Gluteal Region & Femoral Triangle Anatomy - PDF

Gluteal region Dr Sapna , Asst Professor www.gmu.ac.ae COLLEGE OF MEDICINE Objectives Describe the origin, insertion, nerve supply and action of muscles of the gluteal region Muscles of the gluteal region Superficial layer ✓Gluteus maximus ✓G...

Gluteal region Dr Sapna , Asst Professor www.gmu.ac.ae COLLEGE OF MEDICINE Objectives Describe the origin, insertion, nerve supply and action of muscles of the gluteal region Muscles of the gluteal region Superficial layer ✓Gluteus maximus ✓Gluteus medius ✓Gluteus minimus Deep layer ✓Piriformis ✓Superior & inferior gamelli ✓Obturator internus ✓Quadratus femoris PAI  Gluteus maximus Origin: ilium behind posterior gluteal line. Insertion: Iliotibial tract.Gluteal tuberosity of femur. Nerve supply: Inferior gluteal nerve  Gluteus medius Origin: ilium between the anterior & posterior gluteal lines Insertion: Lateral surface of greater trochanter Nerve supply: Superior gluteal nerve  Gluteus minimus Origin: ilium between the anterior & inferior gluteal lines Insertion: front of the of greater trochanter Nerve supply: superior gluteal nerve  Tensor fascia lata (Iliotibial tract) ✓Origin: Outer lip of iliac crest & ASIS ✓Insertion: lateral condyle of tibia via iliotibial tract ✓Nerve supply: Superior gluteal nerve  Glutei action Tensor fascia Gluteus medius & minimus lata 1. Abduction of hip. + 1. Stabilization of 2. Prevent the pelvis from knee during dropping on the swing side extension. (flexed leg) during walking. Gluteus maximus 1. Stabilization of knee during extension. 2. Extension of hip. 3. Lateral rotation of the thigh. 4. Assist in rising from siting position.  Nerve supply Piriformis (key muscle) sacral nerves Superior gamelli :nerve to obturator internus Obturator internus:nerve to obturator internus 1 Inferior gamelli :nerve to quadratus 2 femoris 3 5 4 Quadratus femoris :nerve to quadratus femoris  Trendelenburg's sign Gluteus medius& minimus ✓Abductors of hipjoint ✓Prevent unsupported side of pelvis from dipping down (opposite side). Thus maintain the horizontal line of pelvis during walking running Paralysis of gluteus medius & minimus ✓Pelvis sinks on unsupported side - Trendelenburg's sign ✓Lurching gait  Femoral triangle & Anterior aspect of thigh Dr Sapna Shevade, Asst Professor www.gmu.ac.ae COLLEGE OF MEDICINE Objectives Describe the boundaries of femoral triangle List the contents of femoral triangle Describe the femoral sheath Describe the origin ,insertion, nerve supply and action of muscles of the front of the thigh Femoral triangle Is triangular depression in the upper anterior thigh. Boundaries: ✓Base: is the inguinal ligament. ✓Medial border: is the medial margin of the adductor longus muscle. ✓Lateral border is the medial margin of the sartorius. Floor: 1.Adductor longus , 2. Pectineus, 3.Psoas major 4. Iliacus  Apex : meeting point of sartorius & adductor longus. Its continuous with adductor canal Roof Skin Superficial fascia Fascia lata: deep fascia of thigh  Contents : from lateral to medial side Femoral Nerve Femoral artery Femoral vein Femoral lymph nodes  Femoral sheath ✓A funnel-shaped sleeve of fascia that surround the artery, the vein & the lymphatics. ✓It is 3-4 cm long. ✓Its medial wall is shorter than lateral wall. Contents Femoral artery Femoral vein Femoral lymphnodes Compartments Lateral : Femoral artery & femoral branch of genitofemoral N Intermediate : femoral vein Medial : Femoral canal  Femoral artery ✓Continuation of external iliac artery ✓Passes under inguinal ligament ✓Passes through the femoral triangle ✓Further passes through adductor hiatus in adductor magus muscle in adductor canal to reach the posterior aspect of knee ✓Continues as popliteal artery  Branches : ✓Superficial epigastric artery ✓Superficial circumflex iliac ✓Superficial external pudendal ✓Deep external pudendal Muscular branches ✓Profunda femoris : supplies the muscles of the thigh It gives ▪ Medial circumplex femoral ▪ Lateral circumflex femoral branch ✓Perforating arteries : Pierce the adductor magnus & supplies the adductor and hamstring muscles  Femoral vein From the adductor canal it enters the femoral triangle through its apex Lies medial to the femoral artery It continues with the external iliac vein beneath the inguinal ligament Tributaries : Profunda femoris Great sephanous vein  Femoral Nerve ✓Originates from lumbar plexus ✓Passes under inguinal ligament to enter the femoral triangle ✓Divides into anterior & posterior divisions ✓Supplies quadriceps muscles  Ilio Psoas Iliacus & Psoas major Nerve supply ✓Iliacus by femoral nerve. ✓Psoas major by lumbar (L1, L2, L3) nerves. Action: ✓Psoas major flexes the thigh(hip joint) on the pelvis (laying down or standing). Flexes the vertebral column on the thigh. ✓Iliacus flexes the thigh (hipjoint) on pelvis only ✓Both muscle medially rotate the thigh Pectineus Nerve supply:Femoral & obturator nerves Action:Flexes, adducts & medially rotates thigh at hip joint. Anterior compartment of thigh Quadriceps femoris ✓Rectus femoris ✓Vastus lateralis ✓Vastus medialis ✓Vastus intermedius Sartorius  MUSCLE ORIGIN INSERTION ACTION NERVE SUPPLY Sartorius Anterior Superior Iliac Spine Medial surface of flexion of hip & Femoral tibia, medial to laterally rotates nerve tibial tuberosity it & knee joints Rectus femoris Straight head: the anterior inferior iliac Insert into patella Extension of leg spine. then extend from (knee joint) Reflected head: the ilium just above the patella as patellar acetabulum tendon which inserts into tibial Vastus medialis Medial part of intertrochanteric line, tuberosity Pectineal line of femur, Medial lip of the linea aspera, Medial supracondylar line. Vastus Lateralis Lateral part of intertrochanteric line, Margin of greater trochanter, Lateral margin of gluteal tuberosity, Lateral lip of the linea aspera of femur. Vastus intermedius Upper 2/3 of anterior and lateral surfaces of femur References Netter’s Clinical Anatomy,4th Edition-2019,John T Hanson, Chapter 6,Page 291-366,ISBN 978-0-323-53188-7 https://www-clinicalkey-com.gmulibrary.com/#!/content/book/3- s2.0-B9780323531887000068 https://usmle-rx.scholarrx.com/rx-bricks/brick/CP_MUS0055  Hip joint Dr Sapna Shevade www.gmu.ac.ae COLLEGE OF MEDICINE Objectives Classify the hip joint Name the articular surfaces Name the ligaments of hip joint Identify the attachment of ligaments Name the movements of hip joint Name the muscles producing the movements  Ball and socket variety of synovial joint Articulating bones : head of femur with acetabulum Ligaments Capsular ligament : lined by synovial membrane  Ligaments Acetabular labrum : fibrocartilaginous rim attached to the margin of acetabulum Transverse acetabular ligament : across acetabular notch Ligaments Ligament of the head of the femur (ligamentum teres) Apex attached to fovea. Base attached to two ends of acetabular notch. Blends with transverse acetabular ligament  Iliofemoral ligament : inverted Y shaped. Apex attached to ASIS. Lower part attached to intertrochanteric line Ischiofemoral ligament Pubofemoral ligament Movement Muscles Flexion Iliacus,Psoas major Extension Gluteus maximus & hamstrings Abduction Gluteus maximus, medius, minimus & TFL Adduction Adductor magnus,brevis,longus,gracilis & pectineus Medial Gluteus medius,minimus & TFL Rotation Lateral Gluteus maximus & all deep muscles Rotation Femoral necrosis Fractures Dislocations Congenital causes