2. LL - Muscles of gluteal region.pdf

Anatomy of LOWER Limb Muscles of Gluteal Region By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology LOWER LIMB Case Study Intramuscular (Intragluteal) Injection Trendelenburg's Sign Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October...

Anatomy of LOWER Limb Muscles of Gluteal Region By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology LOWER LIMB Case Study Intramuscular (Intragluteal) Injection Trendelenburg's Sign Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 2 LOWER LIMB Objectives: by the end of this lecture the student must understand the following knowledge: 1) Define and Identify the Components of Gluteal Region. 2) Identify the attachments (Origin & Insertion), nerve supply, joint acting upon and action of the following: A. Muscles of Gluteal Region Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 3 LOWER LIMB Objective # ( 1 ) Define and Identify the Components of Gluteal Region ▪ Definition: Upper most posterior region of lower limb and seen only posteriorly. ▪ Components: 1) Bones: A. B. C. D. Sacrum Coccyex. Hip Upper portion of femur 2) Joints: A. Sacroiliac joint (not discussed in this block). B. Hip Joint. 3) Muscle: (9 Muscles) A. Superficial layer (Abductors and Extensors of thigh) 1) 2) 3) 4) Gluteus maximus muscle (Gmx) Gluteus medius muscle (Gmd) Gluteus minimus muscle (Gmn) Tensor fascia lata (TFL) B. Deep layer (Small Lateral rotators of thigh) 1) 2) 3) 4) 5) Piriformis. (P) Obturator internus. (OI) Gemellus superior. (GS) Gemellus inferior. (GI) Quadratus femoris. (QF) Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 4 Deep Superficial (Gluteal) Skin Fascia Fascia • Gluteus Maximus is the most superficial muscle in gluteal region Glueus Medius Gluteus Maximus ▪ ▪ Gluteus medius is patially seen undercover from gluteus maximus. Glueus minimus is completely hidden by glueus medius Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk Iliotibial Tract LOWER LIMB Arrangement of Muscles of Gluteal Region ▪ Tensor fascia lata is the only gluteal muscle seen anteriorly. October 3, 2023 5 Iliotibial Tract LOWER LIMB Arrangement of Muscles of Gluteal Region Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 6 LOWER LIMB How can you identify these muscles on cadavers? 1. Tensor fascia latae: ▪ Is the only muscle that lies outside the gluteal region (may appear or may not appear in the gluteal region). ▪ It appears BETTER in the anterior compartment of thigh. ▪ It lies very close to the origin of sartorius. 2. Gluteus maximus: (the largest and most superficial muscle) ▪ All contents of gluteal region are covered by gluteus maximus EXCEPT upper lateral part which is superficial. ▪ To demonstrate the contents of the gluteal region, it must be cut and reflected. 3. Gluteus medius: It is partially covered by gluteus maximus EXCEPT its upper lateral part which is superficial. 4. Gluteus minimus ▪ It is completely covered by gluteus medius. ▪ To demonstrate gluteus minimus, gluteus medius mut be cut and reflected. 5. Piriformis muscle (key muscle for the deep layer of gluteal region): Triangular muscle. ▪ Originates inside the pelvis. ▪ Leaves the pelvis and enters the gluteal region through greater sciatic foramen. ▪ All the structures pass through greater sciatic foramen are classified either superior and inferior to it. 6. Obturator Internus muscle: ▪ Originates inside the pelvis. ▪ Leaves the pelvis and enters the gluteal region through the lesser sciatic foramen. ▪ The superior and inferior gemelli are inserted in its tendon. 7. Quadratus femoris muscle: Quadrilateral in shape. ▪ Its lower border is the inferior boundary of the gluteal region (after which you will enter the hamstring). Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 7 LOWER LIMB A P Piriformis Obturator Internus Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 8 LOWER LIMB A P Greater sciatic foramen Lesser sciatic foramen Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 9 Pectineus 1. Before turning the cadaver: Identify the tensor fascia latae. 2. After turning the cadaver, follow the next order: 1) Gluteus maximus (must be cut and reflected). 2) Gluteus medius. Gracilis LOWER LIMB Sequence of Studying 3) Gluteus minimus (appears only if gluteus medius is cut and reflected). Rectus femoris 4) Piriformis. 5) Superior gemellus. 6) Tendon of obturator internus. 7) Inferior gemellus. 8) Quadratus femoris. Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 10 LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 11 (1) Gluteus Maximus Muscle Attachments LOWER LIMB Objective # ( 2 ) 1. Gluteal surface of the ilium behind the posterior gluteal line. Origin 2. Back of the sacrum and coccyx. 3. Back of the sacro-tuberous ligament. Insertion Nerve supply Joint Acting Upon 1. Superficial ¾ of the muscle: into the iliotibial tract. 2. Deep lower ¼ of the muscle: into the gluteal tuberosity of the femur. Inferior Gluteal Nerve (which is a branch from sacral plexus). 1) Hip Joint, responsible for movements of thigh. 2) Knee joint through its insertion in ilio-tibial tract. 1. On Hip joint : A. Powerful extensor of the hip joint. Action (Movements) B. Powerful lateral rotator C. Abduction. 3. Extension of the knee joint. 4. Stabilizes the pelvis on the thigh during walking. Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 12 LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 13 LOWER LIMB Gluteal surface of the ilium behind the posterior gluteal line Origin Back of the sacrum and coccyx Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 14 LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 15 Inferior gluteal nerve Gmn P Gmd Iliotibial Tract (L. 5, S. 1,2). TFL LOWER LIMB Gmd SG OI IG QF Gmx Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 16 Attachments LOWER LIMB Objective # ( 3 ) (2) Gluteus Medius Muscle Origin Gluteal surface of the ilium between the anterior and posterior gluteal lines. Insertion Lateral surface of greater trochanter of femur Nerve supply Superior Gluteal Nerve (which is a branch from sacral plexus). Joint Acting Upon Hip Joint, responsible for movements of thigh. Action (Movements) 1. 2. 3. 4. Abduction of the thigh. Medial rotation of the thigh (by its anterior fibers). Stabilize the pelvis during walking (Pelvis secure) Prevents pelvic drop on the opposite during walking Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 17 LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 18 Superior gluteal nerve (L. 4, 5, S. 1). TFL LOWER LIMB Gmd Gmn P Gmd SG OI IG QF Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk Gmx October 3, 2023 19 LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 20 Attachments LOWER LIMB Objective # ( 4 ) (3) Gluteus Minimus Muscle Origin Gluteal surface of the ilium between the anterior (middle) and inferior gluteal lines. Insertion Anterior surface of greater trochanter of femur Nerve supply Superior Gluteal Nerve (which is a branch from sacral plexus). Joint Acting Upon Hip Joint, responsible for movements of thigh. Action (Movements) 1. 2. 3. 4. Abduction of the thigh. Medial rotation of the thigh. Stabilize the pelvis during walking (Pelvis secure) Prevents pelvic drop on the opposite during walking Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 21 LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 22 LOWER LIMB Actions of the Gluteus Medius and Minimus muscles 1. Abduction of the thigh. 2. Medial rotation of the thigh. 3. Stabilize the pelvis during walking (prevent tilting of the pelvis when the opposite limb is raised off the ground). standing Normal walking Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk Walking with paralysis October 3, 2023 23 Attachments LOWER LIMB Objective # ( 5 ) (4) Tensor Fascia Latae Muscle Origin From anterior part of the outer lip of iliac crest. Insertion Iliotibial tract Nerve supply Joint Acting Upon Action (Movements) Superior Gluteal Nerve (which is a branch from sacral plexus). 1) Hip Joint, responsible for movements of thigh. 2) Knee joint through its insertion in ilio-tibial tract. Stabilizes the knee joint during extension Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 24 Iliotibial Tract LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 25 LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 26 TFL LOWER LIMB Gmd Gmn Nerve to Obturator Internus P Gmd SG OI Nerve to Quadratus Femoris. IG QF Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk Gmx October 3, 2023 27 Objective # ( 6 ) LOWER LIMB Muscle 1 Piriformis. (P) 2 Obturator internus. (OI) 3 Gemellus superior. (GS) 4 Gemellus inferior. (GI) 5 Quadratus femoris. (QF) Small Lateral Rotators of Thigh (Deep Gluteal Muscles) Site All are covered by Gluteus Maximux. Nerve Supply Acting Joint Ventral rami of S1 & S2 Hip Joint Nerve to Obturator Internus. Hip Joint Hip Joint Hip Joint Nerve to Quadratus Femoris. Its lower border is the border between gluteal region and back of thigh Action Lateral Rotation Hip Joint All superficial gluteal muscles abduct and medially rotate the thigh. All deep gluteal muscles and the gluteus maximus laterally rotate the thigh. Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 28 Gluteal Region LOWER LIMB GS Posterior View Anterior View OI GI QF Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 29 TFL LOWER LIMB Gmd Gmn Nerve to Obturator Internus P Gmd SG OI Nerve to Quadratus Femoris. IG QF Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk Gmx October 3, 2023 30 LOWER LIMB Clinical correlation ▪ The sciatic nerve and major vessels and nerves appear through the lower medial quadrant of gluteal region. ▪ Injections can be carried out in the upper lateral quadrant (gluteus medius) to avoid injury to the sciatic nerve and major vessels in the region Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 31 Trendelenburg Sign LOWER LIMB Clinical correlation Superior Gluteal Nerve Injury Commonest Cause 1. 2. 3. Intramuscular injection in gluteal region. Greater trochanter fracture. Posterior hip joint dislocation. Commonest site Supero-medial quadrant of the gluteal region. Deformity Limp (Waddling Gait) (Gluteal Gait) (Lurching Gait). Muscles paralyzed 1. 2. 3. Motor loss 1) Abduction of thigh. 2) Medial rotation of thigh. Gluteus medius. Gluteus minimus. Tensor fascia latae. Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 32 LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 33 LOWER LIMB Trendelenburg’s sign (Lurching Gait) ▪ Due to paralysis of gluteus medius and gluteus minimus due to injury of superior gluteal nerve. ▪ The sign is demonstrated by asking the patient to stand on one limb. ▪ When the patient stands on the affected limb (injured side), the pelvis severely drops over the swing limb (healthy side) (contralateral side). ▪ The patient compensates for the pelvic drop by lurching the trunk to the affected side (injured side) to maintain the level of the pelvis throughout the gait cycle. Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 34 LOWER LIMB Case Scenario Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 35 LOWER LIMB Reference • • • ISBN: 978-0-7020-5131-9 Copyright© 2015, 2010, 2005 by Churchill Livingstone, an imprint of Elsevier Inc. Chapter 6. • • • ISBN: 978-07817-7525-0 Copyright© 2010, by Lippincott Williams & Wilkins, a Wolters Kluwer business. Chapter 5. Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk • • • ISBN: 978-1-60913-446-4 Copyright© 2012, by Lippincott Williams & Wilkins, a Wolters Kluwer business. Chapter 10. October 3, 2023 36 LOWER LIMB Lect. 2 - Lower Limb - Muscles of Gluteal Region By Dr. Hassan Rezk October 3, 2023 37