Gluteal region
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Anatomy of gluteal region for medical students
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Gluteal region
- 1. • 5 differences between human superior and inferior extremity
- 2. INFERIOR EXTREMITY GLUTEAL REGION Maj Rishi Pokhrel NAIHS rongon28us@yahoo.com www.slideshare.net
- 5. Compartments
- 7. Gluteal region • Transitional between trunk & lower extremity. • Anatomically – trunk • Functionally - lower extremity • Includes rounded posterior buttocks & lateral hip
- 8. Boundaries • Superiorly: iliac crest L4 • Medially: intergluteal cleft, • Laterally: Greater trochanter • Inferiorly: gluteal fold • Gluteal muscles form prominent majority
- 9. Skeleton
- 10. Key muscles
- 11. Key ligament
- 12. Gluteus maximus Origin •Outer surface of ilium behind posterior gluteal line •Posterior surface of sacrum, coccyx and sacrotuberous ligament. Insertion • 75% of fibres into ilio-tibial tract – 25%(deep) into gluteal tuberosity Largest muscle responsible for the prominence of the ‘buttocks’
- 14. Gluteus maximus Nerve supply - inferior gluteal nerve Action •Extensor & lateral rotator of thigh at hip joint. •Helps to maintain extension at knee through the ilio-tibial tract •Paralysis of muscle – inability to raise the trunk from sitting or stooping positions. Largest muscle responsible for the prominence of the ‘buttocks’
- 15. Iliotibial tract &Tensor fascia lata Tensor fascia lata • Origin: anterior part of iliac crest, ASIS and notch below • Insertion: inserts into the iliotibial tract. • Nerve: Superior gluteal nerve • Action: Assists gluteus maximus in keeping knee in extended position
- 16. Structures undercover of gluteus maximus • Muscles • Vessels • Nerves • Bones & Joints • Ligaments • Bursae
- 17. Structures undercover of gluteus maximus Muscles • Gluteus Medius, • Gluteus Minimus, • Reflected Head of the Rectus Femoris, • Obturator Internus with 2 Gemelli, • Obturator Externus, • Pyriformis, • Quadratus Femoris, • origin of the four hamstring muscles from the ischial tuberosity • Insertion of the upper fibres of the adductor magnus,
- 18. Structures undercover of gluteus maximus Vessels • superior gluteal vessels, • inferior gluteal vessels, • internal pudendal vessels, • ascending branch of the medial circumflex femoral artery, • trochanteric anastomoses, • cruciate anastomoses, • first perforating artery
- 19. Structures undercover of gluteus maximus Nerves • Superior gluteal nerve (L4,L5,S1), • Inferior gluteus nerve (L5,S1, S2), • Pudendal Nerve (S2,S3,S4), • Posterior Cutaneous Nerve of thigh (S1,S2,S3), • Perforating Cutaneous Nerve (S2,S3), • Sciatic Nerve (L4,L5,S1,S2,S3), • Nerve to Quadratus Femoris (L4,L5,S1), • Nerve to Obturator Internus (L5,S1,S2)
- 20. Structures undercover of gluteus maximus • Bones & Joints – Illium, – Ischium with the ischial tuberosity, – hip joint, – sacroilliac joint, – sacrum and coccyx, – upper end of the femur with the greater trochanter • Ligaments – Sacrotuberous, – Sacrospinous, – ischiofemoral
- 21. Structures undercover of gluteus maximus Bursae • trochanteric bursa of the glut max, • bursa above the ischial tuberosity, • bursa between the gluteus maximus and the vastus lateralis
- 22. Gluteus medius Posterior part covered by gluteus maximus Origin Outer surface of ilium b/w iliac crest above & posterior gluteal line behind and middle gluteal line below. Insertion Lateral surface of greater trochanter Nerve – superior gluteal nerve Action •With G minimus and tensor fascia lata -powerful abductor at hip. •Anterior fibres medially rotate the thigh •Walking and running •Holds opposite side of pelvis horizontally when foot is off the ground.
- 24. Gluteus minimus Origin Outer surface of ilium b/w middle & inferior gluteal lines Insertion - Anterior surface of greater trochanter Nerve-superior gluteal nerve Action •With G minimus and tensor fascia lata -powerful abductor at hip. •Anterior fibres medially rotate the thigh
- 25. Short Lateral Rotators of Thigh
- 26. Piriformis • Key muscle of gluteal region Origin • Pelvic surface of sacrum 2nd,3rd & 4th pieces • Sacrotuberous ligament Insertion • Upper border of greater trochanter • Leaves the pelvis through greater sciatic foramen and separates gleuteal vessels and nerves to superior and inferior Nerve • S1 2 anterior rami Short Lateral Rotators of Thigh
- 28. Structures through greater sciatic foramen • Above piriformis- – superior gluteal vessels and nerves • Below piriformis – Sciatic N – posterior femoral cutaneous nerves – Inferior gluteal vessels & nerves – PIN structures • Pudendal nerve • Internal pudendal vessels • Nerve to obturator internus – Nerve to quadratus femoris
- 29. Structures through lesser sciatic foramen – PIN structures • Pudendal nerve • Internal pudendal vessels • Nerve to obturator internus
- 31. Origin: from pelvic surfaces of • Body of ischium • Ischial tuberosity • Ischio-pubic ramus • Obturator membrane & fascia. Insertion: tendon passes out of the pelvis through the lesser sciatic foramen and enters gluteal region >> upper border of greater trochanter. Obturator Internus Nerve: Nerve to obturator internus L5 S1 2 One ½ of muscle in pelvis other ½ in perineum Tendon in gluteal region Short Lateral Rotators of Thigh
- 32. Gamellus superior Origin-spine of ischium Insertion-tendon of OBT int Nerve- to OBT internus Gamellus inferior Origin-ischial tuberosity Insertion-tendon of OBT internus Nerve-to Quadratus femoris Quadratus femoris Origin-ischial tuberosity Insertion-quadrate tubercle Nerve-sacral plexus Short Lateral Rotators of Thigh