GLUTEAL REGION Prof Saeed Abuel Makarem UPPER MEDIAL

GLUTEAL REGION Prof. Saeed Abuel Makarem

UPPER MEDIAL QUADRANT: UPPER LATERAL QUADRANT: posterior rami of L 1, 2, 3 and S 1, 2, 3 CUTANEOUS SUPPLY lateral branches of Subcostal & Iliohypogastric nerves LOWER MEDIAL QUADRANT: Gluteal branches of posterior cutaneous nerve of the thigh LOWER LATERAL QUADRANT: posterior branch of lateral cutaneous nerve of the thigh Prof. Saeed Abuel Makarem

CONTENTS 1. 2. 3. 4. MUSCLES: GLUTEI Gluteus maximus Gluteus medius Gluteus minimus GROUP OF SMALL MUSCLES (Lateral rotators of thigh) Piriformis Obturator internus Gemilli (superior & inferior) Quadratus femoris Prof. Saeed Abuel Makarem

CONTENTS NERVES : (FROM SACRAL PLEXUS): Superior & inferior gluteal, Posterior cutaneous nerve of thigh, Nerve to obturator internus, Nerve to quadratus femoris, Pudendal nerve, Sciatic nerve. VESSELS : (INTERNAL ILIAC ARTERY): Superior & inferior gluteal, Internal pudendal vessels. Prof. Saeed Abuel Makarem

Gluteus maximus: 5. Main origin: back of sacrum & coccyx back of sacrotuberous ligament Other origin: gluteal surface of ilium, Gluteus minimus: 1. 2. 3. 4. behind posterior gluteal line gluteal surface of ilium, Gluteus medius: GLUTEI between inferior & middle gluteal lines gluteal surface of ilium, between middle & posterior gluteal lines Prof. Saeed Abuel Makarem

GLUTEI INSERTIONS 1. 2. 3. 4. Gluteus minimus: anterior surface of greater trochanter Gluteus medius: lateral surface of greater trochanter Gluteus maximus: Main insertion: iliotibial tract Other insertion: gluteal tuberosity of femur Prof. Saeed Abuel Makarem

GLUTEI NERVE SUPPLY & ACTION Gluteus medius & minimus: Nerve supply: Superior gluteal nerve Action: Abduction & medial rotation of hip joint Gluteus maximus: Nerve supply: Inferior gluteal nerve Main action: Extension & lateral rotation of hip joint Other action: Through its attachment to iliotibial tract, it stabilizes the femur on tibia during standing Prof. Saeed Abuel Makarem

Group of small muscles ALL MUSCLES HAVE SIMILAR ACTION: Control movements of the hip join Help in lateral rotation of the hip Prof. Saeed Abuel Makarem

Group of small muscles QUADRATUS FEMORIS Origin: lateral border of ischial tuberosity Insertion: quadrate tubercle & intertrochanteric crest Nerve supply: nerve to quadratus femoris Prof. Saeed Abuel Makarem

Group of small muscles OBTURATOR INTERNUS Origin: inner surface of obturator membrane, inner margin of obturator foramen & wide area above & behind it Insertion: the tendon passes through LSF to be inserted into the inner surface of greater trochanter. Nerve supply: nerve to obturator internus SUPERIOR & INFERIOR GEMILLUS Origin: upper part & lower part of lesser sciatic notch respectively Insertion: upper part & lower part of tendon of obturator internus Nerve supply: nerve to obturator internus supply superior gemellus nerve to quadratus femoris supply inferior gemellus Prof. Saeed Abuel Makarem

Group of small muscles PIRIFORMIS Origin: pelvic surface of middle 3 sacral vertebrae. Insertion: the msucle passes through GSF to be inserted into the upper border of greater trochanter Nerve supply: anterior rami of S 1, 2 Prof. Saeed Abuel Makarem

SUPERIOR GLUTEAL Course: passes through GSF, above piriformis, then between NERVES gluteus medius & minimus Branches: Muscular to gluteus medius, minimus & tensor fasciae latae 2. Articular to hip joint INFERIOR GLUTERAL Course: passes through GSF, below piriformis, then deep to 1. gluteus maximus Branches: muscular to gluteus maximus NERVE TO QUADRATUS FEMORIS Course: passes through GSF, below piriformis Branches: 1. Muscular to quadratus femoris & inferior gemillus 2. Articular to hip joint Prof. Saeed Abuel Makarem

NERVES Posterior cutaneous nerve of the thigh Course: passes through GSF, below piriformis, then descends deep to deep fascia Branches: cutaneous branches to: gluteal region, back of scrotum (labium majus) back of thigh & upper part of back of leg. Prof. Saeed Abuel Makarem

SCIATIC Course: passes through GSF, below piriformis, then superficial to: ischial spine, superior gemillus, tendon of obturator internus, inferior gemillus, quadratus femoris & adductor magnus Branches: no branches in gluteal region, It divides into tibial & common peroneal nerves, in the middle of back of thigh Prof. Saeed Abuel Makarem

NERVE TO OBTURATOR INTERNUS Course: passes through GSF, below piriformis, then crosses the base of ischial spine & passes through LSF Branches: muscular to obturator internus & superior gemillus PUDENDAL Course: passes through GSF, below piriformis, then crosses the sacrospinous ligament & passes through LSF Branches: no branches in gluteal region NERVES Prof. Saeed Abuel Makarem

ARTERIES SUPERIOR GLUTEAL Course: passes through GSF, above piriformis, then divides into superficial branch between gluteus maximus & medius and deep branch between gluteus medius & minimus INFERIOR GLUTEAL Course: passes through GSF, below piriformis, then deep to gluteus maximus with the inferior gluteal nerve Branches of superior & inferior gluteal: muscular branches & articular branches to hip hoint INTERNAL PUDENDAL Course: passes through GSF, below piriformis, then crosses the tip of ischial spine & passes through LSF Branches: no branches in gluteal region Prof. Saeed Abuel Makarem

IMPORTANT ANASTOMOSES IN THE THIGH These are collateral anastomosis between the internal & external iliac arteries. They are of great importance, when the femoral artery is obstructed above the origin of the profunda femoris artery. Prof. Saeed Abuel Makarem

IMPORTANT ANASTOMOSES TROCHANTERIC ANASTOMOSIS Site: in the region of trochanteric fossa Importance: main supply for neck & head of femur Constituents: 1. Superior gluteal 2. Inferior gluteal 3. Medial circumflex femoral Prof. Saeed Abuel Makarem

CRUCIATE ANASTOMOSIS Site: at the upper border of adductor magnus (at level of lesser trochanter, UPPER ART OF THE BACK OF THE THIGH) Constituents: Inferior gluteal MCF LCF 1 st perforating Prof. Saeed Abuel Makarem

Greater Sciatic Foramen BOUNDARIES Greater sciatic notch, sacrotuberous & sacrospinous ligament & ischial spine STRUCTURES PASSING THROUGH IT Piriformis 2 structures above piriformis: superior gluteal nerve & vessels 8 structures below piriformis: inferior gluteal nerve & vessels, sciatic nerve, posterior cutaneous nerve of thigh, nerve to quadratus femoris, nerve to obturator internus, internal pudendal vessels, pudendal nerve Prof. Saeed Abuel Makarem

Lesser Sciatic Foramen BOUNDARIES Body of ischium, sacrotuberous ligament & sacrospinous ligament & ischial spine STRUCTURES PASSING THROUGH IT: Tendon of obturator internus, nerve to obturator internus, internal pudendal vessels, pudendal nerve Prof. Saeed Abuel Makarem

Prof. Saeed Abuel Makarem