Podcast
Questions and Answers
Which arteries contribute to the extracapsular arterial ring at the base of the femoral neck?
Which arteries contribute to the extracapsular arterial ring at the base of the femoral neck?
What is the approximate degree of pelvic rotation that occurs during gait?
What is the approximate degree of pelvic rotation that occurs during gait?
What occurs during pelvic list in the context of gait?
What occurs during pelvic list in the context of gait?
Which artery is primarily responsible for supplying the artery of ligamentum teres?
Which artery is primarily responsible for supplying the artery of ligamentum teres?
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Which of the following functions is primarily associated with the gluteal muscles?
Which of the following functions is primarily associated with the gluteal muscles?
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Which nerve primarily innervates the posterior thigh, lower leg, and foot?
Which nerve primarily innervates the posterior thigh, lower leg, and foot?
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Which of the following nerves is NOT implicated in supplying the hip joint?
Which of the following nerves is NOT implicated in supplying the hip joint?
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What is the maximum range of flexion at the hip joint?
What is the maximum range of flexion at the hip joint?
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Which ligament provides strong support at the posterior aspect of the hip joint?
Which ligament provides strong support at the posterior aspect of the hip joint?
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Which structure allows passage of the obturator nerve and vessels?
Which structure allows passage of the obturator nerve and vessels?
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Which vascular structure is NOT a branch of the internal iliac artery?
Which vascular structure is NOT a branch of the internal iliac artery?
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What is the approximate range of external rotation at the hip joint?
What is the approximate range of external rotation at the hip joint?
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What action do both the gluteus medius and gluteus minimus perform at the hip joint?
What action do both the gluteus medius and gluteus minimus perform at the hip joint?
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Which structure is primarily supplied by the posterior branch of the obturator artery?
Which structure is primarily supplied by the posterior branch of the obturator artery?
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Which muscle is primarily responsible for hip extension and external rotation?
Which muscle is primarily responsible for hip extension and external rotation?
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The Trendelenburg sign indicates weakness in which muscles?
The Trendelenburg sign indicates weakness in which muscles?
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What is the minimum required range of abduction at the hip joint for optimal gait?
What is the minimum required range of abduction at the hip joint for optimal gait?
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Which of the following is NOT an antagonist to the hip flexors?
Which of the following is NOT an antagonist to the hip flexors?
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Which plane of motion includes internal and external rotation of the hip?
Which plane of motion includes internal and external rotation of the hip?
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What is the insertion point for the piriformis muscle?
What is the insertion point for the piriformis muscle?
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Which group of muscles is primarily responsible for external rotation of the hip?
Which group of muscles is primarily responsible for external rotation of the hip?
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Which muscle is innervated by the Quadratus femoris nerve?
Which muscle is innervated by the Quadratus femoris nerve?
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What is the primary action of the Obturator externus muscle?
What is the primary action of the Obturator externus muscle?
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Which nerves are primarily involved in the innervation of the gluteus medius muscle?
Which nerves are primarily involved in the innervation of the gluteus medius muscle?
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Which ligaments are primarily responsible for the stability of the sacroiliac joint?
Which ligaments are primarily responsible for the stability of the sacroiliac joint?
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Which muscles assist the obturator internus in its function?
Which muscles assist the obturator internus in its function?
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Which joint connects the right and left pubic bones?
Which joint connects the right and left pubic bones?
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What type of joint is the pubic symphysis classified as?
What type of joint is the pubic symphysis classified as?
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Which of the following nerves does NOT innervate Gluteus maximus?
Which of the following nerves does NOT innervate Gluteus maximus?
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What is the role of the sacroiliac joint in terms of motion?
What is the role of the sacroiliac joint in terms of motion?
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Which origin is associated with the Inferior gemellus?
Which origin is associated with the Inferior gemellus?
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What is the main role of the sensory nerves arising from the lumbar and sacral plexi in the gluteal region?
What is the main role of the sensory nerves arising from the lumbar and sacral plexi in the gluteal region?
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Which ligament connects the sacrum to the ischial spine?
Which ligament connects the sacrum to the ischial spine?
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Which of the following pairs of muscles is innervated by the Obturator nerve?
Which of the following pairs of muscles is innervated by the Obturator nerve?
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Which of the following structures are considered foramina within the gluteal region?
Which of the following structures are considered foramina within the gluteal region?
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Which ligaments contribute to the stabilization of the hip joint's articulation with the pelvis?
Which ligaments contribute to the stabilization of the hip joint's articulation with the pelvis?
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What is the primary function of the gluteal muscles?
What is the primary function of the gluteal muscles?
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Study Notes
Gluteal Region: Lecture Notes
- The gluteal region includes bones, joints, attachments, foramina, hip joint movements, muscles (gluteals, external rotators), nerves, vascular structures, and clinical significance.
Outline
- A revision of prior learning is included.
- Details about the bones, joints, attachments, and foramina of the gluteal region are provided.
- Hip joint motion is discussed in detail.
- Detailed information on gluteal and external rotator muscles is offered.
- Information is provided on the nerves and vascular structures in the area.
- An exploration into the clinical significance of the region and a summary are outlined.
Questions
- Students are asked to name the thigh's medial fascial compartment muscles.
- Students are asked to determine the main motion associated with these muscles.
- Students are asked to identify the main artery supplying the region.
- Students are asked to identify the main nerve supplying the region.
Aims
- Study the bones, joints, attachments and foramina of the region.
- Explore the motions of the hip joint.
- Understand the arrangement and function of the gluteal and external rotator muscles.
- Investigate nerve and blood supply to gluteal and external rotator muscles and hip joint.
- Introduce the clinical importance of the region.
Bones
- Lumbar spine, sacrum
- Ilium, ischium, pubis, and femur are parts of the pelvis
- Sacroiliac joint and hip joint are visible.
- Coccyx is part of pelvis.
Sacroiliac Joint
- Articulation of the sacrum to the pelvis is described.
- Limited motion in the joint exists.
- It's a synovial and cartilaginous structure.
- Ligaments hold the joint together. - The anterior sacroiliac ligament is relatively weak and thin. - The posterior sacroiliac ligament is stronger and is further divided into long and short ligaments. - The interosseous sacroiliac ligament is the strongest ligament.
- Sacrospinous ligament stabilizes the joint.
- Sacrotuberous ligament stabilizes the joint.
Pubic Symphysis
- Articulation between right and left pubic bones.
- Fibrocartilage joint (synchondrosis).
- Supported by ligaments.
- Obturator, greater sciatic, lesser sciatic are foramina present.
Foramina
- Obturator foramen is covered by the obturator membrane.
- Obturator foramen is the origin of obturator internus and externus muscles.
- Obturator foramen allows nerves and vessels to pass through it.
- Greater sciatic foramen: Formed by greater sciatic notch and sacrotuberous/spinous ligaments.
- Greater sciatic foramen: Allows structures to pass from pelvis to gluteal region.
- Lesser sciatic foramen: Formed by lesser sciatic notch and sacrotuberous/spinous ligaments.
- Lesser sciatic foramen: Allows structures to pass from gluteal region to perineum.
Structures passing through sciatic foramina
- Structures that pass through the greater sciatic foramen:
- Superior gluteal vessels and nerve
- Inferior gluteal vessels and nerve
- Sciatic nerve
- Perforating and posterior femoral cutaneous nerves
- Nerve to quadratus femoris
- Pudendal nerve and internal pudendal vessels
- Structures that pass through the lesser sciatic foramen:
- Tendon of obturator internus
- Nerve to obturator internus
- Internal pudendal vessels
- Pudendal nerve
Hip Joint Motion
- Sagittal plane: Extension/flexion
- Frontal plane: Abduction/adduction
- Transverse plane: Internal/external rotation
- Circumduction: Movement in all three planes.
Hip Problems
- Fracture/dislocations and consequences
- Osteoarthritis (OA)
- Developmental dysplasia of the hip (DDH)
- Bursitis
Muscles
- Two main groups: gluteals and external rotators.
Gluteus Maximus
- Origin: Posterior surface of ilium and sacrum, sacrotuberous ligament
- Insertion: Gluteal tuberosity of femur, iliotibial tract
- Action: Hip extension and external rotation. Stabilises pelvis and knee.
- Antagonists: Hip flexors
- Innervation: Inferior gluteal; L5, S1, S2
Gluteus Medius
- Origin: Ilium between anterior and posterior gluteal lines.
- Insertion: Lateral surface of greater trochanter
- Function: Abduction and internal rotation of the thigh.
- Antagonists: Adductors and external rotators
- Innervation: Superior gluteal, L4,L5, S1
Gluteus Minimus
- Origin: Ilium, between anterior and inferior gluteal lines
- Insertion: Anterior surface of greater trochanter
- Action: Abduction and internal rotation of thigh at hip
- Antagonists: Adductors, external rotators
- Nerve supply: Superior gluteal, L4, L5, S1
Trendelenburg Sign
- Gluteus medius and minimus are required to maintain stability of the pelvis during single-leg stance.
- Weakness manifests as pelvis sagging to the unsupported side.
- Caused by nerve damage (superior gluteal).
External Rotators
- Piriformis
- Gemellus
- Quadratus femoris
- Obturator internus
- Obturator externus
Piriformis
- Origin: Middle three parts of sacrum
- Insertion: Upper border of greater trochanter
- Action: Abduction and external rotation of thigh
- Antagonists: Adductors, internal rotators
- Innervation: Branches from L5, S1 and S2
Quadratus Femoris
- Origin: Upper and outer ischial tuberosity
- Insertion: Quadratus tubercle of the intertrochanteric crest
- Action: External rotation of hip and stabilization
- Antagonists: Internal rotators
- Innervation: L4-L5-S1
Obturator Internus
- Origin: Obturator membrane and surrounding bones
- Insertion: greater trochanter, above the intertrochanteric fossa
- Action: External rotation and stabilization of hip
- Antagonists: Internal rotators
- Nerve supply: L5, S1, S2.
Gemellus
- Origins: Superior and inferior ischial spine/tuberosities
- Insertion: with obturator internus
- Action: Assists obturator internus
- Antagonists: Internal rotators
- Nerve supply: Obturator internus and Quadratus femoris
Obturator Externus
- Origin: External surface of obturator membrane and ischiopubic ramus
- Insertion: Trochanteric fossa
- Action: External rotation of thigh
- Antagonists: Internal rotators
- Innervation: Obturator (L3, L4)
Nerves
- The nerves of the gluteal region originate from both the lumbar and sacral plexuses.
- Muscles of the region are often innervated by individual nerves rather than branches of larger nerves.
- Sensory (cutaneous) nerves arise from the lumbar and sacral plexuses.
Nerves 2 (Motor)
- Superior gluteal (L4,L5,S1): Gluteus medius, minimus, and tensor fasciae latae
- Inferior gluteal (L5,S1,S2): Gluteus maximus
- Obturator internus (L5,S1,S2): Obturator internus and gemellus superior
- Quadratus femoris (L4,L5,S1): Quadratus femoris, gemellus inferior
- Piriformis (S1,S2): Piriformis
- Obturator externus (L3, L4): Obturator externus
Nerves 3 (Motor)
- Superior gluteal
- Inferior gluteal
- Sciatic
- Piriformis
- Pudendal
Nerves 4 (Motor)
- Pudendal, supplies "naughty bits"
- Sciatic: Important, traverses the gluteal region but doesn't innervate gluteal muscles. (supplies posterior thigh, lower leg and foot).
Nerves 5 (Sensory)
- Subcostal
- Iliohypogastric
- Lumbar 1-3: Posterior rami, perforating cutaneous nerve
- Sacral posterior rami
Nerves 6 (Hip Joint)
- Hip joint supply: Femoral nerve, obturator nerve (and/or accessory obturator), nerve to quadratus femoris, superior gluteal nerve, sciatic.
Nerve 7 - Sciatic Nerve
- Detailed description of the sciatic nerve
Nerve 8 - More Sciatic Nerve
- Detailed description of various branches of the sciatic nerve
Nerve 9 - Sciatic Variations
- Percentage of variations in relation of the sciatic nerve to the piriformis muscle in 1510 extremities.
Nerve 10 - Injection Site
- Safe injection site for nerves in the gluteal region.
Vascular Structures
- Superior gluteal artery
- Inferior gluteal artery: Both branches of internal iliac artery, pass through greater sciatic foramen.
- Trochanteric anastomosis and cruciate anastomosis.
Vascular Structures 2
- superior and inferior gluteal arteries.
- internal pudendal artery
Vascular Structures 3 (Hip Joint)
- Head of femur--supplied by posterior branch of obturator artery (intracapsular) or medial circumflex femoral artery
- Remainder of hip joint--supplied by medial and lateral circumflex femoral arteries (extracapsular).
Vascular Structures 4 (Hip Joint)
- Arterial supply to hip joint from obturator and circumflex femoral arteries
Pelvic Motion During Gait
- Pelvic rotation. occurs across the transverse plane
- Pelvic tilt. occurs in the frontal plane.
Summary
- Students should be able to categorize and name the gluteal and external rotator muscles and understand their functions.
- Identify the major nerves in the gluteal area, and understand what they innervate or the cutaneous areas that they supply.
- Know the major vascular structures and blood supply to the hip joint.
- Have a basic understanding of the clinical relevance of the area and how injuries can impact the region.
Look Forward
- Read and review the general details discussed
- Focus on muscle structures, locations, and functions
- Study vascular structures and nerves
- Prepare for the following week's lecture on the posterior thigh and knee.
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Description
Test your knowledge on the anatomy of the gluteal region, including its bones, joints, muscles, and vascular structures. This quiz covers both basic and advanced concepts related to hip joint movements and the clinical significance of the area. Prepare to identify key components such as nerves and arteries that supply the region.
