The gluteal region contains important muscles, nerves and vessels. It is bounded by the ilium, sacrum and ischial tuberosity. The gluteal region contains nine muscles including the gluteus maximus, medius and minimus. The gluteal region receives its blood supply from the superior and inferior gluteal arteries and contains important nerves like the superior and inferior gluteal nerves. The piriformis muscle passes through the greater sciatic foramen along with blood vessels and nerves.

1. GLUTEAL REGION
Varun Walia (145)

2. Contents:
 Gluteal region and boundaries
 Cutaneous innervations
 Muscles of gluteal region
 Arteries of gluteal region
 Nerves of gluteal region
 Applied Aspect

3. Introduction:
 Transitional area b/w trunk and lower extremity
 Anatomically it is a part of trunk. Functionally it is a part of lower extremity
 Gluteal region includes rounded, posterior buttocks and laterally placed hip region

4. Boundaries:

5. Superficial fascia:
 Thick, dense, well developed, laden with large quantities of fat (specially
in women) that:
- Gives the characteristic convexity to the buttock
- Forms a thick cushion over the ischial tuberosity
 It contains cutaneous innervations, vessels and lymphatics

6. Cutaneous innervations:

7. Cutaneous vessels & lymphatics:
 Blood supply:
-branches of superior and inferior gluteal arteries
 Lymphatics:
- lateral group of superficial inguinal lymph nodes

8. Deep Fascia
 Is continuation of the fascia lata (deep
fascia of the thigh)
 At the lower border of the gluteus
maximus, fascia lata splits 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

9. • Gluteus maximus
• Gluteus medius
• Gluteus minimus
• Tensor fascia lata
• Piriformis
• Obturator internus
• Superior Gemellus
• Inferior Gemellus
• Quadratus femoris
• obturator externus
Muscles of the Gluteal Region

10.  Largest muscle in the body
 Forms the prominence of buttock
ilium
S
C
Gluteus Maximus

11.  Origin:
Outer surface of ilium behind
the posterior gluteal line
Lumbar fascia
Posterior surface of sacrum &
coccyx
Sacrotuberous ligament
 Insertion:
 Most of the muscle (3/4th)
inserted into the iliotibial tract
Deeper fibers inserted to the
gluteal tuberosity
 Nerve supply:
Inferior gluteal nerve (L5, S1, 2)

12. Actions:
 Extends & laterally rotates the hip joint
 Extends the knee joint (through iliotibial tract)
 Gives simultaneous stability to the hip and knee joints
through the iliotibial tract

13. Structures under the cover of gluteus maximus:
 gluteus Medius & minimus
 rectus femoris
 Piriformis
 obturator internus with two
gemelli
 Quadratus femoris
 obturator externus
 Origin of four hamstring from
ischial tuberosity
 Insertion of pubic fibers of ad.
magnus
Muscles:-

14.  Superior gluteal vessels
 inferior gluteal vessels
 internal pudendal
 Medial femoral circumflex artery
 trochanteric & cruciate
anastomosis
Vessels:-

15.  Superior gluteal
 inferior gluteal
 sciatic
 Post. cut. Nerve of thigh
 nerve to quadratus
femoris
 pudendal nerve
 nerve to obturator
internus
 perforating cutaneous
nerves
Nerves:-

16.  Bones & joints- ilium, ischial tuberosity, upper end of femur with greater
trochanter, sacrum, coccyx, hip joint &sacroiliac joint
 Ligaments- sacrotuberous, sacrospinous & ischiofemoral
 Bursa- trochanteric bursa of glut. maximus, of ischial tuberosity, & bet. glut. max, &
vastus lateralis

17. Ligaments of gluteal region:
2 ligaments:
Sacrospinous, connecting sacrum to ischial spine
Sacrotuberous, connecting sacrum to ischial
tuberosity
They convert the greater & lesser sciatic notches
into greater & lesser sciatic foramina
Their main function is to:
-Stabilize the sacrum
-Prevent its posterior rotation at the
sacroiliac joint

18. Origin: outer surface of ilium
between the middle and
posterior gluteal lines
Insertion: Lateral surface of
greater trochanter
Nerve supply: Superior
gluteal nerve (L4,5, S1)
Action:
Abducts & medially
rotates the thigh
Steady pelvis in walking
Gluteus Medius

19. Origin: outer surface
of ilium
Insertion: Anterior
surface of greater
trochanter
Nerve supply:
Superior gluteal
nerve (L4,5, S1)
Action: Abducts &
medially rotates the
thigh
Gluteus Minimus

20. Origin: Anterior surface of
sacrum between the
anterior sacrum foramina
Insertion: Apex of greater
trochanter
Nerve supply: direct
branch from L5, S1&S2
 Action: lateral rotator of
femur
Piriformis

21.  Origin: Deep surface of
obturator membrane and
surrounding bone
 Insertion: Medial side of
greater trochanter above
the trochanteric fossa
 Nerve supply: nerve to
obturator internus
 Action: Lateral rotator of
femur
Obturator internus

22.  Origin:
Superior gemellus- external
surface of ischial spine
Inferior gemellus- Upper
aspect of ischial tuberosity
 Insertion: Both Gemelli
insert into the tendon of
obturator internus
 Nerve supply:
superior gemelli by nerve
to obturator internus
inferior gemelli by nerve
to quadratus femoris
 Action: help in lateral
rotation
Superior & Inferior gemelli

23. Origin: Lateral border
of ischial tuberosity
Insertion: Quadrate
tubercle of femur
Nerve supply: nerve
to quadratus femoris
Action: lateral rotator
of thigh
Quadratus femoris

24.  Origin:
Obturator membrane
Ramus of pubis
Ramus of ischium
 Insertion: Trochanteric fossa
on the medial aspect of
greater trochanter
 Nerve supply: Obturator
nerve
 Action: Lateral rotator of
femur
Obturator externus

25. Arteries
 Inferior gluteal artery
• Originates from the ant.
Trunk of the internal iliac
artery
• Supplies adjacent muscles
and desends through the
gluteal region into the
posterior thigh
 Superior gluteal artery
• Originates form the post.
Trunk of the internal iliac
artery
• Divides into a superficial
and a deep branch
 Internal pudendal artery
 Various anastomosis

26. Arterial anastomosis of the gluteal region
 Cruciate anastomosis:
• Present in the lower part of the
gluteal region.
• Arteries taking part in anastomosis
are inferior gluteal artery, first
perforating artery and the lateral &
medial Circumflex Femoral arteries.
 Trochanteric artery:
• Seen in relation to greater
trochanter.
• Arteries taking part in anastomosis
are superior gluteal artery and the
medial & lateral circumflex femoral
arteries.

27. Nerves in gluteal region

28.  Structures passing through greater
sciatic foramen
 Piriformis
 Structures passing above the piriformis are: superior gluteal nerve and
superior gluteal vessels
 Structures passing below the piriformis are: Inferior gluteal nerve and vessels,
sciatic nerve, posterior cutaneous nerve of thigh, nerve to quadratus femoris,
pudendal nerve, internal pudendal vessels, nerve to obturator internus
 Structures passing through lesser sciatic
foramen
 Pudendal nerve, Internal pudendal vessels, nerve to obturator internus, tendon of
obturator internus

29. Applied
 I/m injection is given in
superolateral quadrant
of gluteal region to
avoid injury to nerves

30.  When gluteus maximus is paralysed, the
patient cannot stand up from sitting posture
without support.
 When the gluteus Medius & minimus are
paralysed, patient sways on the paralysed side
while walking. This is known as lurching gait.
When bilateral, the gait is called as waddling
gait.
 Trendelenburg sign: Normally when the body
weight is supported on one limb, the glutei of
the supported side raise the opposite
(unsupported) side of the pelvis.
However if abductor mechanism is defective, the
unsupported side of the pelvis drops and this is
known as positive trendelenburg sign.