658855 Gluteal Region

GLUTEAL REGION

GLUTEAL REGION

Boundaries: Superior = Iliac Crests Inferior = Inferior Gluteal Folds Lateral = Sides of the Thigh Medial = Intergluteal Canal

MUSCLES

Gluteus maximus action = 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 FORAMEN LESSER SCIATIC FORAMEN - formed by Sacrotuberous & Sacrospinous ligament - filled with muscles, nerves & blood vessels GREATER SCIATIC FORAMEN - Piriformis - Sciatic Nerve - Superior Gluteal N, A & V - Inferior Gluteal N, A & V - Pudendal Nerve

transmits the ffg: - Internal Pudendal Artery - Posterior Femoral Cutaneous Nerve - Nerve to Obturator internus - Nerve to Quadratus femoris

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, base of the neck

intertrochanteric

line &

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 GROUP SEMITENDINOSUS* SEMIMEMBRANOSUS* BICEPS FEMORIS Long Head* Short Head** Functions: Extensors of the thigh Flexors of the leg Innervation: * TIBIAL NERVE (L5, S1 & S2) ** COMMON FIBULAR (PERONEAL) NERVE (L5,S1 & S2)

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