Gluteal Region Anatomy PDF

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 Trendelenbu...

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 Anatomy. 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  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 PSIS Ischial spine PIIS Pubic Ischial Ischiu tubercle Pubis Pubis tuberosit m Superior y Body of pubis pubic Ischia ramus l Inferior ramu pubic s ramus Ligaments of the Sacrospinous pelvic wall ligament Convert notches into Sacrotuberou foramina: s ligament Greater sciatic foramen Lesser sciatic foramen Obturator membrane Stabilize the sacrum and prevent its rotation. Sacrotuberou s ligament  Anterior sacro-iliac ligament Ligaments of the pelvic wall Sacrospinous ligament Obturator membrane Sacrotuberous ligament Pubic symphysis  Apertures and Getaways Greater sciatic foramen Above piriformis Superior gluteal vessels Superior gluteal nerve Subinguin Below piriformis al hiatus Inferior gluteal vessels Inferior gluteal nerve Iliopsoas Sciatic nerve Femoral vessels Posterior femoral cutaneous Femoral nerve nerve Nerve to quadratus femoris Pudendal nerve Internal pudendal vessels Nerve to obturator internus Lesser sciatic foramen Obturator canal Pudendal nerve Internal pudendal vessels Obturator nerve Nerve to obturator internus Obturator vessels Obturator internus muscle 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 Gluteal region Iliac crust Gluteal region extends Superiorly: iliac crust Gluteal region Inferiorly: gluteal fold Gluteal fold Bonny framework: Posterolateral bony pelvis Proximal femur Muscles: mainly abduct, extend and rotate Important regions: greater and lesser sciatic foramen General arrangement Deep group: Superficial group: Mainly lateral Mainly aBduct the hip rotators Gluteus maximus (extensor) Piriformis Gluteus medius Obturator internus Gluteus minimus Gemellus superior Tensor fascia lata Gemellus inferior (Does NOT abduct the hip, sometimes it is considered an anterior compartment muscle) Quadratus femoris  Gluteal muscles-superficial group Tensor fascia lata Gluteus medius Gluteus maximus Lateral aspect of the ilium to Gluteus minimus the iliotibial From ilium and tract of fascia External surface posterior lata of the ilium to the sacrum/coccyx Superior greater trochanter to iliotibial tract, gluteal nerve Superior gluteal greater Stabilizes the nerve trochanter of knee in Hip abduction and femur. extension Inferior gluteal medial rotation, nerve stabilizes the hip Very powerful while walking. hip extension E.g. climbing stairs, running, rising from a seated position Lateral rotation Trendelenburg gait Contraction of gluteus minimus and medius on the stance side Function of gluteus minimus and prevents excessive pelvic tilt during the swing phase on the medius opposite side Gluteus medius and minimus Pelvis Full support If support from one leg is taken away on two legs The pelvis should drop BUT……  If support from one leg is taken away The pelvis should drop BUT the contraction of the gluteus medius and minimus on the opposite side abduct the pelvis and maintain it Gluteal muscles-deep group Piriformis muscle Gemellus superior From anterior sacrum to From ischial spine to greater greater trochanter. trochanter S1-2 Nerve to obturator internus Laterally rotates extended Laterally rotates extended femur femur at hip and femur femur at hip and abducts flexed femur at hip abducts flexed femur at hip Gemellus inferior From ischial tuberosity to greater trochanter Nerve to quadratus femoris Obturator internus Laterally rotates extended From obturator membrane to femur femur at hip and abducts flexed femur at hip greater trochanter Nerve to obturator internus Laterally rotates extended femur femur at hip and Quadratus femoris From ischium to intertrochanteric abducts flexed femur at hip crest Nerve to quadratus femoris Laterally rotates femur A day at the gym Just for fun! Let’s apply our anatomical knowledge…  Sacral plexus Lumbosacral trunk Superior gluteal nerve Anterior rami of S1-S4 and the lumbosacral trunk (L4-L5). Pudendal nerve Obturator Found anterior to the piriformis muscle nerve Main branches: 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 Inferior gluteal Posterior cutaneous nerve of the nerve thigh (S1-S3) Pudendal nerve (S2-4) Sciatic nerve Pelvic splanchnic nerves (S2-4) Preganglionic parasympathetic and visceral afferents  Superior gluteal nerve Lumbosacral trunk Superior gluteal nerve Obturator nerve Sciatic nerve Posterior Inferior gluteal cutaneous nerve nerve of the Inferior gluteal thigh nerve Sciatic nerve Sciatic nerve Tibial (L4 – S3) Runs vertically along the Sciatic nerve middle of the popliteal fossa Common fibular Common fibular Tibial nerve (peroneal) (peroneal) (L4 – S2) Runs laterally Medial to biceps tendon 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 Highest point on iliac crust Ischial tuberosity Greater trochanter  Posterior compartment of the thigh Biceps femoris (Long head) Semitendinosus Two heads: Semimembranosus From ischial Long head: ischial From ischial tuberosity to tuberosity medial tibia Short head: femur tuberosity to Sciatic nerve Sciatic nerve medial tibia Long head: tibial division Flexes leg at Sciatic nerve Short head: fibular division Flexes leg at the knee, Flexes leg at the knee extends thigh and laterally rotates the the knee, at the hip, extends thigh leg. Extends and medially laterally rotates the thigh at the hip, rotates the leg medially at the hip (only long head). rotates the leg Biceps femoris Hamstring (Short head) Hamstring group: Same origin group Same function Blood supply Superior and inferior gluteal From internal iliac Medial and lateral femoral circumflex From deep femoral artery  Think Pes anserinus Say Grace before Tea! Latin for "goose's foot" and was named based on its similar appearance to Gracilis the webbed three-toed feet of geese. Sartoris In order, from anterior to posterior: Semitendinosus Tendon of Sartorius Tendon Gracilis Tendon of semiTendinosus Thank you