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GLUTEAL REGION

GLUTEAL REGION

Boundaries:

Superior = Iliac Crests

Inferior = Inferior Gluteal Folds

Lateral = Sides of the Thigh

Medial = Intergluteal Canal

MUSCLES

Gluteus maximusaction = extends & laterally

rotates thigh Nerve = Inferior gluteal nerve

Gluteus medius Gluteus minimus Tensor fasciae latae

Action: Abducts & medially rotate the thigh

Nerve: Superior Gluteal Nerve

MUSCLES

Piriformis*Obturator internus**Gemellus superior** Gemellus inferior***Quaratus femoris***

Common Action: Laterally rotates the thigh

Innervation: * S1 & S2 of Sacral Plexus ** Nerve to Obturator internus

*** Nerve to Quadratus femoris

NERVES - derived from the Lumbosacral Plexus (L4, L5, S1, S2, & S3)

SUPERIOR GLUTEAL NERVE (L4, L5 & S1)- emerges thru GSF above piriformis muscle- runs b/w g.medius & minimus w/ superior gluteal artery- supplies: G. medius, G. minimus, T. fasciae latae & Hip

joint

INFERIOR GLUTEAL NERVE (L5, S1 & S2)- emerges thru GSF below piriformis muscle- runs w/ inferior gluteal artery- supplies: Gluteus maximus

NERVES

SCIATIC NERVE (L4, L5, S1, S2, & S3)

- largest branch of LS plexus & largest nerve of the body

- emerges thru GSF below piriformis muscle

*NO BRANCHES IN THE GLUTEAL REGION

Branches: TIBIAL NERVE

COMMON PERONEAL NERVE

POSTERIOR FEMORAL CUTANEOUS NERVE (S1, S2 & S3)

- emerges thru GSF below piriformis muscle

- supplies skin of: buttocks, posterior thigh, popliteal fossa & external genitalia

NERVES

NERVE TO OBTURATOR INTERNUS (L5, S1 & S2)- emerges thru GSF below piriformis muscle- supplies: Gemellus superior & Obturator internus

NERVE TO QUADRATUS FEMORIS (L4, L5 & S1)- enters gluteal region thru GSF below piriformis muscle- supplies: Gemellus inferior & Quadratus femoris

PUDENDAL NERVE (S2, S3, & S4)- emerges thru GSF below piriformis muscle- no branch in gluteal region- supplies: Perineum

BLOOD VESSELS

SUPERIOR GLUTEAL ARTERY- largest branch of the Internal Iliac Artery- emerges thru GSF above piriformis muscle

Branches: Superficial Branch = Gluteus maximus Deep Branch = Gluteus medius & minimus

INFERIOR GLUTEAL ARTERY- from Internal Iliac Artery- emerges thru GSF below piriformis muscle- supplies: Gluteal & Hamstring Muscles & Hip Joint

BLOOD VESSELS

INTERNAL PUDENDAL ARTERY- emerges thru GSF below piriformis muscle- no branch in gluteal region- supplies: Perineum

GLUTEAL VEINS- usually double & accompany corresponding artery- drains into Internal iliac Veins- communicates with tributaries of Femoral Vein

(Alternate Pathway)

IMPORTANT ANATOMIC FEATURES

SACROTUBEROUS LIGAMENT- connects posterior iliac spine,

lower sacrum & coccyx to ischial tuberosity

- forms medial border of GSF & LSF

SACROSPINOUS LIGAMENT- connects posterior surface of

sacrum & coccyx to ischial spine- separates the GSF from the LSF

GREATER SCIATIC FORAMENLESSER SCIATIC FORAMEN

- formed by Sacrotuberous & Sacrospinous ligament- filled with muscles, nerves & blood vessels

GREATER SCIATIC FORAMEN transmits the ffg:- Piriformis - Internal Pudendal Artery- Sciatic Nerve - Posterior Femoral Cutaneous Nerve- Superior Gluteal N, A & V - Nerve to Obturator internus- Inferior Gluteal N, A & V- Nerve to Quadratus femoris- Pudendal Nerve

LESSER SCIATIC FORAMEN transmits the ffg:- Tendon of obturator internus- Nerve to obturator internus- Pudendal Nerve- Internal Pudendal Artery & Vein

HIP JOINT

- Synovial (Ball and Socket) joint b/w femoral head and acetabulum- Links the lower extremity to the pelvic girdle- most often disclocated posteriorly after a severe force to the knee

Movements: flexion, extension, abduction, adduction, medial & lateral rotation

Blood Supply: SGA, IGA, Medial & Lateral Femoral Circumflex Arteries

Innervation: Femoral & Obeturator Nerves

HIP JOINT

Anatomic Characteristics: LABRUM ACETABULARE

- fibrocatilagenous rim- deepens the acetabulum- forms the Transverse Acetabular Ligament (TAL)

FIBROUS CAPSULE- restricts free movement- encloses femoral head & neck- proximally attached to acetabulum & TAL- distally attached to greater trochanter,

intertrochanteric line & base of the neck

LIGAMENTS of THE HIP JOINT

ILIOFEMORAL LIGAMENT- strongest & most important ligament of hip joint- inverted Y reinforcing the fibrous capsule anteriorly- attachments: Proximal = ASIS Distal = Intertrochanteric Line- function: Resists Hyperextension & Medial Rotation of the Hip

ISCHIOFEMORAL LIGAMENT- supports the posterior part of Hip joint- thinnest hip joint ligament- attachments: Proximal = Ischium

Distal = Base of Femoral Neck- function: Resists Extension and Medial Rotation of the Hip

LIGAMENTS of THE HIP JOINT

PUBOFEMORAL LIGAMENT- support anterior & inferior part of Hip joint- attachments: Proximal = Pubis

Distal = Base of Femoral Neck- function: Resists excessive Abduction of the Hip

LIGAMENT OF THE FEMORAL HEAD (LIGAMENTUM TERES FEMORIS)

- attachments: fovea of femoral head to TAL & margins of the acetabular notch

- function: Resists Abduction of the Hip in children Transmits Artery to the Femoral Head

POSTERIOR THIGH COMPARTMENT

MUSCLES

HAMSTRING GROUPSEMITENDINOSUS*SEMIMEMBRANOSUS*BICEPS FEMORIS

Long Head*Short Head**

Functions:Extensors of the thighFlexors of the leg

Innervation:* TIBIAL NERVE (L5, S1 & S2)** COMMON FIBULAR (PERONEAL) NERVE (L5,S1 & S2)

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