GLUTEAL REGION

DR. NOMAN ULLAH WAZIR

3 Dr. Vohra

Vessels:Superior & inferior gluteal arteries

Nerve:Sciatic, posterior cutaneous nerve of thigh, superior gluteal,

inferior gluteal, nerve to quadratus femoris, nerve to obturator

internus & pudendal nerve

Contents of the Gluteal Region

ForaminaGreater sciatic & lesser sciatic

LigamentsSacrotuberous & sacrospinous Ligaments

MusclesGluteal maximus, gluteal medius, gluteal minimus,

tensor fasciae latae, piriformis, obturator internus,

superior/inferior gemelli & quadratus femoris

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Ligaments of the Gluteal RegionThe function of these ligaments is to stabilize the sacrum and prevent its

rotation at the sacroiliac joint by the weight of the vertebral column

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Foramina of the Gluteal Region

Is formed by the greater sciatic notch of the hip bone and the sacrotuberous and sacrospinousligaments.

Structures exit the foramen 1. Piriformis2. Sciatic nerve3. Posterior cutaneous nerve of the thigh4. Superior and inferior gluteal nerves5. Nerves to the obturator internus and quadratus

femoris6. Pudendal nerve 7. Superior and inferior gluteal arteries and veins8. Internal pudendal artery and vein

1. Greater Sciatic Foramen

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Is formed by the lesser sciatic notch of the hip bone and the sacrotuberous and sacrospinous ligaments.

Structures exit the foramen 1. Tendon of obturator internus muscle2. Nerve to obturator internus3. Pudendal nerve4. Internal pudendal artery and vein

2. Lesser Sciatic Foramen

GLUTEAL MUSCLES

• Muscles of gluteal region share a common compartment but are organized into 2 layers.

• The superficial layer :consists of three large overlapping glutei(Maximus,Medius,Minimus) which mainly abduct and extend the hip.

• An additional muscle in this group , is the tensor fascia latae.

• These muscles are mainly Extensor ,Abductor and Medial rotator of the thigh.

GLUTEUS MAXIMUS

• Is the largest muscle in the gluteal region and overlies most of the other gluteal muscles.

• Is quadrangular in shape

• ORIGIN: Fascia covering the gluteus medius, external surface of ilium behind posterior gluteal line, dorsal surface of sacrum and coccyx , sacrotuberous ligament.

GLUTEUS MAXIMUS CONT……….

• INSERTION: Posterior aspect of iliotibial tract of fascia lata and gluteal tuberosity of proximal femur.

• INNERVATION:Inf glutial nerve (L5,S1,S2)

• FUNCTION: Powerful extensor of flexed femur at hip joint, assists in lateral rotation of hip and knee joint and in rising from sitting position

GLUTEUS MEDIUS

• A fan shape muscle which overlies gluteus minimus .

• ORIGIN: External surface of ilium between ant and post gluteal line.

• INSERTION: Lateral surface of greater trochanter of femur.

• INNERVATION: Sup gluteal nerve(L5,S1)

• FUNCTION: Abducts femur at hip joint, medially rotates the thigh, prevents pelvic drop on the opposite swing side during walking.

GLUTEUS MINIMUS

• Is the smaller fan shape gluteal muscle.

• ORIGIN: External surface of ilium between ant and inf gluteal line.

• INSERTION: Ant surface of greater trochanter of femur.

• INNERVATION: Sup gluteal nerve (L5,S1)

• FUNCTION: Abducts and medially rotates the thigh, prevents pelvic drop on the opposite swing side during walking.

TENSOR FASCIA LATA

• Is a fusiform muscle almost 15cm long is enclosed between 2 layers fascia lata.

• ORIGIN: Lateral aspect of crest of ilium between ASIS and tubercle of the crest.

• INSERTION: Iliotibial tract of fascia lata.

• INNERVATION: Sup gluteal nerve(L4,L5,S1)

• FUNCTION: Stabilizes the knee in extension.

DEEP LAYER MUSCLES

• The deep layer consists of smaller muscles (Piriformis, Obturator internus, Superior and Inferior Gemelli, and Quadratusfemoris ) covered by the inferior half of the gluteus maximus .

• They all have distal attachment on or adjacent to the intertrochantric crest of femur.

• They are lateral Rotator of the thigh and also stabilizes the hip joint.

PIRIFORMIS

• Is the most superior of the deep group muscles.

• ORIGIN: Ant surface of sacrum between ant sacral foramina.

• INSERTION: Medial side of sup border of greater trochanter of femur.

• INNERVATION: Branches from (L5,S1,S2)

• FUNCTION: Laterally rotates the extended femur at hip joint, and abducts flexed femur at this joint.

OBTURATOR INTERNUS

• It is a flat fan shaped muscle. Like the piriformis is a muscle of the pelvic wall and gluteal region.

• ORIGIN: Pelvic surface of the obturatormembrane and surronding bone.

• INSERTION: Medial side of greater trochanter of femur.

• INNERVATION: Nerve to obturatorinternus (L5, S1)

• FUNCTION: Laterally rotates the extended femur at hip joint and abducts flexed femur at hip joint.

GEMELLUS SUPERIOR

• A triangular shaped muscle associated with the upper and lower margin of the Obt Int tendon.

• ORIGIN: External surface of ischialspine.

• INSERTION: Along with the tendon of the obturator internus to the medial side of greater trochanter of femur.

• INNERVATION: Nerve to Obt Int (L5,S1)

• FUNCTION: Laterally rotates the extended femur at hip joint and abducts flexed femur at this joint.

GEMELLUS INFERIOR

• A triangular muscle associated with the upper and lower margins of the Obt Int tendon.

• ORIGIN: Upper aspect of ischialtuberosity.

• INSERTION: Along with the tendon of Obt Int to the medial side od greater trochanter of F

• INNERVATION: Nerve to quadratusfemoris (L5 , S1).

• FUNCTION: Laterally rotates the extended femur at hip joint , abducts flexed femur at hip joint.

QUADRATUS FEMORIS

• A flat rectangular muscle that is the most inferior muscle of the deep group, is below the Obt Int and it’s associated gemellusmuscles.

• ORIGIN: Lateral aspect of ischium just anterior to ischial tuberosity.

• INSERTION: Quadrate tubercle on the intertrochantric crest of the proximal femur.

• INNERVATION:Nerve to quadratus femoris(L5,S1)

• FUNCTION: Laterally rotates femur at hip joint.

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Muscles of the Gluteal Region

Muscle Origin Insertion Nerve Supply

Nerve

Roots Action

Gluteus

maximus

Outer surface of

ilium, sacrum,

coccyx,

sacrotuberous

ligament

Iliotibial tract and gluteal

tuberosity of femur

Inferior gluteal nerve L5; S1, 2 Extends and laterally rotates hip joint;

through iliotibial tract, it extends knee

joint

Gluteus

medius

Outer surface of

ilium

Lateral surface of greater

trochanter of femur

Superior gluteal nerve L5; S1 Abducts thigh at hip joint; tilts pelvis when

walking to permit opposite leg to clear

ground

Gluteus

minimus

Outer surface of

ilium

Anterior surface of greater

trochanter of femur

Superior gluteal nerve L5; S1 Abducts thigh at hip joint; tilts pelvis when

walking to permit opposite leg to clear

ground

Tensor

fasciae

latae

Iliac crest Iliotibial tract Superior gluteal nerve L4; 5 Assists gluteus maximus in extending the

knee joint

Piriformis Anterior surface of

sacrum

Upper border of greater

trochanter of femur

First and second sacral

nerves

L5; S1, 2 Lateral rotator of thigh at hip joint

Obturator

internus

Inner surface of

obturator

membrane

Upper border of greater

trochanter of femur

Sacral plexus L5; S1 Lateral rotator of thigh at hip joint

Gemellus

superior

Spine of ischium Upper border of greater

trochanter of femur

Sacral plexus L5; S1 Lateral rotator of thigh at hip joint

Gemellus

inferior

Ischial tuberosity Upper border of greater

trochanter of femur

Sacral plexus L5; S1 Lateral rotator of thigh at hip joint

Quadratus

femoris

Lateral border of

ischial tuberosity

Quadrate tubercle of femur Sacral plexus L5; S1 Lateral rotator of thigh at hip joint

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Nerves of the Gluteal Region

Sciatic Nerve• Is a branch of the sacral plexus (L4 and 5;

S1, 2, and 3), emerges from the pelvis through the lower part of the greater sciatic foramen.

• It is the largest nerve in the body and consists of the tibial and common peroneal nerves bound together with fascia.

• The sciatic nerve usually gives no branches in the gluteal region.

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Nerves of the Gluteal Region

Posterior Cutaneous Nerve of the ThighIs a branch of the sacral plexus, enters the gluteal region through the lower part of the greater sciatic foramen below the piriformis muscle.

Superior Gluteal NerveIs a branch of the sacral plexus, leaves the pelvis through the upper part of the greater sciatic foramen above the piriformis.

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Inferior Gluteal NerveIs a branch of the sacral plexus, leaves the pelvis through the lower part of the greater sciatic foramen below the piriformis.

Nerve to the Quadratus FemorisA branch of the sacral plexus, leaves the pelvis through the lower part of the greater sciatic foramen. Ends by supplying the quadratusfemoris and the inferior gemellus.

Pudendal Nerve & the Nerve to the ObturatorInternusBranches of the sacral plexus, they leave the pelvis through the lower part of the greater sciatic foramen, below the piriformis

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Arteries of the Gluteal Region

• The major arteries that supply the gluteal region are the superior gluteal artery and the inferior gluteal artery which are branches from the internal iliac artery.

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Veins of the Gluteal Region

The superior and inferior gluteal veins that drains into the internal iliac veins