Podcast
Questions and Answers
What are the bony landmarks in the gluteal region?
What are the bony landmarks in the gluteal region?
Which of the following is TRUE about the muscles of the gluteal region?
Which of the following is TRUE about the muscles of the gluteal region?
Which of the following is NOT a lateral rotator muscle?
Which of the following is NOT a lateral rotator muscle?
Which of the following is a known complication that can happen with an injection in the gluteal region?
Which of the following is a known complication that can happen with an injection in the gluteal region?
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Which of the following nerves innervates the gluteus medius and gluteus minimus?
Which of the following nerves innervates the gluteus medius and gluteus minimus?
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What is the clinical sign that can indicate weakness in the hip abductors?
What is the clinical sign that can indicate weakness in the hip abductors?
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What is the condition called when the femoral neck is fractured?
What is the condition called when the femoral neck is fractured?
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Which of the following is a condition that affects the hip joint?
Which of the following is a condition that affects the hip joint?
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Match the following structures with their appropriate location:
Match the following structures with their appropriate location:
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What is the primary blood supply to the head of the femur in adults?
What is the primary blood supply to the head of the femur in adults?
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Which of the following accurately describes the function of the superior gluteal artery?
Which of the following accurately describes the function of the superior gluteal artery?
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Which of the following nerves exits the pelvis superior to the piriformis muscle?
Which of the following nerves exits the pelvis superior to the piriformis muscle?
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What is the function of the piriformis muscle?
What is the function of the piriformis muscle?
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The common fibular portion of the sciatic nerve may pass through or over the piriformis muscle.
The common fibular portion of the sciatic nerve may pass through or over the piriformis muscle.
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Which of the following nerves supplies the muscles of the posterior thigh?
Which of the following nerves supplies the muscles of the posterior thigh?
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Which of the following is a dermatome?
Which of the following is a dermatome?
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The gluteal region receives lymphatic drainage from both deep and superficial tissues.
The gluteal region receives lymphatic drainage from both deep and superficial tissues.
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Where do the deep tissues of the gluteal region drain?
Where do the deep tissues of the gluteal region drain?
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The superficial tissues of the gluteal region drain to the superficial inguinal lymph nodes.
The superficial tissues of the gluteal region drain to the superficial inguinal lymph nodes.
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According to the practice question, which muscle is most likely responsible for the loss of function in hip extension?
According to the practice question, which muscle is most likely responsible for the loss of function in hip extension?
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The ______ nerve exits the pelvis inferior to the piriformis muscle.
The ______ nerve exits the pelvis inferior to the piriformis muscle.
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The superior gluteal nerve innervates the gluteus maximus muscle.
The superior gluteal nerve innervates the gluteus maximus muscle.
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The gluteal region is supplied by which two major arteries?
The gluteal region is supplied by which two major arteries?
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The superior gluteal artery exits the pelvis superior to the piriformis muscle.
The superior gluteal artery exits the pelvis superior to the piriformis muscle.
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The inferior gluteal artery exits the pelvis inferior to the piriformis muscle.
The inferior gluteal artery exits the pelvis inferior to the piriformis muscle.
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What is the primary function of the gluteus maximus muscle?
What is the primary function of the gluteus maximus muscle?
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Which nerve is responsible for innervating the gluteus medius and minimus?
Which nerve is responsible for innervating the gluteus medius and minimus?
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Which muscle is primarily contained within the iliotibial band?
Which muscle is primarily contained within the iliotibial band?
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Which structure lies over the greater trochanter and is deep to the iliotibial band?
Which structure lies over the greater trochanter and is deep to the iliotibial band?
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Which area is considered the safest zone for intramuscular injections in the gluteal region?
Which area is considered the safest zone for intramuscular injections in the gluteal region?
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What is the primary action of the tensor fasciae latae muscle?
What is the primary action of the tensor fasciae latae muscle?
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Which of the following is true about the gluteal region's innervation?
Which of the following is true about the gluteal region's innervation?
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Which of the following muscles inserts on the lateral tibia?
Which of the following muscles inserts on the lateral tibia?
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Which statement is true regarding the path of the sciatic nerve?
Which statement is true regarding the path of the sciatic nerve?
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What percentage of the common fibular portion of the sciatic nerve may pass through or over the piriformis muscle?
What percentage of the common fibular portion of the sciatic nerve may pass through or over the piriformis muscle?
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Which nerves innervate the obturator internus muscle?
Which nerves innervate the obturator internus muscle?
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What is the main reason for identifying the safe zone for intramuscular injections in the gluteal region?
What is the main reason for identifying the safe zone for intramuscular injections in the gluteal region?
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Which muscle is NOT typically associated with the gluteal region based on the mentioned innervation?
Which muscle is NOT typically associated with the gluteal region based on the mentioned innervation?
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Which nerve is responsible for sensory innervation over the inferior portion of the buttock?
Which nerve is responsible for sensory innervation over the inferior portion of the buttock?
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What is the primary function of the inferior gluteal artery?
What is the primary function of the inferior gluteal artery?
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Which statement correctly describes the entry point of the pudendal nerve into the ischio-anal fossa?
Which statement correctly describes the entry point of the pudendal nerve into the ischio-anal fossa?
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Which structure joins the sacral plexus to form the lumbosacral plexus?
Which structure joins the sacral plexus to form the lumbosacral plexus?
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What is the role of the superior gluteal nerve?
What is the role of the superior gluteal nerve?
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Which condition is associated with damage to the inferior gluteal nerve?
Which condition is associated with damage to the inferior gluteal nerve?
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Which of the following describes a safe zone for intramuscular injections in the gluteal region?
Which of the following describes a safe zone for intramuscular injections in the gluteal region?
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Which muscle is NOT involved in lateral rotation of the hip?
Which muscle is NOT involved in lateral rotation of the hip?
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What is the nerve level associated with the inferior gluteal nerve?
What is the nerve level associated with the inferior gluteal nerve?
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Which of the following muscles does the superior gluteal nerve NOT innervate?
Which of the following muscles does the superior gluteal nerve NOT innervate?
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The lumbosacral plexus is formed by the combination of which two parts?
The lumbosacral plexus is formed by the combination of which two parts?
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Study Notes
Notice and Agreement
- Class recordings are for student use only at LMU DeBusk College of Osteopathic Medicine.
- Students agree to the terms and conditions set by the faculty regarding use of recordings.
- Students acknowledging use of recordings agree to the faculty’s intellectual property rights in recorded lectures and class materials, and that distribution of recordings is a violation.
- Students acknowledge the privacy rights of their fellow students and that distribution or uploading of recordings to unauthorized individuals is a violation.
- The exact course name, lecture number, and lecture title must be used as listed on the LMU-DCOM website for faculty.
Hip Joint; Gluteal Region
- The lecture covers hip joint and gluteal regions.
- Anatomical structures of hip joint are studied (bony and soft tissue structures).
- Radiographic images of hip are examined.
- Functional deficits in lower limb due to hip injuries and pathologies are considered.
- Important gluteal anatomical landmarks are identified.
- The attachments, nerve supply, and action of gluteal muscles are discussed.
- The spinal makeup, course, and relationships of named nerves and blood vessels in the gluteal region are described.
Learning Objectives
- Students will identify bony and soft tissue structures of the hip joint.
- Students will identify bony structures in radiographic hip images.
- Students will determine functional deficits in the lower limbs due to hip injuries or pathologies.
- Students will identify gluteal bony landmarks.
- Students will name, identify, and describe attachments, nerve supply, and action of the gluteal muscles.
- Students will describe the spinal makeup, course, relationships of named nerves, and blood vessels in the gluteal area.
Lower Limb Regions
- The document contains diagrams of lower limb regions.
- The diagrams display various anatomical structures, such as those of the anterior, posterior, lower limb, lower extremity, anterior thigh, posterior thigh, gluteal fold, knee joint, popliteal region, ankle joint, and foot.
Lower Limb Osteology
- The axial-appendicular articulations, including the sacroiliac joints are discussed.
- Weight of the body, including the head, arms, and trunk are transmitted to the os coxae through these joints.
- Body weight above the hip joints is transmitted to the lower limbs.
Bony Pelvis
- The acetabulum is the concave surface of the hip joint.
- The acetabulum forms at the junction of the three pelvic bone parts.
Hip Joint
- Diagrams and descriptions of anterior and posterior hip joint structures are contained within this document.
Proximal Femur
- A diagram displaying the front and back views of a proximal femur is shown.
- Labeling includes the head, neck, greater trochanter, and lesser trochanter.
- Diagrams illustrating abnormal angles of inclination (coxa vara and Coxa valga) are also included.
Hip Joint Capsule
- The posterior femur capsule attaches to the intertrochanteric crest.
- The os coxa has a capsule that attaches circumferentially around the acetabulum.
- The anterior femur’s capsule is attached to the intertrochanteric line.
Iliofemoral Ligament
- The iliofemoral ligament limits hip joint hyperextension.
- It also prevents anterior dislocation of the femur.
Hip Joint Acetabulum
- Fibrocartilage extends the joint cavity on the acetabulum.
- A fovea is present on the femoral head, along with an acetabular labrum.
- The labrum is connected to the femoral head by the acetabular branch of the obturator artery.
A-P Pelvis
- A-P Pelvis X-rays are used as surveys of the pelvic region in trauma cases.
- X-rays help identify areas with potential injury.
Hip PA/AP, Hip Lateral
- Identify acetabular fossa, fovea (head of femur), superior pubic ramus, obturator foramen, ischiopubic ramus, and ischial tuberosity on X-rays.
- Analyze the articular surface of acetabulum, head of femur, neck of femur, and greater and lesser trochanters on X-rays.
Blood Supply to Head of Femur
- Medial circumflex femoral artery is the primary contributor to blood supply to the femoral head in adults.
- Blood vessels penetrate the joint capsules at the lower neck of the femur, traveling up the neck.
- In aging, this arterial penetration provides almost the sole blood supply to the femoral head.
Proximal Femur Fractures
- Images showcase X-ray views of displaced and intertrochanteric fracture types in proximal femurs.
Fixation of Proximal Femur Fractures
- Images illustrate fixation methods for intertrochanteric and non-displaced femoral neck fractures.
Degenerative Arthritis of Hip Joint
- Images show hip resurfacing and total hip arthroplasty procedures.
Hip Joint Movements
- Diagrams demonstrate open-chain hip movements in various positions of the lower extremities.
- Diagrams show flexion, extension, abduction, adduction, rotation (medial and lateral), and circumduction movements.
Palpable Bony Landmarks - Gluteal
- Anatomical landmarks in the gluteal region (diagram):
- Iliac crest, posterior superior iliac spine, sacrum, and ischial tuberosity.
Cutaneous Nn. of Gluteal Region
- Collectively named superior, middle, and inferior clunial nerves.
- Details regarding dorsal rami, posterior femoral cutaneous nerve, etc.
Fascia Lata
- Deep fascia of gluteal region and thigh.
- Continuous with crural fascia (leg region) and deep fascia foot.
Iliotibial Tract
- IT band is thickening of fascia lata on lateral aspect of thigh.
- Contains Tensor fascia lata.
- Extends from tubercle of iliac crest to lateral tubercle of tibia, patella, and head of fibula.
Gluteus Maximus m.
- Medial (Superior) attachment - ilium, sacrum, coccyx, and sacrotuberous ligament.
- Lateral (Inferior) attachment – gluteal tuberosity.
- Function - extension and lateral rotation of thigh at hip joint.
Trochanteric Bursa/Bursitis
- Lies over greater trochanter and deep to IT band.
Gluteus Medius m.
- Lateral ilium to greater trochanter.
- Superior gluteal nerve (L5, S1).
Gluteus Minimus m.
- Lateral ilium to greater trochanter, deep to gluteus medius.
- Superior gluteal nerve (L5, S1).
Gluteus Medius and Minimus Mm.
- Anatomical structures: gluteus medius (G. medius) and gluteus minimus (G. minimus).
Gluteus Medius and Minimus Function
- Primary function is hip abduction.
- Secondary function is medial rotation of the femur at the hip joint.
Hip Abductor Functional Strength
- Abductors function when in a weight-bearing stance.
- Maintaining a level pelvic girdle requires contraction and isometric action by stance limb hip abductors.
- Trendelenburg sign for weak hip abductors.
Tensor Fasciae Latae
- Origin: anterior iliac crest.
- Insertion: iliotibial tract; innervation: superior gluteal n.
- Action: Abduction and medial rotation of the thigh.
Greater and Lesser Sciatic Foramina
- Diagrams of greater sciatic foramen (surrounding structures/ligaments).
- Lesser sciatic foramen (surrounding structures/ligaments).
Lateral Rotators
- Diagram of the muscles, detailing their origins, exits through foramina, attachments to greater trochanter region. Muscles include: piriformis, obturator internus, superior gemellus, inferior gemellus, and quadratus femoris.
Piriformis m. Obturator Internus m.
- Piriformis attachment – anterior sacrum.
- Obturator internus attachment – pelvic surface of obturator membrane.
Obturator Externus
- Bone surrounding obturator foramen and obturator membrane to greater trochanter.
Rotator Muscles of the Hip Joint
- Diagram of the hip joint and different muscles, detailing their function in medial and lateral rotation.
Lumbosacral Plexus
- Formed by anterior rami from L4-S3.
- Lumbosacral trunk (L4-L5) joins with sacral plexuses (S1-S3) to create the lumbosacral plexus.
Superior Gluteal n.
- Exits pelvis superior to piriformis; located between gluteus medius & minimus.
- Innervates gluteus minimus, gluteus medius, and tensor fasciae latae muscles.
Inferior Gluteal n.
- Exits pelvis inferior to piriformis.
- Innervates the gluteus maximus muscle.
Sciatic n.
- Exits pelvis below piriformis.
- Innervates hamstrings and various muscles of the lower limb.
Sciatic nerve variations
- 87% of individuals have the common fibular portion of the sciatic nerve passing through or over the piriformis.
Safe Zone for Intramuscular (IM) Injection in Gluteal Region
- The safe quadrant for gluteal injections is shown.
- Areas to avoid when injecting.
Other Motor Nerves Gluteal Region
- Anterior rami of S1 and S2 provide innervation for piriformis, obturator internus, superior gemellus, inferior gemellus, and quadratus femoris.
Posterior Femoral Cutaneous n.
- Innervates the skin over inferior buttocks and posterior thigh.
Pudendal n.
- Exits the pelvis via the greater sciatic foramen.
- Crosses the sacrospinous ligament and enters the ischial anal fossa.
- Passes through the lesser sciatic foramen with accompanying artery and vein.
Gluteal Region Dermatomes
- Diagrams illustrating dermatomes related to gluteal region.
Lower Limb Blood Supply
- Structures include abdominal aorta, common iliac artery, external iliac artery, femoral artery, etc.
Gluteal Region Blood Supply
- Superior gluteal artery exits the pelvis.
- Travels between gluteus medius/minimus.
- Supplies the upper portion of gluteus maximus.
- Inferior gluteal artery exits inferior to piriformis.
- Supplies gluteus maximus muscle.
Gluteal Region Lymphatic Drainage
- Superficial tissues drain to superficial inguinal nodes.
- Deep tissues drain to internal iliac nodes along gluteal vessels.
Practice Question
- A 80-year-old woman reporting difficulty climbing stairs likely has gluteus maximus weakness.
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Description
This lecture focuses on the hip joint and gluteal region, exploring the anatomical structures involved, both bony and soft tissue. Students will examine radiographic images and consider functional deficits related to hip injuries and pathologies. A thorough understanding of these components is essential for effective practice in osteopathic medicine.
