BFM 4 Gluteal region version Final 2324 (1).pptx

Gluteal region Body Movement and Function Dr Sara Sulaiman [email protected] Learning outcomes By the end of this lecture, you should be able to: • Describe the bones of the pelvis and thigh • Discuss the contents of the gluteal region, including muscles, nerves and vessels • Explain Trendelenbur...

Gluteal region Body Movement and Function Dr Sara Sulaiman [email protected] Learning outcomes By the end of this lecture, you should be able to: • Describe the bones of the pelvis and thigh • Discuss the contents of the gluteal region, including muscles, nerves and vessels • Explain Trendelenburg gait • Describe the greater and lesser sciatic foramina • Discuss the anatomy of intramuscular injections to the gluteal region • Describe the muscles and innervation of the posterior compartment of the thigh Recommended reading • Abrahams, Peter H. et al. McMinn & Abrahams’ Clinical Atlas of Human A natomy . Seventh edition. Maryland Heights, Missouri: Elsevier Mosby, 2013. Print • Drake, Richard L. Gray’s Anatomy For Students . 4th. ed. Philadelphia: Elsevier, Inc., 2020. Print. • Moore, Keith L., Arthur F. Dalley, and A. M. R. Agur. Essential Clinical Anatomy. 4th ed. Philadelphia, Pa.; London: Lippincott Williams & Wilkins, 2011. Print. • Netter, Frank H. (Frank Henry). Atlas of Human Anatomy. 5th ed. Philadelphia, Pa.; London: Saunders, 2010. Print. • Smith, C., Dilley, A., Mitchell, B. and Drake, R.L., 2017. Gray’s Surface Anatomy and Ultrasound: Gray’s Surface Anatomy and Ultrasound E-Book. Elsevier Health Sciences. • Spratt, J., Salkowski, L.R., Loukas, M., Turmezei, T., Weir, J. and Abrahams, P.H., 2020. Weir & Abrahams' Imaging Atlas of Human Anatomy. Elsevier Health Sciences. Pelvic girdle • Bear the weight of upper body when sitting and standing • Transfer the weight from axial to lower appendicular skeleton for standing and walking • Provide the attachment for the powerful muscles of locomotion • Contain and protect pelvic viscera During a surgical procedure, a surgeon is isolating the proximal part of the femoral artery. Posterior to the femoral sheath. What muscle forms the lateral portion of the floor of the femoral triangle? A. Pectineus B. Adductor longus C. Iliopsoas D. Sartorius E. Vastus lateralis Pelvic bones Greater Sciatic notch • The pelvic bone is irregular in shape and is made up: the ilium, pubis and ischium. Iliac crest Lesser Sciatic notch Ilium ASIS OF AIIS Ischial spine Ischial tuberosit y Ischiu m Pubis Pubic tubercle Body of pubis PSIS PIIS Pubis Ischia l ramu s Superior pubic ramus Inferior pubic ramus Ligaments of the pelvic wall Sacrospinous ligament • Convert notches into foramina: Sacrotuberou s ligament • Greater sciatic foramen • Lesser sciatic foramen Obturator membrane • Stabilize the sacrum and prevent its rotation. Sacrotuberou s ligament Ligaments of the pelvic wall Anterior sacro-iliac ligament Sacrospinous ligament Obturator membrane Sacrotuberous ligament Pubic symphysis Apertures and Getaways Greater sciatic Above piriformis foramen Superior gluteal vessels Superior gluteal nerve Subinguin al hiatus Iliopsoas Femoral vessels Femoral nerve Below piriformis Inferior gluteal vessels Inferior gluteal nerve Sciatic nerve Posterior femoral cutaneous nerve Nerve to quadratus femoris Pudendal nerve Internal pudendal vessels Nerve to obturator internus Lesser sciatic foramen Obturator foramen Obturator nerve Obturator vessels Pudendal nerve Internal pudendal vessels Nerve to obturator internus Obturator internus muscle Just for Fun! Putting things together.. Read more: https://prisoncellphones.co m/blog/2011/07/20/inmate-f ound-with-3-cellular-phonesin-his-rectum/ 1.Anterior inferior iliac spine 2.Anterior sacral foramen 3.Anterior superior iliac spine 4.Body of pubis 10. Centre for ischial tuberosity 11. Ischial spine 12. Obturator foramen 13. Pubic symphysis 15. Sacro-iliac joint 16.Segment of coccyx 17.superior ramus of pubis 18.Tubercle of pubis A 52-year-old women is admitted to the emergency department with a painful lump on the proximal medial aspect of her thigh. Radiologic and physical examinations reveal that the patient has a herniation of abdominal viscera beneath the inguinal ligament into the thigh. Through which of the following openings will a hernia of this type initially pass to extend from the abdomen into the thigh? A. B. C. D. E. Obturator canal Femoral ring Superficial inguinal ring Acetabulum Greater sciatic foramen Gluteal region Iliac crust • Gluteal region extends • Bonny framework: • Posterolateral bony pelvis • Proximal femur • Muscles: mainly abduct, extend and rotate • Important regions: greater and lesser sciatic foramen Gluteal fold Gluteal region • Superiorly: iliac crust • Inferiorly: gluteal fold General arrangement Superficial group: Mainly aBduct the hip Deep group: Mainly lateral rotators Gluteus maximus (extensor) Piriformis Gluteus medius Obturator internus Gluteus minimus Gemellus superior Tensor fascia lata (Does NOT abduct the hip, sometimes it is concerned an anterior compartment muscle) Gemellus inferior Quadratus femoris Gluteal muscles-superficial group Gluteus maximus • From ilium and posterior sacrum/coccyx to iliotibial tract, greater trochanter of femur. • Inferior gluteal nerve • Very powerful hip extension • E.g. climbing stairs, running, rising from a seated position • Lateral rotation Tensor fascia lata • Lateral aspect of the ilium to the iliotibial tract of fascia lata • Superior gluteal nerve • Stabilizes the knee in extension Gluteus medius Gluteus minimus • External surface of the ilium to the greater trochanter • Superior gluteal nerve • Hip abduction and medial rotation, stabilizes the hip while walking. Gluteal muscles-deep group Piriformis muscle • From anterior sacrum to greater trochanter. • S1-2 • Laterally rotates extended femur femur at hip and abducts flexed femur at hip Obturator internus • From obturator membrane to greater trochanter • Nerve to obturator internus • Laterally rotates extended femur femur at hip and abducts flexed femur at hip Gemellus superior • From ischial spine to greater trochanter • Nerve to obturator internus • Laterally rotates extended femur femur at hip and abducts flexed femur at hip Gemellus inferior • From ischial tuberosity to greater trochanter • Nerve to quadratus femoris • Laterally rotates extended femur femur at hip and abducts flexed femur at hip Quadratus femoris • From ischium to intertrochanteric crest • Nerve to quadratus femoris • Laterally rotates femur Trendelenburg gait Function of gluteus minimus and medius Contraction of gluteus minimus and medius on the stance side prevents excessive pelvic tilt during the swing phase on the opposite side Sacral plexus • Anterior rami of S1-4 and the lumbosacral trunk. • Found anterior to the piriformis muscle • Main branches: Lumbosacral trunk Superior gluteal nerve Pudendal nerve Obturator nerve • Sciatic nerve (L4-S3) • largest nerve in the body • Has a tibial (L4-S3) division and common fibular (peroneal) division (L4-S2) • Superior (L4-S1) and inferior (L5-S2) gluteal nerves • Posterior cutaneous nerve of the thigh (S1-S3) • Pudendal nerve (S2-4) • Pelvic splanchnic nerves (S2-4) • Preganglionic parasympathetic and visceral afferents Inferior gluteal nerve Sciatic nerve Superior gluteal nerve Lumbosacral trunk Superior gluteal nerve Obturator nerve Sciatic nerve Inferior gluteal nerve Inferior gluteal nerve Sciatic nerve Posterior cutaneous nerve of the thigh Sciatic nerve Tibial (L4 – S3) • Runs vertically along the middle of the popliteal fossa Common fibular (peroneal) (L4 – S2) • Runs laterally • Medial to biceps tendon Sciatic nerve Tibial nerve Common fibular (peroneal) Sciatica • Sciatica is a term used to describe pain radiating down the leg, with or without back pain. • Posterolateral herniation is most common in the lumbar region; approximately 95% of protrusions occur at the L4–L5 or L5–S1 levels • The most frequent cause of acute sciatica is disc herniation. Intramuscular injections Ischial tuberosity Greater trochanter Posterior compartment of the thigh Biceps femoris (Long head) Semitendinosus Semimembranosus • From ischial tuberosity to medial tibia • Sciatic nerve • Flexes leg at the knee, extends thigh at the hip, medially rotates the leg Hamstring group: • Same origin • Same function • From ischial tuberosity to medial tibia • Sciatic nerve • Flexes leg at the knee, extends thigh at the hip, medially rotates the leg Biceps femoris (Short head) • Two heads: • Long head: ischial tuberosity • Short head: femur • Sciatic nerve • Long head: tibial division • Short head: fibular division • Flexes leg at the knee and laterally rotates the leg. Extends and laterally rotates the thigh at the hip (only long head). Hamstring group A 20-year-old man is admitted to the hospital following a bad car accident. After the accident, he mentioned that he could not flex his leg. What nerve was most likely injured as a result of the accident? A. B. C. D. E. Sciatic Femoral Saphenous Superior gluteal Obturator Blood supply • Superior and inferior gluteal • From internal iliac • Medial and lateral femoral circumflex • From deep femoral artery Pes anserinus Think Say Grace before Tea! • Latin for "goose's foot" and was named based on its similar appearance to the webbed three-toed feet of geese. Gracilis Sartoris • In order, from anterior to posterior: • Tendon of sartorius • Tendon gracilis • Tendon of semitendinosus Semitendinosus Thank you