neurovascular supply of gluteal region

NEUROVASCULAR SUPPLY OF GLUTEAL REGION

MOHAMMED MUNEER University of Karbala

• Superior gluteal artery• Inferior gluteal artery• They are branches of the internal

iliac artery• They supply the gluteal region• Obturator artery is abranch of

the internal iliac artery • It passes through obturator

foramen• It supplies the medal side of the

upper thigh

Femoral Artery• It is the contiuation of

the external iliac artery at the mid inguinal point

• It descends in the femoral triangle

• Then, it continues in the adductor canal

• It reaches the adductor hiatus where it becomes the popliteal artery

• It supplies all structures in the thigh

Femoral Artery

In the femoral triangle, it gives the following branches:

3 superficial branchesSuperficial circumflex iliac arterySuperficial Epigastric arteryExternal pudendal artery 3 deep branchesDeep artery of the thighDeep external pudendal Descending genicular

Deep Artery of the Thigh

• It is the main artery of the thigh• It gives the following branches• Medial circumflex femoral artery• Lateral circumflex femoral artery

which gives a descending branch• Perforating arteries

Arteries of Gluteal Region

Superior gluteal-from internal iliac posterior division above piriformis

Inferior gluteal-from internal iliac anterior division-below piriformis

Trochanteric anastomosis- main supply to head of femur. Retinacular nutrient arteries pass along neck of femur to head.

Formation 1. Superior gluteal A2. Inferior gluteal A3. Medial Circumflex A4. Lateral circumflex A

Cruciate anastomosis5. Inferior gluteal6. MCF and LCF7. 1st perforating branch of PFA

Superior gluteal artery• Branch from posterior division of the internal iliac

artery• Leaves the pelvis by passing through the greater

sciatic foramen above the piriformis muscle

INFERIOR GLUTEAL ARTERYArises from anterior division of Internal iliac artery.

• Leaves the pelvis by passing through the greater sciatic foramen below the piriformis muscle

Trochanteric Anastomosis Is the main supply to the head &

neck of femur Provides a connection between

internal iliac and femoral arteries Lies near the trochanteric fossa,

branches run along the femoral neck beneath the reticular fibers of the capsule

Formed by: Descending branches of

superior and inferior gluteal arteries &

Ascending branches of lateral and medial circumflex arteries

Posterior view

Arterial supply to Femoral head

• Medial & lateral femoral circumflex arteries

• Superior and inferior gluteal arteries

• Post. obdurator artery via artery of femoral ligament

TROCHANTERIC ANASTOMOSIS

Cruciate Anastomosis Lies at the level of lesser

trochanter Provides a connection between

internal iliac and femoral arteries

Formed by: Descending branch of

inferior gluteal artery Transverse branches of

medial and lateral circumflex arteries &

Ascending branch of first perforating artery

•The sacral plexus supplies innervation to the pelvic muscles, gluteal muscles, and perineal muscles. It also forms the sciatic nerve.

Sacral plexus Formed by the 4th & 5th lumbar ventral rami (lumbosacral trunk) and S1234

• Forms on the ventral surface of the piriformis muscle

Sciatic nerve (L4, L5, SI, S2, S3) • Is the largest branch of the sacral plexus and the largest nerve in body

• Consists of two separate nerves, the common peroneal nerve and the tibial nerve• Leaves the pelvis through the greater sciatic foramen below the piriformis muscle

Superior gluteal nerve (L4, L5, S1) • Leaves the pelvis through the greater sciatic foramen abovethe piriformis muscle with the superior gluteal artery and vein

• In the gluteal region supplies the gluteus medius, the gluteus minimus, the tensor fasciae latae, and the hip joint

Inferior gluteal nerve (L5, S1, S2)• Leaves the pelvis through the greater sciatic foramen below the piriformis muscle with the inferior gluteal artery and vein

• In the gluteal region supplies the gluteus maximus muscle

Posterior femorai cutaneous nerve (SI, S2, S3)

• Leaves the pelvis through the greater sciatic foramen inferior to the piriformis

• In the gluteal region descends on the posterior surface of the sciatic nerve

• Supplies the skin of the buttocks, posterior thigh, popliteal fossa, and external genitalia

Nerve to the obturator internus (L5, S1, S2)

• Leaves the pelvis through the greater sciatic foramen below the piriformis muscle • In the gluteal region descends on the superior gemellus muscle to pass below the ischial spine and enter the lesser sciatic foramen

• Supplies the superior gemellus and obturator internus muscles

Nerve to the quadratus femoris (L4, L5, SI) • Leaves the pelvis through the greater sciatic foramen below the piriformis muscle and deep to the sciatic nerve

• In the gluteal region runs anterior to the superior and inferior gemellus and obturator internus muscles

• Supplies the inferior gemellus and quadratus femoris muscles

Pudendal nerve (S2, S3, S4) • Leaves the pelvis through the greater sciatic foramen inferior to the piriformis muscle along with the internal pudendal artery and vein

• In the gluteal region descends posterior to the ischial spine and enters the lesser sciatic foramen

• Is distributed to the perineum and has no branches in the gluteal region