GLUTEAL REGION IN 10 QUESTIONS Kaan Ycel M

GLUTEAL REGION IN 10 QUESTIONS Kaan Yücel M. D. , Ph. D. 27. February. 2013 Wednesday 1

1. What is gluteal region? (G. gloutos, buttocks) transitional region between trunk & lower limbs. Anterior superior iliac spine 2

2. How are the muscles of the gluteal region organized? Deep lateral rotators of the femur @ hip joint. piriformis, obturator internus, gemellus superior, gemellus inferior, and quadratus femoris Superficial abduct and extend the hip gluteus minimus, gluteus medius, and gluteus maximus 3

3. . . deep muscles of the gluteal region? . 4

Piriformis Anterior surface of sacrum Sacrotuberous ligament Superior border of greater trochanter of femur 5

Superior gemellus-Obturator internus-Inferior gemellus • Ischial spine • Pelvic surface of obturator membrane and surrounding bones • Ischial tuberosity Medial surface of greater trochanter (trochanteric fossa) of femur 6

Quadratus femoris Ischial tuberosity Quadrate tubercle on intertrochanteric crest of femur and area inferior to it 7

4. . . superficial muscles in the gluteal region? . External surface of ilium between anterior and posterior gluteal lines External Ilium posterior surfacetoofposterior gluteal ilium between line; dorsal surface of sacrum anterior and coccyx; inferior Lateraland surface of Anterior surface of sacrotuberous gluteal lines ligament greater trochanter of greater trochanter femur of femur Iliotibial tract & gluteal tuberosity of femur 8

5. . . functions of the gluteal region muscles? Muscles in the gluteal region mainly abduct , extend, and laterally rotate the femur. relative to the pelvic bone. 9

6. . innervation of the gluteal region muscles? Superior gluteal nerve Inferior gluteal nerve Gluteus minimus & medius. Tensor fascia latae Gluteus maximus Nerve to the quadratus femoris Quadratus femoris Gemellus inferior Nerve to the obturator internus Obturator internus Gemellus superior Nerve to the piriformis Piriformis 10

Between gluteus maximus & greater trochanter Present @ birth G L U T E A L BURSAE 11

7. . nerves of the gluteal region? 1. 2. . 3. 4. 5. 6. 7. Superior gluteal nerve Inferior gluteal nerve Sciatic nerve Nerve to the quadratus femoris Nerve to the obturator internus Posterior cutaneous nerve of the thigh Pudendal nerve greater sciatic foramen 12

Superior & inferior gluteal nerves. * Above the piriformis tensor fasciae latae Posterior to 13

Sciatic nerve Superficial muscles Deep muscles . lies just deep to gluteus maximus midpoint between ischial tuberosity & greater trochanter Enters thigh 14

Nerve to Quadratus Femoris. Inferior to piriformis Deep to sciatic nerve * anterior to the plane of the deep muscles 15

Nerve to Obturator Internus between. posterior cutaneous nerve of thigh & pudendal nerve + GS 16

Posterior Cutaneous Nerve of Thigh. Medial to sciatic nerve Skin over the gluteal fold 17

Pudendal nerve. 18

Sensory Innervation of the Gluteal Region Nerve . Superior clunial nerves Origin (Contributing spinal nerves) L 1 -L 3 posterior rami Course Distrubition Penetrate thoracodorsal fascia; course laterally and inferiorly in subcutaneous tissue Medial clunial S 1 -S 3 posterior Emerge from dorsal sacral nerves rami foramina; directly enter overlying subcutaneous tissue Inferior clunial Posterior Arise deep to gluteus maximus; nerves cutaneous nerve of emerge from beneath inferior thigh (S 2 -S 3) border of muscle Skin overlying superior and central parts of buttock Subcostal Lateral cutaneous branch supplies skin of hip region inferior to anterior part of iliac crest and anterior to greater trochanter Lateral cutaneous branch supplies superolateral quadrant of buttock T 12 anterior ramus Courses along inferior border of 12 th rib; lateral cutaneous branch descends over iliac crest Iliohypogastric Lumbar plexus (L 1; Parallels iliac crest; divides into occasionally T 12) lateral and anterior cutaneous branches Skin of medial buttock and intergluteal cleft Skin of inferior buttock (overlying gluteal fold) Lateral cutaneous nerve of thigh skin overlying the lower lateral quadrant of the buttock. Perforating cutaneous nerve skin over the medial aspect of the gluteus maximus. 19

8. . . arteries in the gluteal region? . 20

9. . . veins in the gluteal region? Internal iliac veins . Femoral vein 21

10. . . lymphatics of the gluteal region? Lymph from deep tissue superior & inferior gluteal lymph nodes. internal, external, common iliac lymph nodes lateral lumbar (aortic/caval) lymph nodes Lymph from superficial tissue superficial inguinal lymph nodes external iliac lymph nodes 22