University:
Kentucky State University
Course:
BIO 301 | Human Anatomy
Academic year:

2024
Views:

125

Pages:

48
Author:

slypery5hy

Gluteal region Iliohypogastric nerve Subcostal nerve Skin of the Buttock (Gluteal region) T12 Subcostal nerve L1 L1 Ilio-hypogastric nerve Ilio-inguinal nerve L2 L3 L4 L5 Fascia of the Buttock (Gluteal region) 1-Superficial fascia; is thick especially in women. It contributes to the prominence of the buttock. 2-Deep fascia; continuous with the deep fascia of the thigh (fascia lata). Gluteus Maximus Posterior view Anterior gluteal line Inferior gluteal line Posterior gluteal line Greater sciatic foramen Lessor sciatic foramen Gluteus maximus Gluteus maximus Origin: 1-Ilium (area behind the posterior gluteal line) 2-Back of sacrum and coccyx Posterior view 3-Back of sacrotuberous ligament Insertion: 1-The superficial three –fourths are inserted into the iliotibial tract 2-The deep one fourth is inserted into the gluteal tuberosity of femur Iliotibial tract Action: 1-Extends thigh, some lateral rotation (Main extensor of hip joint) 2-Plays an important role in climbing upstairs and cycling Powerful extensor of flexed femur at hip joint 3-Supports the extended knee joint through iliotibial tract Nerve supply: Inferior gluteal nerve (L5;S1,2) Facts about Gluteus Maximus Gluteus maximus gait Lurching gait (gluteus maximus) characterized by posterior leaning of the trunk at heel strike in order to keep the hip extended during stance phase Gluteus medius Gluteus minimus Origin: Ilium ? Insertion: Greater trochanter of femur Action: 1-Abduction (main abductors of the hip joint) 2-Medial rotation (anterior fibers) 3-Both muscle contract reflexly on each side alternatively during walking to prevent tilting of the pelvis to the unsupported side Nerve supply: Superior gluteal nerve (L4, L5, S1) Medius Minimus Posterior view Stance Swing During walking, the glutei medius and minimus of the stance limb tilt the pelvis so that the swinging limb can clear the ground During walking, the glutei medius and minimus of the stance limb tilt the pelvis so that the swinging limb can clear the ground When standing on one leg, the abductors of the hip on this side (gluteus medius and minimus and tensor fascia lata) maintain fixation at the hip joint If, however, there is any defect in these muscles or lever mechanism of the hip joint, the weight of the body in these circumstances forces the pelvis to tilt downwards on the opposite side. Trendelenburg’s test Left Right The normal pelvis (right) tilts downwards Injury to the superior gluteal nerve On one side causes Lurching gait Both sides Waddling gait Positive Trendelenburg’s test Note Other conditions also my cause lurching and waddling gates such as: Clinical Notes During the stance phase, the weakened abductor muscles allow the pelvis to tilt down on the opposite side. The pelvis sags on the opposite side of the lesioned superior gluteal nerve. Lurching gait (gluteus medius and minimus) To compensate, the trunk lurches to the weakened side to attempt to maintain a level pelvis throughout the gait cycle Tensor fascia lata Tensor fascia lata Origin: Iliac crest Insertion: Iliotibial tract Action: Assist gluteus maximus in extending the knee joint Nerve supply: Superior gluteal nerve Iliotibial tract The two muscles are inserted on iliotibial tract Gluteus maximus Tensor fascia latae Tense the iliotibial tract and help extend the knee This reduces the amount of muscle energy required to keep the joint extended when standing Iliotibial tract Short Lateral rotator muscles 1- Piriformis 2- Obturator internus 3- Superior gemellus 4- Inferior gemellus 5-Quadratus femoris 6- Obturator externus Muscle Origin Insertion Nerve supply Piriformis Anterior surface of sacrum Upper border of greater trochanter (medial side) First and second sacral nerves Obturator internus Inner surface of obturator membrane and surrounding bone Medial side of greater trochanter Nerve to obturator internus (L5 S1) Sacral plexus Superior gemellus Ischial spine Medial side of greater trochanter Nerve to obturator internus (L5 S1) Sacral plexus Inferior gemellus Ischial tuberosity (Upper aspect) Medial side of greater trochanter Nerve to quadratus femoris (L5 S1) Sacral plexus Quadratus femoris Lateral border of ischial tuberosity Intertrochanteric crest (quadrate tubercle) Nerve to quadratus femoris (L5 S1) Sacral plexus Piriformis Superior gemellus Obturator internus Inferior gemellus Quadratus femoris Posterior view Gluteus Medius Gluteus Minimus Piriformis Superior gemellus Obturator internus Inferior gemellus Quadratus femoris Posterior view Obturator internus Posterior view Obturator externus Posterior view Origin: Outer surface of obturator membrane and surrounding bone Insertion: Medial surface of greater trochanter Nerve supply: Obturator nerve Action: Laterally rotates thigh at hip joint Obturator membrane Structures passing through the greater sciatic foramen: o Piriformis: fills the foramen almost completely leaving some structures to pass either above or below it. Structures passing above Piriformis muscle: o Superior gluteal nerve and vessels Structures passing below Piriformis muscle: o Inferior gluteal nerve and vessels o Sciatic nerve o Posterior cutaneous nerve of the thigh o Nerve to quadratus femoris o Pudendal nerve o Internal pudendal vessels o Nerve to obturator internus Structures passing through the lesser sciatic foramen: o Tendon of obturator internus o Nerve to obturator internus o Pudendal nerve o Internal pudendal vessels Piriformis passes through the greater sciatic foramen. Piriformis fills the greater sciatic foramen almost completely leaving some structures to pass either above or below it. Obturator internus passes through the lesser sciatic foramen. Posterior view Superior gluteal vessels and nerve Piriformis Inferior gluteal vessels and nerve Sciatic nerve Posterior cutaneous nerve of the thigh Internal pudendal vessels and pudendal nerve Obturator internus and nerve to obturator internus Posterior view Internal pudendal vessels and pudendal nerve Obturator internus and nerve to obturator internus Structures passing through the lesser sciatic foramen: Superior Gluteal Nerve (L4, L5, S1)  A branch of the sacral plexus  Leaves the pelvis through the greater sciatic foramen above the piriformis  Supplies the gluteus medius, minimus, tensor fascia lata Inferior Gluteal Nerve (L5, S1, S2)  A branch of the sacral plexus, leaves the pelvis through the greater sciatic foramen below the piriformis  Supplies the gluteus maximus Arteries of the Gluteal Region 1-Superior Gluteal Artery  A branch from the internal iliac artery  Enters the gluteal region through the greater sciatic foramen above the piriformis 2-Inferior Gluteal Artery  A branch of the internal iliac artery  Enters the gluteal region through the greater sciatic foramen below the piriformis Note Superior gluteal artery Inferior gluteal artery Obturator artery (from the internal iliac artery) Medial femoral circumflex artery Lateral femoral circumflex artery (From Profunda femoris- femoral artery- External iliac artery) Provides a connection between the internal iliac and the external iliac arteries Supply the hip joint The muscles of the gluteal region are acting on the hip joint as different functional groups Gluteus maximus Acts as the main extensor of the hip joint Gluteus medius and minimus Act as the main abductors of the hip joint while their anterior fibers act as medial rotators on the hip joint Short Lateral rotator muscles Act as lateral rotators on the hip joint The muscles of the gluteal region, therefore, extend, abduct and rotate the hip joint medially and laterally Leaving adduction and flexion to other groups of muscles, which ? Why? Muscles of the Anterior and medial compartments of the thigh Intramuscular (IM) injection Clinical Notes The great thickness of gluteus maximus muscle makes it ideal for intramuscular injections. To avoid injury to the underlying sciatic nerve, the injection should be given well forward on The upper outer quadrant of the buttock However, the upper lateral quadrant, most likely to be made by the Gluteus medius muscle rather than the gluteus maximus muscle. The gluteus maximus covers the posterior part only of the Gluteus medius while the anterior part (which makes the upper lateral quadrant) is covered by skin and fascia only Therefore, the intramuscular injection will be injected into the gluteus medius muscle rather than gluteus maximus muscle A better surface marking for the safe area of buttock injections can be defined as that area which lies under the outstretched hand when the thumb and thenar eminence are placed along the iliac crest with the tip of the thumb touching the ASIS STRUCTURES UNDER THE COVER OF GLUTEUS MAXIMUS MUSCLE Bony structures: Ischial tuberosity and bursa Greater trochanter and bursa Muscles: Gluteus medius and minimus Short lateral rotators Origin of hamstring muscles Vessels: Superior gluteal Inferior gluteal Internal pudendal Ligaments: Sacrospinous Sacrotuberous Nerves: Superior gluteal nerve Inferior gluteal nerve Sciatic nerve Posterior cutanous nerve of thigh Pudendal nerve Nerve to obturator internus Nerve to quadratus femoris Sacrospinous ligament Sacrotuberous ligament Bursa Bursa Greater trochanter Ischial tuberosity

Gluteal Region

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