1Kaan Yücel M.D., Ph.D. 25.April.2014 Friday

GLUTEAL REGION

IN 10 QUESTIONS

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1. What is gluteal region?

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(G. gloutos, buttocks) transitional region between trunk & lower limbs

Anterior superior iliac spine

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2. How are the muscles of the gluteal region organized?

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Deeplateral rotators of the femur @ hip joint piriformis, obturator internus, gemellus superior, gemellus inferior, and quadratus femoris

Superficialabduct and extend the hip gluteus minimus, gluteus medius, and gluteus maximus

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Gluteus maximusPowerful extensor of (especially) flexed femur at hip joint; lateral stabilizer of hip joint and knee joint; laterally rotates and abducts thigh; steadies thigh and assists in rising from sitting position.

Gluteus medius et minimusAbduct and medially rotate thigh; keep pelvis level when ipsilateral limb is weight-bearing and advance opposite (unsupported) side during its swing phase

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Gluteus mediusparalysis

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3...deep muscles of the gluteal region?

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PiriformisAnterior surface of sacrumSacrotuberous ligament

Superior border of greater trochanter of femur

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Superior gemellus-Obturator internus-Inferior gemellus• Ischial spine• Pelvic surface of obturator membrane and surrounding bones• Ischial tuberosity

Medial surface of greater trochanter (trochanteric fossa) of femur

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Quadratus femoris Ischial tuberosity

Quadrate tubercle on intertrochanteric crest of femur and area inferior to it

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4...superficial muscles in the gluteal region?

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Ilium posterior to posterior gluteal line; dorsal surface of sacrum and coccyx; sacrotuberous ligament

Iliotibial tract & gluteal tuberosity of femur

External surface of ilium between anterior and posterior gluteal lines

Lateral surface of greater trochanter of femur

External surface of ilium between anterior and inferior gluteal lines Anterior surface of

greater trochanter of femur

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5...functions of the gluteal region muscles?

. Muscles in the gluteal region mainly abduct, extend, and laterally rotate the femur relative to the pelvic bone.

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6....innervation of the gluteal region muscles?

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Superior gluteal nerveGluteus minimus & mediusTensor fascia latae

Inferior gluteal nerveGluteus maximus

Nerve to the quadratus femorisQuadratus femorisGemellus inferior Nerve to the obturator internusObturator internusGemellus superior

Nerve to the piriformisPiriformis

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GLUTEAL

BURSAEBetween gluteus maximus & greater trochanterPresent @ birth

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7....nerves of the gluteal region?

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1. Superior gluteal nerve2. Inferior gluteal nerve3. Sciatic nerve4. Nerve to the quadratus femoris5. Nerve to the obturator internus6. Posterior cutaneous nerve of the thigh7. Pudendal nerve

greater sciatic foramen

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Superior & inferior gluteal nerves

* Above the piriformis

tensor fasciae latae

Posterior to

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Sciatic nerve

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Superficial musclesDeep muscles

lies just deep to gluteus maximus midpoint between ischial tuberosity&greater trochanter

Enters thigh

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Nerve to Quadratus Femoris

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Inferior to piriformis

Deep to sciatic nerve

* anterior to the plane of the deep muscles

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Nerve to Obturator Internus

. between posterior cutaneous nerve of thigh &pudendal nerve

+ GS

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Posterior Cutaneous Nerve of Thigh

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Medial to sciatic nerveSkin over the gluteal fold

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Pudendal nerve

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Sensory Innervation of the Gluteal RegionNerve Origin

(Contributing spinal nerves)

Course Distrubition

Superior clunial nerves

L1-L3 posterior rami

Penetrate thoracodorsal fascia; course laterally and inferiorly in subcutaneous tissue

Skin overlying superior and central parts of buttock

Medial clunial nerves

S1-S3 posterior rami

Emerge from dorsal sacral foramina; directly enter overlying subcutaneous tissue

Skin of medial buttock and intergluteal cleft

Inferior clunial nerves

Posterior cutaneous nerve of thigh (S2-S3)

Arise deep to gluteus maximus; emerge from beneath inferior border of muscle

Skin of inferior buttock (overlying gluteal fold)

Subcostal T12 anterior ramus Courses along inferior border of 12th rib; lateral cutaneous branch descends over iliac crest

Lateral cutaneous branch supplies skin of hip region inferior to anterior part of iliac crest and anterior to greater trochanter

Iliohypogastric Lumbar plexus (L1; occasionally T12)

Parallels iliac crest; divides into lateral and anterior cutaneous branches

Lateral cutaneous branch supplies superolateral quadrant of buttock

Lateral cutaneous nerve of thigh skin overlying the lower lateral quadrant of the buttock.Perforating cutaneous nerve skin over the medial aspect of the gluteus maximus.

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8...arteries in the gluteal region?

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9...veins in the gluteal region?

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Internal iliac veins

Femoral vein

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10...lymphatics of the gluteal region?

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Lymph from deep tissuesuperior & inferior gluteal lymph nodes

internal,external,common iliac lymph nodes

lateral lumbar (aortic/caval) lymph nodes

Lymph from superficial tissuesuperficial inguinal lymph nodes

external iliac lymph nodes

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