658855 gluteal-region
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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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