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Gluteal region

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Anatomy of gluteal region for medical students

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Gluteal region

  1. 1. • 5 differences between human superior and inferior extremity
  2. 2. INFERIOR EXTREMITY GLUTEAL REGION Maj Rishi Pokhrel NAIHS rongon28us@yahoo.com www.slideshare.net
  3. 3. Anatomical regions Thigh Leg Foot Gluteal region
  4. 4. Compartments
  5. 5. Compartmental nerve supply
  6. 6. Gluteal region • Transitional between trunk & lower extremity. • Anatomically – trunk • Functionally - lower extremity • Includes rounded posterior buttocks & lateral hip
  7. 7. Boundaries • Superiorly: iliac crest L4 • Medially: intergluteal cleft, • Laterally: Greater trochanter • Inferiorly: gluteal fold • Gluteal muscles form prominent majority
  8. 8. Skeleton
  9. 9. Key muscles
  10. 10. Key ligament
  11. 11. Gluteus maximus Origin •Outer surface of ilium behind posterior gluteal line •Posterior surface of sacrum, coccyx and sacrotuberous ligament. Insertion • 75% of fibres into ilio-tibial tract – 25%(deep) into gluteal tuberosity Largest muscle responsible for the prominence of the ‘buttocks’
  12. 12. Gluteus maximus Nerve supply - inferior gluteal nerve Action •Extensor & lateral rotator of thigh at hip joint. •Helps to maintain extension at knee through the ilio-tibial tract •Paralysis of muscle – inability to raise the trunk from sitting or stooping positions. Largest muscle responsible for the prominence of the ‘buttocks’
  13. 13. Iliotibial tract &Tensor fascia lata Tensor fascia lata • Origin: anterior part of iliac crest, ASIS and notch below • Insertion: inserts into the iliotibial tract. • Nerve: Superior gluteal nerve • Action: Assists gluteus maximus in keeping knee in extended position
  14. 14. Structures undercover of gluteus maximus • Muscles • Vessels • Nerves • Bones & Joints • Ligaments • Bursae
  15. 15. Structures undercover of gluteus maximus Muscles • Gluteus Medius, • Gluteus Minimus, • Reflected Head of the Rectus Femoris, • Obturator Internus with 2 Gemelli, • Obturator Externus, • Pyriformis, • Quadratus Femoris, • origin of the four hamstring muscles from the ischial tuberosity • Insertion of the upper fibres of the adductor magnus,
  16. 16. Structures undercover of gluteus maximus Vessels • superior gluteal vessels, • inferior gluteal vessels, • internal pudendal vessels, • ascending branch of the medial circumflex femoral artery, • trochanteric anastomoses, • cruciate anastomoses, • first perforating artery
  17. 17. Structures undercover of gluteus maximus Nerves • Superior gluteal nerve (L4,L5,S1), • Inferior gluteus nerve (L5,S1, S2), • Pudendal Nerve (S2,S3,S4), • Posterior Cutaneous Nerve of thigh (S1,S2,S3), • Perforating Cutaneous Nerve (S2,S3), • Sciatic Nerve (L4,L5,S1,S2,S3), • Nerve to Quadratus Femoris (L4,L5,S1), • Nerve to Obturator Internus (L5,S1,S2)
  18. 18. Structures undercover of gluteus maximus • Bones & Joints – Illium, – Ischium with the ischial tuberosity, – hip joint, – sacroilliac joint, – sacrum and coccyx, – upper end of the femur with the greater trochanter • Ligaments – Sacrotuberous, – Sacrospinous, – ischiofemoral
  19. 19. Structures undercover of gluteus maximus Bursae • trochanteric bursa of the glut max, • bursa above the ischial tuberosity, • bursa between the gluteus maximus and the vastus lateralis
  20. 20. Gluteus medius Posterior part covered by gluteus maximus Origin Outer surface of ilium b/w iliac crest above & posterior gluteal line behind and middle gluteal line below. Insertion Lateral surface of greater trochanter Nerve – superior gluteal nerve Action •With G minimus and tensor fascia lata -powerful abductor at hip. •Anterior fibres medially rotate the thigh •Walking and running •Holds opposite side of pelvis horizontally when foot is off the ground.
  21. 21. Gluteus minimus Origin Outer surface of ilium b/w middle & inferior gluteal lines Insertion - Anterior surface of greater trochanter Nerve-superior gluteal nerve Action •With G minimus and tensor fascia lata -powerful abductor at hip. •Anterior fibres medially rotate the thigh
  22. 22. Short Lateral Rotators of Thigh
  23. 23. Piriformis • Key muscle of gluteal region Origin • Pelvic surface of sacrum 2nd,3rd & 4th pieces • Sacrotuberous ligament Insertion • Upper border of greater trochanter • Leaves the pelvis through greater sciatic foramen and separates gleuteal vessels and nerves to superior and inferior Nerve • S1 2 anterior rami Short Lateral Rotators of Thigh
  24. 24. Structures through greater sciatic foramen • Above piriformis- – superior gluteal vessels and nerves • Below piriformis – Sciatic N – posterior femoral cutaneous nerves – Inferior gluteal vessels & nerves – PIN structures • Pudendal nerve • Internal pudendal vessels • Nerve to obturator internus – Nerve to quadratus femoris
  25. 25. Structures through lesser sciatic foramen – PIN structures • Pudendal nerve • Internal pudendal vessels • Nerve to obturator internus
  26. 26. Origin: from pelvic surfaces of • Body of ischium • Ischial tuberosity • Ischio-pubic ramus • Obturator membrane & fascia. Insertion: tendon passes out of the pelvis through the lesser sciatic foramen and enters gluteal region >> upper border of greater trochanter. Obturator Internus Nerve: Nerve to obturator internus L5 S1 2 One ½ of muscle in pelvis other ½ in perineum Tendon in gluteal region Short Lateral Rotators of Thigh
  27. 27. Gamellus superior Origin-spine of ischium Insertion-tendon of OBT int Nerve- to OBT internus Gamellus inferior Origin-ischial tuberosity Insertion-tendon of OBT internus Nerve-to Quadratus femoris Quadratus femoris Origin-ischial tuberosity Insertion-quadrate tubercle Nerve-sacral plexus Short Lateral Rotators of Thigh
  28. 28. • Trendlenberg test??

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