Class of 2009 Co-op Writer: Marisa ChapmanClinical Human AnatomyNovember 28, 2005 (112805)Hour A/B; 1pm-2pmGluteal Region; Dr. Mark Niedfeldt
The Gluteal Region
Note: Dr. Niedfeldt’s lecture followed the outline in the class notes, as well as previous years’ co-opnotes nearly verbatim.
I. Bony Anatomy
(N340-342); use as landmarks
The iliac crest is at the level of L4-L5 vertebrae; used as a landmark during epidural
Anterior superior iliac spine:
This is where your hands are when they are “on your hips.”
Posterior superior iliac spine:
These are the dimples on either side of the sacrum. Aclinical landmark for the sacroiliac joint.
You’re sitting on them; hamstrings attach here.
Greater trochanter (of the femur):
The bony aspect on the side of either hip. Severalmuscles attach here (listed below). The overlying bursa can be injured, resulting introchanteric bursitis. Refer to N469.Note: The sciatic nerve is located between the ischial tuberosity and greater trochanter.
Refer to body building magazines (or Netter)
in the gluteal region:
lateral rotation (turning foot outwards)
Action: primary hip extensor, lateral rotation of the thigh, raising the trunk from aseated or flexed position. The little old man with a flat butt has an atrophiedgluteus maximus due to decreased activity, and will have problems getting out of his chair and walking up steps. Tell your elderly patients that if they want tomaintain their independence, they need to maintain their gluteus maximus.
Gluteus maximus is a fast twitch muscle = only flexed in movement. It doesnot fire when standing; during normal walking you don’t use the gluteus maximusvery much.
One of the largest muscles in the body; forms a thick pad over ischial tuberosityfor sitting comfortd.Origin: broadly from the iliac crest, sacrum, coccyx, and sacrotuberous ligament
Insertion: 2/3 of gluteus maximus inserts on the iliotibial tract (fascia) and the reston the gluteal tuberosity of the femur. For more intense activities such asrunning, the iliotibial band will tighten up and recruit the gluteus maximus.
Innervation: inferior gluteal nerve (S1), below piriformis.
Test by having person lie prone (face down), bend the knee to relax the hamstringand isolate the gluteus maximus, and raise the thigh off the table.h.Arterial Blood Supply: Inferior Gluteal Artery