.
Nerves in gluteal region
Structures passing through greater sciatic foramen Piriformis Structures passing above the piriformis are: superior gluteal nerve and superior gluteal vessels Structures passing below the piriformis are: Inferior gluteal nerve and vessels, sciatic nerve, posterior cutaneous nerve of thigh, nerve to quadratus femoris, pudendal nerve, internal pudendal vessels, nerve to obturator internus Structures passing through lesser sciatic foramen Pudendal nerve, Internal pudendal vessels, nerve to obturator internus, tendon of obturator internus
Applied I/m injection is given in superolateral quadrant of gluteal region to avoid injury to nerves
When gluteus maximus is paralysed, the patient cannot stand up from sitting posture without support. When the gluteus Medius & minimus are paralysed, patient sways on the paralysed side while walking. This is known as lurching gait. When bilateral, the gait is called as waddling gait. Trendelenburg sign: Normally when the body weight is supported on one limb, the glutei of the supported side raise the opposite (unsupported) side of the pelvis. However if abductor mechanism is defective, the unsupported side of the pelvis drops and this is known as positive trendelenburg sign.
Gluteal region

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Gluteal region

  • 2. Contents: Gluteal region and boundaries Cutaneous innervations Muscles of gluteal region Arteries of gluteal region Nerves of gluteal region Applied Aspect
  • 3. Introduction: Transitional area b/w trunk and lower extremity Anatomically it is a part of trunk. Functionally it is a part of lower extremity Gluteal region includes rounded, posterior buttocks and laterally placed hip region
  • 5. Superficial fascia: Thick, dense, well developed, laden with large quantities of fat (specially in women) that: - Gives the characteristic convexity to the buttock - Forms a thick cushion over the ischial tuberosity It contains cutaneous innervations, vessels and lymphatics
  • 7. Cutaneous vessels & lymphatics: Blood supply: -branches of superior and inferior gluteal arteries Lymphatics: - lateral group of superficial inguinal lymph nodes
  • 8. Deep Fascia Is continuation of the fascia lata (deep fascia of the thigh) At the lower border of the gluteus maximus, fascia lata splits to enclose the muscle Above the gluteus maximus, the deep fascia continues as one layer covering the gluteus medius & gets attached to iliac crest Laterally the fascia merges with the iliotibial tract Fascia over gluteus medius Tensor fascia lata Gluteal fascia Iliotibial tract
  • 9. Gluteus maximus Gluteus medius Gluteus minimus Tensor fascia lata Piriformis Obturator internus Superior Gemellus Inferior Gemellus Quadratus femoris obturator externus Muscles of the Gluteal Region
  • 10. Largest muscle in the body Forms the prominence of buttock ilium S C Gluteus Maximus
  • 11. Origin: Outer surface of ilium behind the posterior gluteal line Lumbar fascia Posterior surface of sacrum & coccyx Sacrotuberous ligament Insertion: Most of the muscle (3/4th) inserted into the iliotibial tract Deeper fibers inserted to the gluteal tuberosity Nerve supply: Inferior gluteal nerve (L5, S1, 2)
  • 12. Actions: Extends & laterally rotates the hip joint Extends the knee joint (through iliotibial tract) Gives simultaneous stability to the hip and knee joints through the iliotibial tract
  • 13. Structures under the cover of gluteus maximus: gluteus Medius & minimus rectus femoris Piriformis obturator internus with two gemelli Quadratus femoris obturator externus Origin of four hamstring from ischial tuberosity Insertion of pubic fibers of ad. magnus Muscles:-
  • 14. Superior gluteal vessels inferior gluteal vessels internal pudendal Medial femoral circumflex artery trochanteric & cruciate anastomosis Vessels:-
  • 15. Superior gluteal inferior gluteal sciatic Post. cut. Nerve of thigh nerve to quadratus femoris pudendal nerve nerve to obturator internus perforating cutaneous nerves Nerves:-
  • 16. Bones & joints- ilium, ischial tuberosity, upper end of femur with greater trochanter, sacrum, coccyx, hip joint &sacroiliac joint Ligaments- sacrotuberous, sacrospinous & ischiofemoral Bursa- trochanteric bursa of glut. maximus, of ischial tuberosity, & bet. glut. max, & vastus lateralis
  • 17. Ligaments of gluteal region: 2 ligaments: Sacrospinous, connecting sacrum to ischial spine Sacrotuberous, connecting sacrum to ischial tuberosity They convert the greater & lesser sciatic notches into greater & lesser sciatic foramina Their main function is to: -Stabilize the sacrum -Prevent its posterior rotation at the sacroiliac joint
  • 18. Origin: outer surface of ilium between the middle and posterior gluteal lines Insertion: Lateral surface of greater trochanter Nerve supply: Superior gluteal nerve (L4,5, S1) Action: Abducts & medially rotates the thigh Steady pelvis in walking Gluteus Medius
  • 19. Origin: outer surface of ilium Insertion: Anterior surface of greater trochanter Nerve supply: Superior gluteal nerve (L4,5, S1) Action: Abducts & medially rotates the thigh Gluteus Minimus
  • 20. Origin: Anterior surface of sacrum between the anterior sacrum foramina Insertion: Apex of greater trochanter Nerve supply: direct branch from L5, S1&S2 Action: lateral rotator of femur Piriformis
  • 21. Origin: Deep surface of obturator membrane and surrounding bone Insertion: Medial side of greater trochanter above the trochanteric fossa Nerve supply: nerve to obturator internus Action: Lateral rotator of femur Obturator internus
  • 22. Origin: Superior gemellus- external surface of ischial spine Inferior gemellus- Upper aspect of ischial tuberosity Insertion: Both Gemelli insert into the tendon of obturator internus Nerve supply: superior gemelli by nerve to obturator internus inferior gemelli by nerve to quadratus femoris Action: help in lateral rotation Superior & Inferior gemelli
  • 23. Origin: Lateral border of ischial tuberosity Insertion: Quadrate tubercle of femur Nerve supply: nerve to quadratus femoris Action: lateral rotator of thigh Quadratus femoris
  • 24. Origin: Obturator membrane Ramus of pubis Ramus of ischium Insertion: Trochanteric fossa on the medial aspect of greater trochanter Nerve supply: Obturator nerve Action: Lateral rotator of femur Obturator externus
  • 25. Arteries Inferior gluteal artery Originates from the ant. Trunk of the internal iliac artery Supplies adjacent muscles and desends through the gluteal region into the posterior thigh Superior gluteal artery Originates form the post. Trunk of the internal iliac artery Divides into a superficial and a deep branch Internal pudendal artery Various anastomosis
  • 26. Arterial anastomosis of the gluteal region Cruciate anastomosis: Present in the lower part of the gluteal region. Arteries taking part in anastomosis are inferior gluteal artery, first perforating artery and the lateral & medial Circumflex Femoral arteries. Trochanteric artery: Seen in relation to greater trochanter. Arteries taking part in anastomosis are superior gluteal artery and the medial & lateral circumflex femoral arteries.
  • 28. Structures passing through greater sciatic foramen Piriformis Structures passing above the piriformis are: superior gluteal nerve and superior gluteal vessels Structures passing below the piriformis are: Inferior gluteal nerve and vessels, sciatic nerve, posterior cutaneous nerve of thigh, nerve to quadratus femoris, pudendal nerve, internal pudendal vessels, nerve to obturator internus Structures passing through lesser sciatic foramen Pudendal nerve, Internal pudendal vessels, nerve to obturator internus, tendon of obturator internus
  • 29. Applied I/m injection is given in superolateral quadrant of gluteal region to avoid injury to nerves
  • 30. When gluteus maximus is paralysed, the patient cannot stand up from sitting posture without support. When the gluteus Medius & minimus are paralysed, patient sways on the paralysed side while walking. This is known as lurching gait. When bilateral, the gait is called as waddling gait. Trendelenburg sign: Normally when the body weight is supported on one limb, the glutei of the supported side raise the opposite (unsupported) side of the pelvis. However if abductor mechanism is defective, the unsupported side of the pelvis drops and this is known as positive trendelenburg sign.