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GLUTEAL REGION,

Gross Anatomyof the

M1 - Gross and Developmental Anatomy8:00 AM, October 29, 2008

Dr. Milton M. SholleyProfessor of Anatomy and Neurobiology

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Posterior view

Grant’s Atlas, 10th ed.Fig. 5.24, pp. 328

Lateral view

Grant’s Atlas, 10th ed.Fig. 5.23, pp. 327

Posterior view

Grant’s Atlas, 10th ed.Fig. 5.41, pp. 344

3Anterior view Posterior view

Anterior superioriliac spine

Iliac crest

Posterior superioriliac spine

Ischial tuberosity

Greater trochanterGreater trochanter

Gluteal tuberosity

Grant’s Atlas, 12th ed.Fig. 5.22A, p. 380

Grant’s Atlas, 12th ed.Fig. 5.22C, p. 381

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Posterior view Posterior viewPosterior view

Grant’s Atlas, 12th ed.Fig. 5.25A, p. 384

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Gluteal Region and Posterior Thigh

Grant’s Atlas, 12th ed.Fig. 5.25B, p. 384

Hamstrings

Grant’s Atlas, 12th ed.Fig. 5.25C, p. 385

Semimembranosus

SemitendinosusBiceps femoris,long head

Gluteus maximus

Iliotibial tract

Commonperoneal nerve

Gastrocnemius,lateral head

Tibial nerve

Gastrocnemius,medial head

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Lateral view Posterior view

Location and Attachments of Gluteus Maximus Muscle

Grant’s Atlas, 12th ed.Fig. 5.24B, p. 383

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Gluteal Muscles

Lateral views of gluteal region-right side

Gluteusmaximus

Gluteusmedius

Gluteusminimus

Nerve:Inferior gluteal

Nerve:Superior gluteal

Nerve:Superior gluteal

Grant’s Atlas, 12th ed.p. 386

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Layering of Gluteal Muscles

Lateral views of gluteal region-right side

Maximus Medius Minimus

Headof femur

Frontal view of gluteal region-right side

Min

Med

Max

Grant’s Atlas, 11th ed.p. 368

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Actions of Gluteal Muscles

Gluteus maximus-

Powerful hip extension(as in standing-up from a sitting position or climbing stairs)

Gluteus medius/minimus muscle complex-

Hip abduction (or the opposite action - lateral balance of pelvis)

Other actions like those of the deltoid muscle(the “deltoid of the hip”)

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Gluteus Gluteus Medius/MinimusMedius/Minimus Muscle ComplexMuscle Complex

Lateral views of gluteal region-right side

Gluteusmedius

Gluteusminimus

Paralysis of the Gluteus Medius/Minimus Muscle Complexcauses a

Trendelenburg's Sign

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Lateral view Anterior view

Iliotibial tract

Tensor fascialata muscle

Location and Attachments of Tensor Fascia Lata Muscle

Nerve:Superior gluteal

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The sacrotuberous and sacrospinous ligaments close offthe greater and lesser sciatic notches to form the

Greater and Lesser Sciatic Foramina

Posterior view

13Grant’s Atlas, 12th ed.Fig. 5.28C, pp. 391

Grant’s Atlas, 12th ed.Fig. 5.28A, p. 390

Short Rotator Muscles

Posterior views

Piriformis-”the key to the gluteal region”(Syllabus-Topic E, page 193)

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From:Hollinshead’s Text, 5th ed.Fig.18-18, p. 364

15Posterior views

Grant’s Atlas, 12th ed.Fig. 5.28A, p. 390

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Structures leaving thegreater sciatic foramen:Above piriformisSuperior gluteal n, a & v

Below piriformisInferior gluteal n, a & vSciatic nPosterior femoral cutaneous nN to sup. gemellus & obturator int.Internal pudendal a & vPudendal n

Structures entering thelesser sciatic foramen:

N to obturator internusInternal pudendal a & vPudendal n

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Structures leaving thegreater sciatic foramen:

Below piriformis, but deepto tendon of obturator int.and gemelliN to inf. gemellus & quadratus fem.

Structures entering thelesser sciatic foramen:

N to obturator internusInternal pudendal a & vPudendal n

18Grant’s Atlas, 12th ed.Fig. 5.28B, pp. 390

Sciatic nerveTwo divisions

Tibial-medial position

Common peroneal (fibular)-lateral position

1%

12%

What might happen to a person whohas this variation and hypertrophieshis/her piriformis because of repeatedlateral rotation? Say, for example, fromplaying a lot of racketball.

87%

Both divisions usuallypass inferior to piriformis.

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Don’t stick needles into the sciatic nerve!

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- A closed sac lined with synovial membrane and containing fluid, usually found in an area subjectto friction; e.g., where a tendon passes over a bone.

Bursa

Ischial bursa(Gluteus maximus slidesover ischial tuberosity)

Trochanteric bursa(Gluteus maximus slidesover greater trochanter)

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POSTERIOR THIGHand

POPLITEAL FOSSA

Gross Anatomyof the

M1 Gross and Developmental Anatomy9:00 AM, October 29, 2008

Dr. Milton M. SholleyProfessor of Anatomy and Neurobiology

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Compartmentalization of the Thigh

Syllabus page 179

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Hamstring Muscles

Posterior views

Medial Lateral

Biceps femorisSemitendinosus

Semimembranosus

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From:Hollinshead’s Text, 5th ed.Fig.18-18, p. 364

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Compartmental Innervationsand

Actions of Contained Muscles

Syllabus page 184

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27Grant’s Atlas, 12th ed.Fig. 5.21A&B, p. 379

Pes anserinus

Combined tendons of:

Medial view

Sartorius

Gracilis

Semitendinosus

Anterior view

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Lateral side

Dynamic Stabilizers of the Knee Joint

Iliotibial tract

Medial side

Pes anserinus

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Popliteal fossa

Medial Lateral

Biceps tendon

Commonperoneal n

Tibial nPopliteal v

Popliteal a

Semitendinosustendon

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Grant’s Atlas, 12th ed.Fig. 5.36B, p. 402

Cutaneous nerves arising in the popliteal fossa

Lateral sural cutaneous n

Peroneal communicating n

Medial sural cutaneous n

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Grant’s Atlas, 12th ed.Fig. 5.37, p. 403

Cutaneous nerves arising in the popliteal fossaHigh origin of sural nerve

Sural n

Peroneal communicating nMedial sural cutaneous n

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Major Segmental Innervationof

Muscles Crossing Lower Extremity Joints

JointMuscles crossing joint

AnteriorlyMuscles crossing joint

Posteriorly

Action Segments Action Segments

Hip: Flexion L2, L3 Extension L4, L5

Knee: Extension L3, L4 Flexion L5, S1

Ankle: Dorsiflexion L4, L5 Plantar flexion S1, S2

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Geniculate Anastomosis

Posterior views

Medial Lateral

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Cruciate Anastomosis(Posterior view)

The Anastomosis around the Hip(Anterior view)

LAT. MED.

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Femoral/Popliteal Artery Angiograms

Normal Bilateral occlusion of femorals