Gluteal Region, Posterior Thigh, and Popliteal Fossa PDF

TABLE OF CONTENTS 1. Os Coxa Gluteal Region, 2. Ligaments of the Pelvic Girdle Posterior Thigh, 3. 4. Hip Joint Muscles of the Gluteal Region Popliteal Fossa 5. Ligaments, Ischioanal Fossa,...

TABLE OF CONTENTS 1. Os Coxa Gluteal Region, 2. Ligaments of the Pelvic Girdle Posterior Thigh, 3. 4. Hip Joint Muscles of the Gluteal Region Popliteal Fossa 5. Ligaments, Ischioanal Fossa, Pudendal Canal, Adductor Hiatus 6. Muscles of the Posterior Thigh 7. Arteries 8. Nerves 9. Practice Questions 10. Muscle Functions 11. Blood Supply and Innervation 12. Clinical - Avulsion Fracture of Hip Bone and Hamstring Muscles 13. Clinical - Gluteal Region Injuries  OUTLINE REVIEW 1. Muscles 2. Arteries (Continued) Quadratus Lumborum Medial Inferior Genicular a. Gluteus Maximus Lateral Inferior Genicular a. Gluteal Region, Gluteus Medius Anterior Tibial a. Gluteus Minimus Anterior Tibial Recurrent a. Piriformis Posterior Thigh, Superior Gemellus Inferior Gemellus Obturator Internus 3. Nerves Superior Gluteal n. Inferior Gluteal n. Popliteal Fossa Quadratus Femoris Adductor Magnus Biceps Femoris Pudendal n. Sciatic n. Posterior Femoral Cutaneous n. Semitendinosus Tibial n. Semimembranosus Common Fibular n. Popliteus Lateral Sural Cutaneous n. Plantaris Medial Sural Cutaneous n. Gastrocnemius 4. Ligaments 2. Arteries Sacrospinous Superior Gluteal a. Sacrotuberous Inferior Gluteal a. Internal Pudendal a. 5. Miscellaneous Perforating a. Pudendal Canal Popliteal a. Ischioanal Fossa Medial Superior Genicular a. Greater Sciatic Foramen Lateral Superior Genicular a. Lesser Sciatic Foraman Middle Genicular a. Adductor Hiatus https://upload.wikimedia.org/wikipedia/commons/8/8d/Quadratuslumborum.png https://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/Posterior https://upload.wikimedia.org/wikipedia/commons/7/70/Posterior _Hip_Muscles_1.svg/1200px-Posterior_Hip_Muscles_1.svg.png _Hip_Muscles_3.PNG TRENDELENBURG SIGN  https://upload.wikimedia.org/wikipedia/commons/e/e5/Gray1243.png NAMING LIGAMENTS LOCATION 1 I LOCATION 2  https://upload.wikimedia.org/wikipedia/commons/b/ba/Gray407.png OSTERIOLATERAL VIEW A SUPERIORVIEW I AN FLOOR LEVATOR PELVIC is GLUTEUSMAX GLUTEUSMAX 5 LevatorAN.IT SKIN E p PEW won INFERIORVIEW https://upload.wikimedia.org/wikipedia/commons/b/b3/Gray402.png To https://upload.wikimedia.org/wikipedia/commons/0/02/Gray433.png  HAMSTRING https://upload.wikimedia.org/wikipedia/commons/b/bf/Semimembranosus_muscle.PNG https://upload.wikimedia.org/wikipedia/commons/3/3f/Semitendinosus_muscle.PNG https://upload.wikimedia.org/wikipedia/commons/b/bc/Biceps_femoris_muscle_long_head.PNG https://upload.wikimedia.org/wikipedia/commons/4/4a/Gray439-Musculus_popliteus.png https://upload.wikimedia.org/wikipedia/commons/6/66/Gray438-Musculus_plantaris.png IIeTF Eigg'i go up erp At https://upload.wikimedia.org/wikipedia/commons/ c/c5/Circumflex_femoral_arteries.png https://upload.wikimedia.org/wikipedia/commons/0/0d/Gray552.png https://upload.wikimedia.org/wikipedia/commons/d/d8/Gray352.png ARTERIALRIEVIEW POPLITEAL A MEDIAL SUP GENICULAR A LATERALSUP GENICULAR A MIDDLE GENICULAR A MEDIAL INF GENICULARA LATERAL INF GENICULAR A ANTERIOR TIBIAL A POSTERIOR TIBIAL A FIBULAR A https://upload.wikimedia.org/wikipedia/commons/thumb/b/b7/Sacral_Plexus_la.svg/777px-Sacral_Plexus_la.svg.png https://upload.wikimedia.org/wikipedia/commons/9/93/Piriformis_muscle.PNG SUPER.GL N INF GL N 14 POST F OUT N 15 PUDENDAL N SI SCIATIC N S2 S3 S4 ANTERIOR DIVISION POSTERIOR DIVISION  https://upload.wikimedia.org/wikipedia/commons/b/bf/Gray826and831.PNG https://upload.wikimedia.org/wikipedia/commons/9/9d/Gray832.png ow  OUTLINE REVIEW 1. Muscles 2. Arteries (Continued) Quadratus Lumborum Medial Inferior Genicular a. Gluteus Maximus Lateral Inferior Genicular a. Gluteal Region, Posterior Thigh, Gluteus Medius Anterior Tibial a. Anterior Tibial Recurrent a. Popliteal Fossa Gluteus Minimus Piriformis Superior Gemellus 3. Nerves Inferior Gemellus Superior Gluteal n. Can you name the borders Obturator Internus Inferior Gluteal n. of the ischioanal fossa? Quadratus Femoris Pudendal n. Adductor Magnus Sciatic n. Can you draw the arteries of Biceps Femoris Posterior Femoral Cutaneous n. Semitendinosus Tibial n. the knee? Semimembranosus Common Fibular n. What are the nerves in Popliteus Lateral Sural Cutaneous n. Plantaris Medial Sural Cutaneous n. SIPPS? Gastrocnemius 4. Ligaments 2. Arteries Sacrospinous Superior Gluteal a. Sacrotuberous Inferior Gluteal a. Internal Pudendal a. 5. Miscellaneous Perforating a. Pudendal Canal Popliteal a. Ischioanal Fossa Medial Superior Genicular a. Greater Sciatic Foramen Lateral Superior Genicular a. Lesser Sciatic Forman Middle Genicular a. Adductor Hiatus REVIEW OUTLINE 1. Function Gluteal Region, 2. Muscles Posterior Thigh, Quadratus lumborum Gluteus maximus Popliteal Fossa Gluteus medius Gluteus minimus Piriformis Superior gemellus Inferior gemellus Obturator internus Quadratus femoris Biceps femoris Semitendinous Semimembranosus Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/8/8d/Quadratuslumborum.png QUADRATUS Lum Borum µ O EXTENSION of trunk f LATERALFLEXIONOFTRUNK  Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com GLUTEUS MAXIMUS 0 my my I BE GLUTEUS MEDIUS O 1 mammoth https://upload.wikimedia.org/wikipedia/commons/7/70/Posterior_Hip_Muscles_3.PNG Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com GLUTEUS MINIMUS man gum mmmm Itamar iWo a man moan https://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/ Posterior_Hip_Muscles_1.svg/1200px-Posterior_Hip_Muscles_1.svg.png Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com PIRIFORMIS O SUPERIOR Gemellus Whyy woman My OBTURATOR INTERNUS isms MAMA My QUADRATUS FEMORIS Mamma https://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/ Posterior_Hip_Muscles_1.svg/1200px-Posterior_Hip_Muscles_1.svg.png  Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/b/bf/Semimembranosus_muscle.PNG  Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com GLUTEUS MAXIMUS OR MM NYA GLUTEUS MEDIUS j AWB MEDIALROTATION OFTHIGH Badaag mammoths https://upload.wikimedia.org/wikipedia/commons/7/70/Posterior_Hip_Muscles_3.PNG Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com PIRIFORMIS SUPERIOR GEMELLUS gAqppqhhMMfMEo MMMM qfffgqpg.no INFERIOR GEMELLUS OBTURATOR INTERNUS got JM Ahhh m OBTURATOR EXTERNUS g EE QUADRATUS FEMORIS E EE ABDUCT FLEXED THIGH Affffffff p Iggy mmmm amaan https://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/ Posterior_Hip_Muscles_1.svg/1200px-Posterior_Hip_Muscles_1.svg.png REVIEW OUTLINE 1. Function Gluteal Region, 2. Muscles Posterior Thigh, Quadratus lumborum Gluteus maximus Popliteal Fossa Gluteus medius Gluteus minimus Piriformis Superior gemellus Inferior gemellus Review Questions Obturator internus Quadratus femoris Can you name the function(s) for Biceps femoris all of the muscles listed? Semitendinous Semimembranosus REVIEW OUTLINE 1. Blood Supply Gluteal Region, 2. Innervation Posterior Thigh, 3. Muscles Popliteal Fossa Quadratus lumborum Gluteus maximus Gluteus medius Gluteus minimus Piriformis Superior gemellus Inferior gemellus Obturator internus Quadratus femoris Biceps femoris Semitendinous Semimembranosus  Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://en.wikipedia.org/wiki/Internal_pudendal_artery#/media/File:Internal_iliac_branches.PNG subcosima 1stuntlumBaran natoi wmon.rorn owmoara.fr Iu ILIAC Branch or.IlIowmBara IEowmbara Internal external n.ca Iu Ian.ca Femorala superior Gluten.in Deep FemorainT LINEERIOR Gluten.in f Internal I raicircumnex puoenon.la Io.mn zn Femorala meDIaicIrcumr orntIna ia.a LExr emorn nncn e sorn.ca premor Descenoenaaenecocara Poparena a v reoriaterm superiorMEDIAL Geniculaten Niemann aa x Errorintern InteriorMEDIAL Inecuatea GeniculateA Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/8/8d/Quadratuslumborum.png subcif 1stunthumbaran LUMIERE IT QUADRATUS LUMBorum mama AM I EYE Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/7/70/Posterior_Hip_Muscles_3.PNG is if MY NM G mmp to GLUTEUS MEDIUS 00 WE a mammoth Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/ Posterior_Hip_Muscles_1.svg/1200px-Posterior_Hip_Muscles_1.svg.png GLUTEUS MINIMUS is mean ma EYE PIRIFORMIS gumma a I Édiam IÉÉÉÉÉ QUADRATUS FEMORIS not Dnm momma  Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/ Posterior_Hip_Muscles_1.svg/1200px-Posterior_Hip_Muscles_1.svg.png SUPERIOR GEMELLUS Mmm EYE mmmm TEETH of B.jo fMMMFEMEEALAT i INFERIOR GEMELLUS mom r In MMM 78 RaiCircumflex n My ing torn OBTURATOR INTERNUS Mpp app MEDIALCIRCUMFLEX I  Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/b/bf/Semimembranosus_muscle.PNG HAMSTRINGS IS is VARIABLE FIERI EYE SEMITENDINOSUS FEMORAL A superior antenna n In RaiCircumflex INTERNAL 1 I Endara looturatora SEMIMEMBRANOSUS FEMORALA portent i a.m INFERIORMEDIAL i Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/8/8d/Quadratuslumborum.png QUADRATUS LUMBORUM FE  Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/7/70/Posterior_Hip_Muscles_3.PNG 14 S2 S3 S4 PUDENDAL n E a pt Nto PIRIFORMIS e on 5 a or i e E NTOOBTURATORINTERNUS E SUPERIOR GEMELLUS s E or E NTOQUADRATUSFEMORIS s a en o e i E INFERIORGeminus  Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/ Posterior_Hip_Muscles_1.svg/1200px-Posterior_Hip_Muscles_1.svg.png 14 S2 S3 S4 PUDENDAL n E a pt Nto PIRIFORMIS e on 5 a or i e E NTOOBTURATORINTERNUS E SUPERIOR GEMELLUS s E or E NTOQUADRATUSFEMORIS s a en o e i E INFERIORGeminus Gluteal Region, Posterior Thigh, Popliteal Fossa Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/b/bf/Semimembranosus_muscle.PNG 14 S2 rn S3 N 54 BICEPSFEMORIS e SEMITENDINOSUS SEMIMEMBRANOWS B e SHORTHEAD i je NioobturatorIn rµu y µ E SUPERIOR GEMELLUS je Es npoaun.mn.to µo E INFERIORGeminus E En REVIEW OUTLINE 1. Blood Supply Gluteal Region, 2. Innervation Posterior Thigh, 3. Muscles Popliteal Fossa Quadratus lumborum Gluteus maximus Gluteus medius Gluteus minimus Piriformis Review Questions Superior gemellus Inferior gemellus Can you name the blood supply Obturator internus and innervation for all of the Quadratus femoris muscles listed? Biceps femoris Semitendinous Semimembranosus REVIEW OUTLINE Avulsion 1. Avulsion Fracture Fracture of 2. Hamstring Muscles Actions the Hip Bone Innervation & Hamstring 3. Clinical Manifestations Muscles  Avulsion Fracture of the Hip Bone & Hamstring Muscles Bootcamp.com Occurs where muscles are attached (e.g. ischial tuberosity for hamstring muscles) Clinical Manifestations Hip or posterior thigh pain Ischial Abnormal gait tuberosity Swelling of buttocks Impaired hip extension & knee flexion Biceps femoris Actions Innervation Hip extension & Tibial n. except for Semitendinosus knee flexion short head of biceps femoris (common fibular n.) Semimembranosus Knowledge Check Bootcamp.com What is an avulsion fracture? An avulsion fracture of the ischial tuberosity would impair which group of muscles? Which actions would be impaired? Knowledge Check Bootcamp.com What is an avulsion fracture? When a piece of bone that is attached to a tendon or ligament separates from the rest of the bone An avulsion fracture of the ischial tuberosity would impair which group of muscles? Which actions would be impaired? Impairs the hamstring muscles (biceps femoris, semitendinosus, semimembranosus) → Impaired hip extension & knee flexion References Bootcamp.com Slide 2 BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons REVIEW OUTLINE Avulsion 1. Avulsion Fracture Fracture of 2. Hamstring Muscles Actions the Hip Bone Innervation & Hamstring 3. Clinical Manifestations Muscles REVIEW OUTLINE 1. Piriformis Syndrome Cause Symptoms Landmarks Gluteal 2. Sciatic Nerve Injury Cause Symptoms Region Other implicated structures Injuries 3. Superior Gluteal Nerve Injury Causes Symptoms Trendelenburg gait 4. Inferior Gluteal Nerve Injury Causes Symptoms Piriformis Syndrome Bootcamp.com Piriformis inflammation/spasm compressing the sciatic n. Symptoms similar to sciatica Pain, tingling, numbness in buttocks that can extend down posterior thigh, leg & foot Increased pain when walking up stairs or after prolonged sitting Sciatic n. Landmark Superior gluteal n./a./v. Piriformis Inferior gluteal n./a./v. Sciatic Nerve Injury Bootcamp.com Sciatica Improper Gluteal Injection Posterior Hip Dislocation Safe area Herniated IV disc compressing the Gluteus maximus sciatic nerve Gluteus medius Sciatic n. Sciatic Nerve Injury Bootcamp.com Sciatic n. Weakened hip extension & knee flexion Posterior thigh Hamstring portion of adductor magnus Foot Drop Tibial n. Inability to Posterior leg dorsiflex foot Intrinsic muscles of the foot Common fibular n. Anterior & lateral leg Flail Foot (inability to dorsiflex Intrinsic muscles of & plantarflex foot) the foot Superior Gluteal Nerve Injury Bootcamp.com Trendelenburg Gait Superior gluteal n. Gluteus medius Gluteus minimus Lose the ability to pull the pelvis up & abduct the thigh Pelvis drops on contralateral side of injury Causes Surgery Greater trochanter fracture Posterior hip dislocation Poliomyelitis Inferior Gluteal Nerve Injury Bootcamp.com Inferior gluteal n. Weakened hip extension Gluteus maximus Most noticeable when climbing stairs or standing from seated Causes Surgery Posterior hip dislocation Knowledge Check Bootcamp.com A patient presents to your clinic complaining of “pins and needles” in her toes and sole of her left foot, and altered sensation (paresthesia) in her left calf. Additionally, she admits that she is experiencing a sharp pain in the center of her buttocks. You determine that she is suffering from piriformis syndrome. 1. Identify the function of the piriformis muscle. A. Internal rotation of the hip B. Hip extension C. External rotation of the hip D. Hip abduction E. Hip flexion Knowledge Check Bootcamp.com A patient presents to your clinic complaining of “pins and needles” in her toes and sole of her left foot, and altered sensation (paresthesia) in her left calf. Additionally, she admits that she is experiencing a sharp pain in the center of her buttocks. You determine that she is suffering from piriformis syndrome. 1. Identify the function of the piriformis muscle. A. Internal rotation of the hip B. Hip extension C. External rotation of the hip D. Hip abduction E. Hip flexion Knowledge Check Bootcamp.com 2. Piriformis syndrome is a result of inflammation or spasm of the piriformis muscle, ultimately causing compression of which nerve? A. Superior gluteal nerve B. Inferior gluteal nerve C. Nerve to piriformis D. Nerve to quadratus femoris E. Sciatic nerve 3. The piriformis muscle also serves as a landmark for which two nerves? Select all that apply. Superior gluteal nerve Inferior gluteal nerve Nerve to piriformis Nerve to quadratus femoris Pudendal nerve Knowledge Check Bootcamp.com 2. Piriformis syndrome is a result of inflammation or spasm of the piriformis muscle, ultimately causing compression of which nerve? A. Superior gluteal nerve B. Inferior gluteal nerve C. Nerve to piriformis D. Nerve to quadratus femoris E. Sciatic nerve 3. The piriformis muscle also serves as a landmark for which two nerves? Select all that apply. Superior gluteal nerve Inferior gluteal nerve Nerve to piriformis Nerve to quadratus femoris Pudendal nerve Knowledge Check Bootcamp.com Based on the anatomy of the gluteal region, which quadrant is safest to administer intragluteal injections? A. Superior lateral quadrant B. Superior medial quadrant C. Inferior lateral quadrant D. Inferior medial quadrant One week after you administered an intragluteal injection, your patient returns complaining of weakness “in his right hip”. You observe him walking and notice that he displays ‘hip drop’ on his left side during gait. 1. Which muscles are responsible for stabilizing the pelvis during gait? Select all that apply. Gluteus maximus Piriformis Gluteus medius Tensor fascia latae Gluteus minimus Quadratus femoris Knowledge Check Bootcamp.com Based on the anatomy of the gluteal region, which quadrant is safest to administer intragluteal injections? A. Superior lateral quadrant B. Superior medial quadrant C. Inferior lateral quadrant D. Inferior medial quadrant One week after you administered an intragluteal injection, your patient returns complaining of weakness “in his right hip”. You observe him walking and notice that he displays ‘hip drop’ on his left side during gait. 1. Which muscles are responsible for stabilizing the pelvis during gait? Select all that apply. Gluteus maximus Piriformis Gluteus medius Tensor fascia latae Gluteus minimus Quadratus femoris Knowledge Check Bootcamp.com 2. Which nerve was most likely damaged during the intragluteal injection, ultimately leading to the gait deficits? A. Femoral nerve B. Nerve to piriformis C. Superior gluteal nerve D. Inferior gluteal nerve E. Sciatic nerve 3. The clinical sign that the patient is presenting with is known as: A. Piriformis syndrome B. Trendelenburg gait C. Ataxia Knowledge Check Bootcamp.com 2. Which nerve was most likely damaged during the intragluteal injection, ultimately leading to the gait deficits? A. Femoral nerve B. Nerve to piriformis C. Superior gluteal nerve D. Inferior gluteal nerve E. Sciatic nerve 3. The clinical sign that the patient is presenting with is known as: A. Piriformis syndrome B. Trendelenburg gait C. Ataxia Knowledge Check Bootcamp.com You are working the night shift when a patient who was a passenger in a car accident comes to the emergency room. Upon examination, you determine that they are suffering from a posterior hip dislocation. Which nerves can be injured as a result of the hip dislocation? Select all that apply. Superior gluteal nerve Inferior gluteal nerve Nerve to piriformis Nerve to quadratus femoris Pudendal nerve Knowledge Check Bootcamp.com You are working the night shift when a patient who was a passenger in a car accident comes to the emergency room. Upon examination, you determine that they are suffering from a posterior hip dislocation. Which nerves can be injured as a result of the hip dislocation? Select all that apply. Superior gluteal nerve Inferior gluteal nerve Nerve to piriformis Nerve to quadratus femoris Pudendal nerve References Bootcamp.com Slide 2 Alice Roberts, CC BY 2.0, via Wikimedia Commons Slide 3 Sciatica: BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons Gluteal Injection: Dr. Johannes Sobotta, Public domain, via Wikimedia Commons Posterior Dislocation: www.scientificanimations.com/, CC BY-SA 4.0, via Wikimedia Commons Slide 4 Nerves: Henry Vandyke Carter, Public domain, via Wikimedia Commons Foot Drop: Pagemaker787, CC BY-SA 4.0, via Wikimedia Commons Slide 5 Muscles: OpenStax College, CC BY 3.0, via Wikimedia Commons Tredelenburg Gait: S. Bhimji, CC BY 4.0, via Wikimedia Commons Slide 6 Alice Roberts, CC BY 2.0, via Wikimedia Commons REVIEW OUTLINE 1. Piriformis Syndrome Cause Symptoms Landmarks Gluteal 2. Sciatic Nerve Injury Cause Symptoms Region Other implicated structures Injuries 3. Superior Gluteal Nerve Injury Causes Symptoms Trendelenburg gait 4. Inferior Gluteal Nerve Injury Causes Symptoms