gluteal region by ritika
TRANSCRIPT
GLUTEAL REGION
INTRODUCTION
• Gluteal = Rump (G)
• Extent: Iliac Crest To Gluteal Fold
• Natis or Buttock
• Hip
SKIN AND FASCIA
• Superficial fasciaThick, dense, well developed, laden with large quantities of fat that:– Gives the characteristic
convexity to the buttock
– Forms a thick cushion over the ischialtuberosity
• Deep fascia•Continuous with the deep fascia of the thigh (fascia lata).•At the lower border of the gluteus maximus, fascia latasplits to enclose the muscle•Above the gluteus maximus, the deep fascia continues as one layer covering the gluteus medius& gets attached to iliac crest•Laterally the fascia merges with the iliotibial tract
Fascia over gluteus medius
Tensor fascia lata
Gluteal fascia
Iliotibial tract
L1
L2
L3
S1
S2
S3
Branches from
posterior cutaneous
nerve of the thigh
Lateral cutaneous branch of iliohypogastric nerve
Lateral cutaneous nerve of the subcostal nerve T12
Branches from lateral
cutaneous nerves of the
thigh
1-The upper medial quadrantSupplied by
2-The upper lateral quadrantSupplied by
Anterior primary rami of
4-The lower lateral quadrant Supplied by
Anterior primary rami of
3-The lower medial quadrant Supplied by
Anterior primary rami of
Cutaneous innervations of gluteal region
UMUL
LMLL
• The gluteal region contains:
–Bones
– Ligaments
–Muscles
–Vessels
–Nerves
GLUTEAL REGION CONTAINS
BONES OF THE GLUTEAL REGION
• Posterior aspect of:
–Hip bone
– Femur
&
–Hip joint
LIGAMENTS OF THE GLUTEAL REGION
• 2 ligaments:
– Sacrospinous, connecting sacrum to ischial spine
– Sacrotuberous, connecting sacrum to ischial tuberosity
• Their main function is to:
– Stabilize the sacrum
– Prevent its posterior rotation at the sacroiliac joint
MUSCLES OF GLUTEAL REGION
•Gluteus maximus•Gluteus medius•Gluteus minimus•Tensor fascia lata•Piriformis•Superior Gemellus•Inferior Gemellus•Obturator internus•Quadratus femoris
Origin:
1- Ilium ( area behind the posterior
gluteal line)
2- Back of sacrum and coccyx
3- Back of sacrotuberous ligament
Insertion
1- The superficial three –fourths
are inserted into the iliotibial
tract
2- The lower deep part is inserted
into the gluteal tuberosity of
femur
GLUTEUS MAXIMUS
Actions
1- Extends thigh- main extensor
of the hip joint
2 - lateral rotation
3 - Abduction of thigh
3 - Plays an important role in
climbing upstairs and cycling
4- Supports the Extended knee
joint through Iliotibial tract
Innervation - Inferior
gluteal nerve, L5,S1,2
STRUCTURES UNDER THE COVER OF GLUTEUS MAXIMUS MUSCLE
A- Bony structures
1-Greater trochanter and bursa
2-Gluteal tuberosity
3-Ischial tuberosity and bursa
1- Sacrotuberous ligament
2- Scrospinous ligament
B- Ligaments
C- Muscles
1- Gluteus medius and minimus
2-Short Lateral rotator muscles (6)
3- origin of the hamstring muscles
D- Vessels
1- Superior gluteal vessels
2- inferior gluteal vessels
3- Internal pudendal vessels
E- Nerves
1- Superior and inferior gluteal nerve
2- Sciatic nerve
3- Pudendal nerve
4- Posterior cutaneous nerve of the thigh
5- Nerve to obturator internus
6- Nerve to quadratus femoris
Origin
Ilium ?
Insertion
Greater trochanter of femur
Actions
1-Abduction (main abductor
of the hip joint)
2-Medial rotation (anterior
fibers)
3-Both muscle contract
reflexly on each side
alternatively during
walking to prevent
tilting of the pelvis to
the unsupported side
Innervation
Superior gluteal nerve
(L4, 5 , S 1)
GLUTEUS MEDIUS & GLUTEUS MINIMUS
POWERFUL ABDUCTORS
1-Piriformis
2-Superior gemellus
3- Inferior gemellus
4- Obturator internus
5-Quadratus femoris
6 -Obturator externus
SHORT LATERAL ROTATOR MUSCLES
INNERVATIONS
VENTRAL RAMI S1 S2
N. TO OBTURATOR INTERNUS L5 S1 S2
N. TO QUADRATUS FEMORIS L4 L5 S1
POST. DIVISION OF OBTURATOR N. (L2 L3 L4)
OBTURATOR EXTERNUS
TENSOR FASCIA LATA
• Origin: Outer lip of iliac crest between anterior superior iliac spine & iliac tubercle
• Insertion: Into the iliotibialtract
• Nerve supply: Superior gluteal nerve (L4,5, S1)
• Action: Maintains the knee in extended position
Tensor fascia lata
Iliotibial tract
STRUCTURES PASSING THROUGH THE GREATER SCIATIC FORAMEN
Piriformis: an important landmark
Above the piriformis:Superior gluteal vessels & nerve
Below the piriformis:Inferior gluteal vessels & nerveSciatic nervePosterior cutaneous nerve of thighPudendalnerve & Internal pudendal vesselsNerve to obturator internusNerve to quadratus femoris
Structures passing through the lesser sciatic foramen
Entering:Pudendal nerve &Internal pudendal vessels
Exiting:Tendon of obturator internusNerve to obturator internus
NERVES OF GLUTEAL REGION
L 4
L 5
S 1
S 2
S 3
ANTERIOR POSTERIOR
N. TO QUADRATUS FEMORIS
SUPERIOR GLUTEAL N.
N. TO OBTURATOR INTERNUS
INFERIOR GLUTEAL N
SCIATIC NERVE TIBIAL PART
S 4
PUDENDAL NERVE
SCIATIC NERVECOMMON
PERONEAL PART
SACRAL PLEXUS
Superior Gluteal Nerve
(L4, 5 and S1)
a branch of the sacral plexus
leaves the pelvis through the greater
sciatic foramen above the piriformis
It divides into superior and
inferior branches
The superior branch supplies the
gluteus medius muscle
The inferior branch supplies the
gluteus minimus muscles and ends
by supplying the tensor fasciae latae
muscle.
Inferior Gluteal Nerve (L5, S1, S2)
a branch of the sacral plexus, leaves
the pelvis through the greater sciatic
foramen below the piriformis
It supplies the gluteus maximus
muscle
1-Superior Gluteal Artery
is a branch from the internal iliac artery
enters the gluteal region through the greater
sciatic foramen above the piriformis
It divides into superficial and deep branches.
The superficial branch supplies the gluteus
maximus & medius muscle
The deep branch take part in formation of
anastomosis.
2-Inferior Gluteal Artery
is a branch of the internal iliac artery
enters the gluteal region through the greater
sciatic foramen, below the piriformis
It divides into numerous branches that are
distributed throughout the gluteal region.
ARTERIES OF THE GLUTEAL REGION
Posterior view
Arterial supply to Femoral head
• Medial & lateral circumflex femoral arteries
• Superior and inferior gluteal arteries
TROCHANTERIC
ANASTOMOSIS
CRUCIATE ANASTOMOSIS
• Lies at the level of lesser trochanter
• between internal iliac and femoral arteries
• Formed by:– Descending branch of
inferior gluteal artery– Transverse branches of
medial and lateral circumflex arteries
– Ascending branch of first perforating artery
APPLIED ANATOMY
SAFE AREA FOR INTRAMUSCULAR INJECTION
• Intramuscular injection enables a large amount of a drug to be introduced at once but absorbed gradually.
• The injection site must be carefully selected to avoid injury to the underlying large vessels and nerves.
Outer upper quadrant of the buttock is the safe area for intramuscular injection to avoid injury to the underlying sciatic nerve
UL
TRENDELENBURG TEST
• To assesses whether the hip abductors (particularly gluteus medius) are functioning normally Observe patient from behind, ask him/her to stand on one foot and then the other
Negative test: Pelvis ‘tilts up’ on contralateral side
Positive test: Pelvis ‘sags’ on contralateral side
Positive test:
Pelvis ‘sags’ on contralateral side
BILATERAL
Waddling Gait
UNILATERAL
Lurching Gait