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GLUTEAL REGION DR MONIKA SHARMA.pptx
- 1. GLUTEAL REGION DR. MONIKA SHARMA PG DEPT. OF RACHANA SHARIR SKAU, KURUKSHETRA
- 2. OBJECTIVES •Surface Anatomy of Gluteal region •Detailed Anatomy •To know the contents of Gluteal Region •Foramen and structures passing through them. •Dissectional Approach of Gluteal region •Importance / Functions
- 3. GLUTEAL REGION • The transitional area between the trunk and the lower extremity. • Forms the prominence at posterior part of lower limb • Area that overlies side & back of pelvis . • Posterior to Pelvic Girdle Pelvic girdle
- 4. SURFACE ANATOMY The gluteal region includes : • Rounded, posterior buttocks and • Laterally placed hip region. • Extends from Iliac crest (L4) Intergluteal cleft Gluteal fold/sulcus
- 5. BOUNDARIES • Superior : Iliac crest • Inferior : Gluteal fold (lower limit of rounded buttock) • Lateral : Line joining ASIS to front of greater trochanter • Medial : Natal cleft between buttocks
- 6. • lateral hip depression, • infragluteal cleft, • supragluteal fossettes (dimples of venus) L4 • sacral triangle
- 7. SURFACE LANDMARKS • BUTTOCKS • NATAL CLEFT • ISCHIAL TUBEROSITY • GREATER TROCHANTER • ILIAC CREST • SACRUM • COCCYX • SACROTUBEROUS LIGAMENT
- 8. CONTENTS OF GLUTEAL REGION • SKIN • SUPERFICIAL FASCIA • DEEP FASCIA • GLUTEAL APONEUROSIS MODIFICATION FASCIA LATAE • MUSCLES • VESSELS • NERVES • BONES • JOINTS • LIGAMENTS • BURSAE
- 9. • SUPERFICIAL FASCIA Dense Tough cushion over gluteal tuberosity Heavily laden with fat, more in females • DEEP FASCIA Continous below the deep fascia of thigh • CUTANEOUS NERVES Converge from all directions, ANTERIOR POSTERIOR CUTANEOUS NERVES
- 10. MUSCLES OF GLUTEAL REGION • Gluteus maximus • Gluteus medius • Gluteus minimus • Piriformis • Superior gemellus • Inferior gemellus • Obturator internus • Quadratus femoris • Obturator externus • The tensor fasciae latae M3 P G2 O Q O T
- 11. GLUTEAL MUSCLE SUPERFICIAL INTERMEDIATE DEEP Gluteus maximus Tensor fasciae latae Gluteus medius Piriformis Superior gemellus. obturator internus. Inferior gemellus Quadratus femoris Upper part of Adductor magnus Hamstrings Gluteus minimus Reflected head of rectus femoris obturator externus
- 12. SUPERFICIAL MUSCLES • GLUTEUS MAXIMUS • TENSOR FASCIA LATAE
- 16. BONY FRAMEWORK
- 17. • Hip bone ileum , ischium , pubis • Dorsal surface of sacrum • Coccyx • Gluteal surface of Ilium • Ischium (ischial tuberosity) • Upper end of femur (greater trochanter) • Posterior aspect of hip joint • Sacrococcygeal , • sacroiliac joint • Hip joint Sacroiliac joint Sacrococcygeal joint
- 18. HIP BONE ILIAC CREST POSTERIOR SUPERIOR ILIAC SPINE SACRAL FORAMINA POSTERIOR INFERIOR ILIAC SPINE GREATER SCIATIC NOTCH ISCHIAL TUBEROSITY TIP OF COCCYX ISCHIAL SPINE ILEUM ISCHIUM PUBIS LESSER SCIATIC NOTCH
- 19. The gluteal lines form the origins of the gluteal muscles PUBIC TUBERCLE ACETABULUM ANTERIOR BORDER ILIAC CREST
- 20. • Outer surface of the ileum is marked by 3 roughened boney lines: 1. Inferior gluteal line near acetabulum 2. Anterior/Middle gluteal line 3. Posterior gluteal line Middle/Anterior gluteal line Inferior gluteal line Posterior gluteal line
- 22. FEMUR • Longest bone of lower limb • Upper end of the femoral shaft has 2 boney prominces: • greater & lesser trochanters • Anteriorly, the intertrochanteric line links the 2 trochanters. Gluteal tuberosity Intertrochanteric line
- 23. • Posteriorly, the trochanters are linked by a more marked intertrochanteric crest. • Trochanteric fossa exists in the medial aspect of the greater trochanter, • Medial to the intertrochanteric crest Site of insertion of Obturator internus & Sup. & Inf. glemellus
- 25. LIGAMENTS OF GLUTEAL REGION 1. SACROTUBEROUS LIGAMENT 2. SACROSPINOUS LIGAMENT
- 26. SACROTUBEROUS LIGAMENT • LONG & STRONG • ATTACHMENT: Posterior superior iliac spine & Dorsal surface of sacrum Medial margin of ischial tuberosity Turns notches into B shaped foramen
- 27. SACROSPINOUS LIGAMENT • SHORT, THICK, TRIANGULAR • Deep to sacrotuberous ligament • ATTACHMENTS : • Ischial spine laterally • Sacrococcygeal junction medially Subdivides B shaped foramen into Greater & lesser sciatic foramina
- 29. FORAMEN Greater Sciatic Foramen • Lies above ischial spine & pelvic diaphragm • Gateway from pelvis to gluteal region Lesser Sciatic Foramen • Lies below ischial spine & pelvic diaphragm • Gateway from gluteal region to perineum SACROTUBEROUS LIG SACROSPINOUS LIG GREATER SCIATIC NOTCH LESSER SCIATIC NOTCH
- 30. ANTERIOR VIEW
- 32. STRUCTURES PASSING THROUGH GREATER SCIATIC NOTCH • Superior gluteal vessles • Superior gluteal nerves • Inferior gluteal vessles • Inf. Gluteal nerve • Internal pudendal vessels • Pudendal nerve • Sciatic nerve • Nerve to obturator int. and quadratus femoris. LESSER SCIATIC NOTCH • Internal pudendal vessels • Pudendal nerve • Tendon of obturator internus • Nerve to obt. internus PIRIFORMIS
- 33. GLUTEUS MAXIMUS ORIGIN • Outer slope of dorsal segment of ileum • Gluteal surface behind posterior gluteal line • Dorsal surface of sacrum • Side of coccyx • Sacrotuberous ligament INSERTION • Deep - ischial tuberosity • Superficial - iliotibial tract
- 34. Fibres pass DOWNWARDS & UPWARDS NERVE SUPPLY INFERIOR GLUTEAL NERVE ( L5 S1 S2 ) FUNCTION Chief Extensor of thigh at hip joint Lateral rotation of thigh STRUCTURES UNDER GLUTEUS MAXIMUS
- 36. GLUTEUS MEDIUS Fanshaped ORIGIN • Gluteal surface of ileum between anterior and posterior gluteal lines INSERTION • Greater trochanter of femur (Oblique ridge on lateral surface)
- 37. Fibres runs DOWNWARDS & FORWARDS NERVE SUPPLY SUPERIOR GLUTEAL NERVE (L4 L5 S1) ACTION POWERFUL ABDUCTOR OF THIGH (Both medius and minimus) Medial rotation of thigh
- 38. GLUTEUS MINIMUS ORIGIN • Gluteal surface of ileum between anterior & inferior gluteal lines INSERTION • oblique ridge on the anterior surface of greater trochanter
- 40. PIRIFORMIS – KEY MUSCLE ORIGIN Arises within PELVIS • By 3 digitations from pelvic surface of middle three pieces of sacrum Leaves the pelvis through Greater sciatic notch INSERTION (Rounded tendon) Apex of greater trochanter of femur
- 41. WHY KEY MUSCLE? • Once PIRIFORMIS is identified in the gluteal region • Other structure that pass above and below the muscle can be identified Muscles Nerves Vessles
- 42. • NERVE SUPPLY VENTRAL RAMI OF S1 S2 • ACTION Lateral rotation of thigh Piriformis, Superior & Inferior Gamellus, Obturator internus, Quadratus femoris
- 44. SUPERIOR & INFERIOR GAMELLUS ORIGIN S. G. Upper part of Lesser Sciatic notch I. G. Lower part of lesser Sciatic notch INSERTION Blends with Tendon of Obturator internus Superior gamellus Inferior gamellus
- 45. NERVE TO OBTURATOR INTERNUS L5 S1 S2 NERVE TO QUADRICEPS FEMORIS L4 L5 S1
- 46. OBTURATOR INTERNUS Belly lies in pelvis & tendon in gluteal region ORIGIN • Pelvic surface of Obturator membrane • Pelvic surface of body of ischium, ishiopubic rami, Obturator fascia INSERTION • Tendon leaves pelvis through lesser sciatic foramen • Turns 90° around lesser sciatic notch, upwards laterally behind neck of femur, reaches gluteal region • Inserted on medial surface of greater trochanter
- 47. NERVE SUPPLY NERVE TO OBTURATOR INTERNUS L5 S1 S2 ACTION LATERAL ROTATION OF THIGH
- 48. OBTURATOR EXTERNUS ORIGIN • Outer surface of Obturator membrane • Adjacent bony margin of obturator foramen INSERTION • Trochanteric fossa on medial surface of greater trochanter Quadriceps femoris Obturator externus
- 49. NERVE SUPPLY POSTERIOR DEVISION OF OBTURATOR NERVE L2 L3 L4
- 50. QUADRICEPS FEMORIS ORIGIN Outer border of Ischial Tuberosity INSERTION Quadrate tubercle on femur NERVE Nerve to Quadratus femoris
- 51. TENSOR FASCIA LATAE ORIGIN • Outer lip of iliac crest INSERTION • Ilio tibial tract below the level of greater trochanter NERVE • Superior gluteal nerve FUNCTION • Abduction • Extension of knee joint
- 53. BURSAE Prevents friction b/w two bones 1. Trochanteric bursa 2. Ischial bursa 3. Glutofemoral bursa Applied - bursitis
- 54. NERVE SUPPLY OF GLUTEAL REGION SUPERIOR GLUTEAL NERVE L4 L5 S1 INFERIOR GLUTEAL NERVE L5 S1 S2 SCIATIC NERVE L4 L5 S1 S2 S3
- 55. SCIATIC NERVE Thickest nerve in the body Main continuation of SACRAL PLEXUS Enters gluteal region through greater sciatic foramen below piriformis Enters back of thigh at lower border of gluteal region
- 56. • (mixed) • Ventral rami of: L4 + L5 + S1 + S2 + S3 • Covers the nerve to the quadratus femoris • Position of sciatic nerve midway between the ischial tuberosity & greater trochanter.
- 57. NERVE TO QUADRATUS FEMORIS L4 L5 S1 NERVE TO OBTURATOR INTERNUS L5 S1 S2 PUDENDAL NERVE S2 S3 S4 CUTANEOUS BRANCHES S2 S3
- 59. ARTERIAL SUPPLY SUPERIOR GLUTEAL ARTERY Branch of posterior division of internal iliac artery INFERIOR GLUTEAL ARTERY Anterior devision of internal iliac artery INTERNAL PUDENDAL ARTERY Internal iliac artery TROCHANTERIC ANASTOMOSES
- 60. Internal iliac artery Superior gluteal artery Inferior gluteal artery Internal pudendal artery Obturator artery Ishioanal fossa
- 61. DISSECTIONALAPPROCH OF GLUTEAL REGION • Make a curved insicion from (A) spine of second sacrum to (C) iliac crest laterally • Make a median vertical cut from second sacral spine downwards upto natal cleft (B) • Cut from (D)medial of back of thigh upto (E) lateral back of thigh • Cut from (B) to (D) in a downwards convexity manner.
- 62. DISSECTIONAL APPROACH • Reflect the thich skin and fascia towards Lateral aspect • Remove deep fascia over gluteus maximus muscle