gluteal region clinical anatomy

Gluteal Region:

Clinical Anatomy

Presented by

Dr. Maryna Kornieieva

Asst. of Anatomy Department

Boundaries

Lateral:

along the side of

the greater

trochanter.

Superior: along the side of the iliac crest.

Inferior: along the side of the gluteal folds.

Fasciae of Gluteal region

Superficial Fascia Deep Fascia

It splits to enclose the gluteus maximus,

then continues as a single layer over the

outer surface of the gluteus medius and

attaches to the iliac crest.

Bellow, it continues with the fascia lata of

the thigh.

It is thick, especially in women, and is

impregnated with large amount of fat. It

gives passage for the superficial nerves and

veins:

Iliotibial Tract (Band)

The iliotibial

tract is a

thickness of

fascia latae on the

lateral side of

thigh.

Function: Stabilizes the knee in

extension.

It extends from the

anterior superior iliac spine to the

anterolateral surface of

the lateral condyle of

the tibia..

Tensor Fascia Lata

Origin:

Iliac crest

Action: Assists gluteus maximus in

extending the knee joint.Innervation:

Superior gluteal nerve

Insertion:

Iliotibial tract

Gluteus MaximusOrigin: Outer surface of ilium,

sacrum, coccyx, Sacrotuberous

ligament

Insertion: Iliotibial tract and gluteal

tuberosity of femur.

Innervation: Inferior gluteal nerve

Action: Extends and laterally rotates hip joint; through iliotibial

tract, it extends knee joint.

Intramuscular injections

Gluteal Abscess after Intramuscular

Injection

CT Scan of a Gluteal Abscess after Intramuscular Injection.

LR

Gluteus MediusOrigin:Outer surface of ilium

Insertion:Lateral surface of

greater trochanter

of femur

Action: Abducts thigh at hip joint; tilts elvis

when walking to permit opposite leg

to clear ground.

Innervation: Superior

gluteal nerve

Gluteus medius is the main abductor

of the hip.

Gluteus MinimusOrigin:Outer surface of

ilium

Insertion:Anterior surface of

greater trochanter

of femur

Innervation: Superior gluteal

nerve

Action:

Abducts thigh at hip

joint; tilts pelvis when

walking to permit

opposite leg to clear

ground

Trendelenburg’s testGoal: to assess

the

integrity

of gluteus

medius

and its

function

as the

main hip

abductor.

Norma: if a patient is asked to stand

on one leg, the other limb is raised by

tilting the pelvis on a fixed limb by

contracting gluteus medius.

Pathology: the opposite (good hip) drops as the gluteus

medius on the affected side does not contract.

Common cause: pain in the hip (osteoarthritis) causing

reflex inhibition of the gluteus medius contraction.

Deep muscles: lateral rotators

Piriformis

Origin:Anterior surface

of sacrum

Action: Lateral rotator of thigh at hip joint

Innervation: 1st and 2nd sacral nerves

Insertion:Upper border of

greater trochanter

of femur

It leaves pelvis by way of the

greater sciatic foramen

Piriformis

Piriformis is the key landmark in the gluteal region – above it are the superior gluteal nerve and vessels and below it are the inferior gluteal nerve and vessels, sciatic nerve, posterior cutaneous nerve of thigh and the structures running around the ischial spine to the perineum

(pudendal nerve, the nerve to obturator internus and the internal pudendal vessels).

Obturator externus

(belongs to the medial fascial

compartment of thigh)

Origin:Outer surface of obturator

membrane and pubic

and ischial ramiInsertion:Medial surface of

greater trochanter

Innervation: Obturator nerve

Action: Laterally rotates thigh at hip joint

Obturator internusInsertion:Upper border of

greater trochanter

of femur

Origin:Inner surface

of obturator

membrane

Innervation: Sacral plexus

Action: Lateral

rotator of

thigh at hip

joint

Gemellus muscles

Origin:Spine and

tuberosity of

ischium

Innervation: Sacral plexus

Action: Lateral rotator of

thigh at hip joint

Insertion:Upper border of

greater trochanter

of femur

Quadratus femoris

Origin:Lateral border

of ischial

tuberosity

Action: Lateral rotator of

thigh at hip joint

Insertion:Quadrate

tubercle of

femur

Innervation: Sacral plexus

Posterior approach to the Hip

The gluteal region is a common approach to the hip joint for arthroplasty and the

lateral rotator muscles are used as landmarks and can be dissected off the femur

and rolled medially over the sciatic nerve to protect it.

Kocher-Langenbeck

Suprapiriform foramen

SPF: contents

Superior Gluteal Nerve Superior Gluteal Artery

• Gluteus minimus

• Gluteus medius

• Tensor fasciae

latae

Infrapiriform foramen

IPF: contents

Inferior Gluteal Artery

Pudendal Artery

Sciatic nerve

Nerve to the quadratus femoris

Nerve to the obturator internus

Posterior cutaneous nerve of the thigh

Pudendal nerve

Inferior gluteal nerve

• Gluteus maximus

• Quadratus femoris

• Gemellus inferior

• Obturatus internus

• Gemellus superiorSkin on the posterior thigh and leg

Perineum

• Semitendinosus

• Semimembranosus

• Biceps femoris

Tibial n. Common

fibular n.

Lumbosacral Plexus

Coccygeal plexusLumbar plexus Sacral plexus

(½)T12+(L1-L4)1/2L4+L5+S1-S4

Coccygeal nerve

(½)S4+S5 + Co1

Sacral plexus

Sciatic nerve

Pudendal nerve

Arteries of Gluteal region

Inferior Gluteal Artery

Superior Gluteal Artery

Internal Iliac Artery

External iliac arteryFemoral artery

Cross-section through the hip

Trochanteric bursa

Obturator externus

Gluteus medius

Iliopsoas

Tensor fasciae lata

Rectus femoris

SartoriusFemoral vessels

Femoral nerve

Ilio-psoas bursa

Obturator internus

Gemellus inferior

Sciatic nerve

T1FS CORONAL IMAGE OF A NORMAL HIP.

T1FS axial image of a normal hip

T1FS sagittal image of a normal hip

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