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Gluteal Region

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Iliac crest vertebral level:
L4-L5
What is L4-L5 important landmark for?
Epidural
What bone do you touch when your hands are on your hips?
Anterior superior iliac spine
Where are the Posterior SIS located?
At the dimples on either side of the sacrum - Sacroiliac joint
Important muscle attaches to ischial tuberosity:
hamstrings
What bone attaches to the hip?
Femur - trochanter
Where does the sciatic nerve pass on its way to the lower leg?
Between the ischial tuberosity and greater trochanter.
3 Main functions of Gluteal muscles:
1. Leg extension
2. Abduction
3. Lateral rotation
Hip Extensor Muscles:
-Gluteus maximus
-Hamstrings
Actions of Gluteus Maximus:
-Hip extension
-Thigh lateral rotation
-Raises trunk from seated or flexed position
What type of muscle is the Gluteus maximus?
fast twitch - only flexed in movement.
Where does the gluteus maximus originate and insert?
Origin: sacrum/coccyx, iliac crest, sacrotuberous ligament.
Insert: 2/3 on IT tract, 1/3 on gluteal tuberosity of femur.
What is the gluteal tuberosity?
A prominance on the femur that is point of insertion for gluteal muscles.
Gluteus maximus nerve:
Blood supply:
Inferior gluteal nerve - S1
-runs below piriformis
Inferior gluteal artery
How do you test the Gluteus max?
-Lie prone
-Bend knee to relax hamstring
-Raise thigh off table
What are the Hamstring muscles?
1. Biceps femoris long head
2. Semitendinosis
3. Semimembranosis
Biceps femoris action:
-Extends the thigh
-Flexes the leg
Biceps femoris longhead:
-Origin
-Insertion
-Nerve
Origin: Ischeal tuberosity
Insertion: head of fibula
Nerve: Tibial portion of Sciatic nerve
Biceps femoris shorthead:
-Origin
-Insertion
-Nerve
Origin: linea aspera
Insertion: head of fibula
Nerve: fibular portion of sciatic nerve
Common origin of Semimembranosis and Semitendinosis:
Ischeal tuberosity
Semitendinosis insertion:
Medial tibia
Semimembranosis insertion:
Medial tibial condyle
Semitendinosis & -membranosis:
-Actions
-Nerve
Action: Extend thigh, Flex leg
(same as glut max)
Nerve: tibial portion of sciatic nerve
How to test the hamstrings:
-Lie supine
-Resist as patient tries to flex leg (lift it).
Relative positions of Hamstrings:
Lateral = biceps femoris
Medial = Semitendinosis
Middle = Semimembranosis
What muscle is responsible for Hip Abduction? What else does it do?
Gluteus MEDIUS
-Primary abductor, tilts pelvis
-Assists medial rotation
Gluteus medius
-origin
-insertion
-nerve
origin = ileum
insertion = lateral surface of greater trochanter
Nerve: Superior gluteal nerve
What results from Gluteus medius weakness?
Trendelenberg gait
Trendelenburg gait:
sexy walk - hip drops and swings out when weight is transferred to that leg.
What assists the glut medius in abduction?
Gluteus minimus
What is the origin and insertion of Gluteus minimus?
Nerve?
Origin: ileum
Insertion: anterior surface of greater trochanter
Nerve: superior gluteal nerve
2 muscles innervated by superior gluteal nerve:
-Gluteus medius
-Gluteus minimus
Primary actions of Piriformis:
-Lateral rotation
-abducts flexed thigh
Piriformis:
-origin
-insertion
how does it leave pelvis?
Origin = anterior surface sacrum
Insertion = superior border of greater trochanter
Leaves pelvis via GSF
Piriformis innervation:
Ventral rami of S1 and S2
Why is piriformis important?
-Sciatic nerve passes between it and superior gamellus
-Vessels/nerves named in re: to it
Safe area for gluteal injections:
Why?
Superior to piriformis - you won't hit the sciatic nerve.
What muscles are responsible for lateral rotation of the thigh?
-Piriformis
-Obturator internus
-Superior/inferior gemelli
-Quadratus femoris
Obturator internus actions:
Extended thigh: lateral rotation
Flexed thigh: abduction
Obturator internus
-origin
-insertion
-how it leaves pelvis
-nerve
origin: obturator membrane
insertion: medial aspect of greater trochanter
leaves pelvis: via LSF
nerve: nerve to obt. internus
Superior gemellus:
-origin
-insertion
-nerve
origin: Ischial Spine
insertion: Obturator internus tendon
Nerve: nerve to obturator internus
Inferior gemellus:
-origin
-insertion
-nerve
Origin: Ischeal tuberosity
Insertion: Obturator internus tendon
Nerve: Nerve to quadratus femoris
Quadratus femoris:
-origin
-insertion
-nerve
Origin: Lateral border of Ischeal tuberosity
Insertion: Intertrochanteric crest of femur
Nerve: nerve to quadratus femoris
What order do the Lateral Rotators run in from Sup->Inf?
PSOIQ
Piriformis - ventral rami S1/2
Sup Gemell - n to Obt. internus
What are the superficial gluteal nerves?
Cluneal - provide cutaneous sensory
What does the Superior cluneal nerve consist of?
Dorsal rami of L1-L3
What does the middle cluneal nerve consist of?
Dorsal rami of S1-S3
Important to remember about inferior cluneal nerve:
pierces sacrotuberous ligament to innervate lower 1/3 buttocks
How do the deep gluteal nerves get to the hip/buttock region?
By exiting thru GSF
Important deep gluteal nerves to know:
1. Superior Gluteal
2. Inferior Gluteal
3. Sciatic
4. Posterior cutaneous nerve
5. Nerve to quadratus femoris
6. Nerve to obturator internus
7. Pudendal nerve
Superior Gluteal nerve:
-nerve roots
-where
-travels w/
Roots: L4,5 S1
Where: superior to piriformis
Travels w/: Sup Gluteal Artery
Muscles supplied by Superior Gluteal nerve:
-Gluteus medius
-Gluteus minimus
-tensor fascia lata
Inferior gluteal nerve:
-nerve roots
-where
-travels w/
Roots: L5, S1,2
Where: inferior to piriformis, superficial to sciatic nerve.
-Travels w/ Inf Gluteal Artery
Muscles supplied by Inferior Gluteal nerve:
Gluteus maximus
Sciatic nerve:
-nerve roots
-course
-makes what
Roots: L4,5, S1-3
Course: exits GSF, pass between ischial tub & greater trochanter
Makes: Tibial + Common Peroneal
Posterior Femoral Cutaneous N.
-roots
-Where
Roots: ventral rami S1-S3
Where: exits pelvis w/ Inf gluteal nerve & Sciatic,
-Passes btwn Glut Max / Post surface of Sciatic n.
Nerve to Quadratus Femoris:
-Roots
-Where
Roots: L4,L5, S1
Where:
-Exits pelvis deep to sciatic nerve and obturator internus
Muscles innervated by Nerve to Quadratus Femoris:
-Quadratus Femoris
-Inferior Gemellus
Nerve to Obturator Internus:
-roots
-Where
Roots: L5, S1, S2
Where: Medial to sciatic nerve
Muscles innervated by N. to Obturator internus:
-Superior gemellus
Then passes behind ischial spine, re-enters LSF to supply
-Obturator internus
Pudendal nerve:
-roots
-Where
Roots: S2-S4
Where: most medial in glut reg
Pass lateral to sacrospinous ligament, re-enters LSF
What does Pudendal nerve do?
Sensory in perineal area
All arteries in the gluteal region are supplied by:
Internal iliac artery
Gluteal branches of internal iliac artery:
-Superior gluteal artery
-Inferior gluteal artery
-Internal Pudendal
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