The Gluteal Region PDF

The Gluteal Region Gluteal Ligaments Bones of the pelvic girdle are bound by strong ligaments 2 important ligaments Sacrospinous Ligament Sacrotuberous Ligament...

The Gluteal Region Gluteal Ligaments Bones of the pelvic girdle are bound by strong ligaments 2 important ligaments Sacrospinous Ligament Sacrotuberous Ligament These turn the Greater & Lesser Sciatic notches into Foramen Greater Sciatic Foramen Lesser Sciatic Foramen Apertures of the pelvic girdle All nerves and blood vessels originate from Spine & Aorta Greater Sciatic Foramen is the exit for all the lower limb nerves and arteries to the Gluteal region Muscles of the Gluteal Region These can be organised in to 2 layers Superficial layer Glutei (maximus, medius and minimus) Tensor Fasciae Latae Deep Layer 6 short lateral rotators Deep Layer – Key principles All originate adjacent to the intertrochanteric crest All insert down the greater trochanter, trochanteric fossa and intertrochanteric crest All pull to laterally rotate the thigh Crucial in stabilizing the hip posteriorly (where the capsule is weakest) Muscle names Piriformis (pear shape) Superior Gemellus (gemini=twin) Obturator Internus Inferior Gemellus (gemini=twin) Quadratus femoris Obturator externus (sometimes put in the medial compartment in textbooks) 4 Muscles we can observe (2 hidden) 4 muscles we can see on the prosection Piriformis Superior Gemellus Inferior Gemellus Quadratus femoris (Obturator internus & externus are hidden) Piriformis – Landmark of the Gluteal region! Originates from Ant surface of Sacrum Exits thru the Greater Sciatic Foramen (almost filling it) Attaches to superior border of greater trochanter Determines the name of the gluteal vessels & nerve Superior gluteal nerve & artery- Superior Inferior gluteal nerve & artery - Inferior Gemelli & Obturator internus Gemelli originate from the ischial bone Superior from ischial spine Inferior from ischial tuberosity Blend with the tendon of Obturator internus and attach to the trochanteric fossa Gemelli & Obturator internus Obturator internus originates from pelvic surface of obturator membrane and surrounding bone Exits via the Lesser sciatic notch Makes a right angle turn! Turns tendinous and blends with gemelli muscles You will only observe the muscle fibres of the Gemelli Quadratus Femoris Originates from lateral border of ischial tuberosity Attaches to intertrochanteric crest Obturator externus Originates from the margins of obturator foramen and the membrane Passes under the neck of the femur Attaches to trochanteric fossa Hidden by attachment of other lateral rotators Nerve Supply Piriformis – br. S1 & S2 Superior Gemellus & Obturator Internus – Nerve to Obturator Internus L5 S1 S2 Inferior Gemellus & Quadratus femoris – Nerve to Quadratus femoris L4 L5 S1 Obturator Externus – Obturator Nerve L2 L3 L4 Gluteus Medius & Gluteus Mininus Their origins are from the external surface of the illium Fan shaped muscles Attach to anterior lateral surface of the greater trochanter Key principle – Pull of the fibres will Abduct the thigh at the hip Gluteus Medius & Gluteus Mininus Important to remember the iliac spine does extend from anterior to posterior Anterior fibres do sit in front of hip joint Key principles - These fibres will Medially rotate thigh at the hip Superior Gluteal Nerve & Artery Gluteus Medius & Minimus are both supplied by the Superior gluteal artery, vein and Nerve L4 L5 S1. How often do we abduct our thighs??? Crucial role in walking Medius & Minimus on the standing leg fix the pelvis so it does not sag on the unsupported side. Keeping the pelvis level allows the non weight bearing leg to clear the ground as it is brought forward Paralysis of Sup Gluteal nerve +Trendelenberg Medial & Lateral rotation in Walking Iliotibial tract (IT band) It’s a longitudinal fibrous reinforcement of the fascia lata Its origin is the anterolateral tubercle of the iliac spine Distal insertion is on the anterolateral tubercle of tibia (Gerdy’s tubercle) It also forms the lateral intermuscular septum (attaching to the length of the femur) Can be thought of as a long aponeurosis of associated muscles Gluteus maximus Origin is from the posterior third of iliac spine, sacrum, coccyx & sacrotuberous ligament Inserts mainly in to the IT tract but some fibres attach directly to femur (gluteal tuberosity) Main actions are Extension and assists in lateral rotation We already have strong lateral rotators and the hamstrings are extensors?????? Why do we have Gluteus maximus? It is the strongest Extensor of the hip We don’t use it for standing We barely use it for walking (on flat ground) Why do we have Gluteus maximus? Main function is primarily between the flexed and standing position (Anti-gravity muscle) eg rising from a sitting position Climbing stairs or walking uphill Extension from a flexed position! Running When force is necessary It also act to stabilise the extended knee Because of the attachment to the femur via the intermuscular septum it can’t actually move the knee Inferior Gluteal Nerve & Artery Gluteus maximus is supplied by the Inferior gluteal artery, vein and Nerve L5 S1 S2 Tensor of the Fascia Lata Synergist or accessory muscle Assists other muscles Iliopsoas & rectus femoris- flexion Gluteus medius & minimus- abduction and medial rotation Gluteus maximus – stabilisation of the knee It is served by the Superior Gluteal neurovascular bundle (same as Gluteus medius & minimus) Gluteal Bursae Bursae are membranous sacs lined with synovial membrane Filled with synovial fluid (slippery) Located in areas subject to friction They reduce friction and permit free movement Gluteal Bursae Trochanteric Bursa Separates superior fibres of glute max from greater trochanter Ischial Bursa Separates inferior fibre of glute max from ischial tuberosity Gluteofemoral Bursa Separates the iliotibial tract from superior part of Vastus Lateralis Bursitis is inflammation of the bursa Trochanteric Bursa Largest of the Bursae Present from birth Repeated actions can cause friction bursitis Climbing with heavy objects Running up hill Point tenderness over the greater trochanter but can radiate along the IT tract causing deep diffuse pain in the lateral thigh Ischial Bursa Often absent Repeated action can cause friction bursitis Repetitive hip extension while seated Cycling, rowing Localized pain icreasing with movement of glute max Sciatic nerve More detail next week Sciatic nerve lies midway between the greater trochanter & ischial tuberosity A third point can be drawn fro the highest point of the iliac spine (not easily palpapable) Gluteal Intramuscular Injections Common site of injection because the muscle is large and thick allowing substantial absorption Safe zone = Superolateral quadrant Avoiding all the neurovascular structures