Discussion about the Gluteal muscles and their functional contribution to human erect posture and bipedal locomotion. Also mention of their neuro-vascularity.
2. Gluteal region
• Extends from iliac crest to the
gluteal folds
• Superficial fascia – contains
coarse fat
• Deep fascia – varies in thickness
• Muscles :-
• Superficial – 3 gluteal
• Deep – piriformis, obturator
internus, sup. & inf. Gemellus
and Quadratus femoris
• Artery – sup. & inf. Gluteal A.
• Nerve : sup. & inf. Gluteal N
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3. Tensor fascia lata
O – ant. part of the outer lip of the iliac crest
I – Iliotibial tract lateral condyle of tibia
A – hip flexor, abductor & medial rotator
knee extensor (postural control)
N – Superior gluteal nerve (L4, 5, S1)
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4. GLUTEUS MAXIMUS
• Origin –
posterior gluteal line of the ilium
posterior, part of the iliac crest
aponeurosis of erector spinae,
dorsal surface of the lower part of the
sacrum and the side of the coccyx,
sacrotuberous ligament
• Insertion –
Deep ½ of lower ½ - gluteal tuberosity
Remaining ¾ - upper end of iliotibial tract
• Vascular supply –
dominant inferior gluteal artery (2/3rd part)
Remainder – superior gluteal artery
• Innervation – inferior gluteal nerve L5 S1,2
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5. G. Maximus
Action : (Powerful Antigravity Muscle)
On the femur is a combination of lateral rotation and
extension of a flexed hip
From below – it acts upon the pelvis, supporting it and
steady the trunk upon the head of the femur; this
is especially obvious in standing on one leg or
forward bending
Through the iliotibial tract its contraction supports the
extended knee & tense fascia lata
Chief antigravity muscle during the act of sitting,
controlling flexion of hip.
most powerful action is to cause the body to regain
the erect position after stooping by rotating the
pelvis backwards on the head of the femur (acts
with the hamstrings)
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6. Bursa deep to G. Maximus
• Three bursae are usually found in relation
with the deep surface of this muscle:
1) Trochanteric: over the greater trochanter
2) Gluteofemoral: between IT tract and
vastus lateralis
3) Ischiofemoral: over the ischial tuberosity
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7. GLUTEUS MEDIUS
• Origin – gluteal surface of ilium betn
middle and post. Gluteal lines
• Insertion – lat. Surface of greater
trochanter.
• Its post 1/3rd is covered by G. maximus and
ant. 2/3rd by a strong layer of deep fascia
• Vascular supply : deep branch of the
superior gluteal artery
• Innervation : superior gluteal nerve, L4, 5
and S1
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8. GLUTEUS MINIMUS
• Origin : gluteal surface of ilium betn
middle and inferior. gluteal lines
• Insertion – anterolateral ridge on the
greater trochanter
• Vascular supply – superior gluteal
artery
• Innervation : superior gluteal nerve, L4,
5 and S1.
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9. Actions of gluteus
medius and minimus
Acting from the pelvis, abduct the thigh, and their anterior fibres rotate it medially
Acting from the femur, they play an essential part in maintaining the trunk upright when
the foot of the opposite side is raised from the ground in walking and running (along
with tensor fasciae latae)
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10. Actions of gluteus medius and minimus
• supportive effect of these 2 glutei on the pelvis when the contralateral foot is
raised depends on the following conditions –
The two muscles, and their innervation, must be functioning normally.
components of the hip jt, which forms the fulcrum, must be in their usual relation.
The neck of the femur must be intact, with its normal angulation to the shaft.
When any one of these conditions is not fulfilled, e.g. in paralysis of the glutei, congenital
dislocation of the hip or coxa vara, # of neck of femur; the supporting mechanism is upset and
the pelvis sinks on the unsupported side when the patient tries to stand on the affected limb.
This is known clinically as Trendelenburg's sign.
And the gait is characteristic lurching gait
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12. PIRIFORMIS
• Arises from the front of middle
three pieces of sacrum
• Passes laterally behind the sacral
plexus to emerge through greater
sciatic foramen almost filling it
• Inserted into the medial surface of
upper border of greater trochanter
• Innervation – Ant. Rami of S1 & 2
• Its relation provide key to
arrangement of str. in the gluteal
region.
• PIRIFORMIS SYNDROME
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13. OBTURATOR INTERNUS
• Arises from the internal surface of the
anterolateral wall of the lesser pelvic cavity
almost surround the obturator foramen
• Curves around the lesser sciatic notch and
ends in a tendon which inserts on the
surface of the greater trochantor on the
femur
• Vascularity –
• Intrapelvic part by the obturator artery
• extrapelvic part from the gemellar branches
of the internal pudendal A.
• Innervation – nerve to obturator internus,
L5 and S1
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14. GEMELLI
• G. Superior arises from the undersurface
of the ischial spine and the inferior one
from the ischial tuberosity
• Their tendon of insertion blend with
that of obturator internus
• Vascular supply :
sup. gemellus - internal pudendal A
• Inf. gemellus - medial circumflex femoral
artery
• Innervation
Gemellus sup. – by nerve to obturator internus,
L5 and S1.
Gemellus inferior - nerve to quadratus femoris,
L5 and S1
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15. QUADRATUS
FEMORIS
• arises from the outer, upper
aspect of the ischial tuberosity
• Inserts on intertrochanteric
crest (quadrate tubercle) of
femur
• Innervation – by N. to Q.
femoris
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16. Superior gluteal N
Formed from dorsal divisions of L4, L5 and S1 of sacral
plexus
Emerge through greater sciatic foramina above
piriformis
Divides into superior and inferior branches
Supplies branches to the G medius & minimus muscles
and terminates by innervating the tensor fasciae lata
Assessed by : Trendelenburg Gait
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17. Inferior gluteal N
Arises from the dorsal branches of L5, S1 & S2
Emerge through greater sciatic foramina below
piriformis
Ramifies to supply G maximus
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18. Superior Gluteal A
Branch from the posterior division of the internal iliac artery
Emerging from greater sciatic foramina divides into superficial &
deep branches
Superficial branch penetrates G maximus supplies it & overlying skin
Deep branch travels between G minimus & medius, supplies it as
well as tensor fascia lata
It gives upper and lower branches
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19. Inferior Gluteal A
Branch of the anterior division of the Internal Iliac Artery
Exits greater sciatic foramen below piriformis
Muscular branches piriformis, G maximus & obturator internus
companion artery to the sciatic nerve
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