GLUTEAL REGION,POSTERIOR THIGH

Course Lecturer: OVIOSUN, AUGUSTINE

Department of Anatomy

Faculty of Basic Medical Science

Edo State University, Uzairue.
.

OVIOSUN, AUGUSTINE
 LEARNING OUTCOMES
• By the end of this class, students should be able to

• 1. Describe the anatomy of the gluteal region

• 2. List and explain the muscles of the gluteal region, posterior thigh

• 3. State their point of origin, insertion, innervation and action.

• 4. Describe the anatomy of popliteal fossa

 GLUTEAL REGION/BUTTOCK
• Prominent area posterior to the pelvis
(the buttocks).

• Extends from the iliac crests down to the

gluteal fold.

• The intergluteal cleft separates the

buttocks from each other.

3
 GLUTEAL MUSCLES
• Muscles in the gluteal region are
organized into two layers

• SUPERFICIAL LAYER – (abduct and

extend the hip)
Gluteus Maximus, Minimus and
Medius, tensor fasciae latae

• DEEP LAYER – (laterally rotates the

femur at the hip joint)
Piriformis, Obturator internus,
superior and inferior Gamelli,
Quadratus femoris.
4
 GLUTEUS MAXIMUS
• It is quadrangular in shape

• It is the largest and most superficial

muscle in the gluteal region

• Overlies most of the other gluteal

muscles.

• Extends thigh (especially

from flexed position) and assists in its
lateral rotation;
5
 GLUTEUS MAXIMUS CONTD…
ORIGIN
• Ilium posterior to posterior gluteal line;
dorsal surface of sacrum

INSERTION
• Most fibers end in iliotibial tract that inserts
into the lateral condyle of femur

• Innervation: Inferior gluteal nerve

• Action: Extends thigh and assists lateral

rotation
6
 GLUTEUS MEDIUS AND MINIMUS
• The gluteus medius and gluteus
minimus, are fan shaped muscles

• The gluteus minimus and most

of the gluteus medius lie deep to the gluteus
maximus on the external surface of the ilium.

• They share the same actions, nerve supply

and are supplied by the same blood vessel
,the superior gluteal nerve and
superior gluteal artery . 7
 GLUTEUS MEDIUS AND MINIMUS
• ORIGIN
• Gluteus medius and minimus:
Lateral surface of ilium, between the inferior
and anterior gluteal line.

• INSERTION
Gluteus Medius:
Lateral border of the greater
trochanter of femur
Gluteus Minimus:
Anterior border of the greater
trochanter of femur
8
 TENSOR FASCIAE LATAE
• The tensor fasciae latae is a fusiform muscle
approximately 15 cm long that is enclosed
between two layers of fascia lata.
ORIGIN
The anterior superior iliac spine
Anterior part of external lip of the crest.
INSERTION
The tensor fasciae latae and the superficial
and anterior part of the gluteus Maximus
share a common distal attachment to the
anterolateral tubercle of the tibia

9
 TENSOR FASCIAE LATAE CONTD….
• INNERVATION
Superior gluteal nerve.

• ACTION
Abduct, medially rotates and flexes the
thigh.

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 DEEP LAYER OF GLUTEAL MUSCLES
• The deep layer muscles consists of
smaller muscles like:

Piriformis,
Obturator internus,
Superior gemellus,
Inferior gemellus
Quadratus femoris) covered by the
inferior half of the gluteus maximus.

43
 THE PIRIFORMIS
• The most superior of the deep group of
muscles.

• Pear shaped muscle

• Origin
Anterior surface of the sacrum
Sacrotuberous ligament

• Passes laterally and inferiorly through the

greater sciatic foramen.
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 THE PIRIFORMIS
• Inserts on the superior border of the greater
trochanter of the femur.

• Action: Laterally rotates thigh and abducts the femur

at the hip joint.

• Innervated by the nerve to piriformis from S1 and S2

of the sacral plexus

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 THE PIRIFORMIS
• Piriformis is an important landmark

• It divides the greater sciatic foramen

into two regions,
one above and
one below the piriformis.

• Neurovascular structures pass between

the pelvis and gluteal region by passing
through the greater sciatic foramen
either above or below the piriformis
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 PIRIFORMIS
• Superior gluteal nerves and vessels pass
through the greater sciatic foramen
above piriformis

• Other structures like

the inferior gluteal nerve and vessels,
pudendal nerve and vessels,
sciatic nerve,
nerve to obturator internus
Nerve to quadratus femoris,

pass below the piriformis

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OBTURATOR INTERNUS
• It is a flat fan-shaped muscle
• Origin
the pelvic surface of the
Obturator membrane
margins of the Obturator
foramen.

• The muscle fibers converge

to form a tendon

• bends 90° around the

ischium between the ischial
spine and ischial tuberosity 18
 OBTURATOR INTERNUS
• Passes through the lesser sciatic
foramen to enter the gluteal
region.

• Insertion: Medial surface of

greater trochanter of the femur.

• Action: Laterally rotates and

abducts the femur at the hip joint

• Innervation: nerve to the

obturator internus.
19
 SUPERIOR AND INFERIOR GEMELLI
• Gemelli is Latin for twins

• Gemelli muscles are a pair of triangular

muscles
• associated with the upper and lower
margins of the obturator internus
tendon.

• Superior gemellus originates from the

ischial spine

• Inferior gemellus originates from the

ischial tuberosity. 20
SUPERIOR AND INFERIOR GEMELLI
• Fibers of the gemelli
muscles attach along the
length of the obturator
internus tendon

• Insertion:
Medial surface of greater
trochanter of the femur.

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 SUPERIOR AND INFERIOR GEMELLI

• Gemellus superior is innervated by the nerve to the obturator

internus

• Gemellus inferior is innervated by the nerve to the quadratus femoris.

• Action: act with the obturator internus muscle to laterally rotate and
abduct the femur at the hip joint.

22
 THE QUADRATUS FEMORIS
• The most inferior of the deep group of
muscles in the gluteal region.

• It is a flat rectangular muscle below the

obturator internus muscle

• Origin: The ischial tuberosity

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 THE QUADRATUS FEMORIS
• Insertion: the quadrate tubercle on the intertrochanteric crest of the
proximal femur.

• Action: laterally rotates the femur at the hip joint

• Innervation: nerve to the quadratus femoris.

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 POSTERIOR COMPARTMENT OF THIGH
• Extends from the gluteal fold to the knee.

• It is separated from the anterior compartment by the

lateral intermuscular septum.

• While posterior intermuscular septum separates it from

the medial compartment.

27
MUSCLES OF THE POSTERIOR
COMPARTMENT OF THIGH
• There are three long muscles in this
compartment collectively called the
'hamstring muscles'.

• They include

• Biceps femoris,

• Semitendinosus, and

• Semimembranosus
28
MUSCLES OF THE POSTERIOR
COMPARTMENT OF THIGH

• All except the short head of biceps femoris

Originate from the ischial tuberosity

Cross both the hip and knee joints

Innervated by tibial division of the sciatic nerve

29
 THE BICEPS FEMORIS MUSCLE
• Lateral in the posterior compartment of
the thigh and has two heads.

• LONG HEAD originates from the upper

and medial part of the ischial tuberosity;

• SHORT HEAD arises from

the lateral lip of the linea aspera on the
shaft

Upper part of lateral supracondylar line

of femur
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 THE BICEPS FEMORIS MUSCLE
• Insertion
Both long and short heads
insert on the lateral side of
head of fibula

• Innervation
• The long head: by the tibial
division of the sciatic nerve

• Short head: by the common

fibular division of the sciatic
nerve.
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 THE SEMITENDINOSUS MUSCLE
• Medial to the biceps femoris muscle.

• Origin:
the upper and medial area of the ischial
tuberosity.

Has a spindle-shaped belly that ends in

the lower half of the thigh

Insertion:
Medial surface of superior part of tibia

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 THE SEMI MEMBRANOSUS MUSCLE
• Lies deep to the semitendinosus muscle.

• Origin: the upper and lateral ischial

tuberosity

• Insertion: to the posterior surfaces of

the medial tibial condyle.

• Expansions from the tendon also insert

into, and contribute to the formation of
ligaments and fascia around the knee
joint.
33
THE SEMIMEMBRANOSUS MUSCLE
• Actions:
flexes the leg at the knee joint
extends the thigh at the hip joint

• Innervation: by the tibial division of the sciatic

nerve.

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 NERVES OF THE GLUTEAL AND POSTERIOR
THIGH REGION
• Sciatic Nerve
• Posterior cutaneous nerve of the thigh
• Superior gluteal nerve
• Inferior gluteal nerve
• Nerve to quadratus femoris
• Nerve to obtruator internus
 ARTERIES OF THE POSTERIOR THIGH AND
GLUTEAL REGION
• Superior gluteal artery
• Inferior gluteal artery
• Internal pudendal artery
• Perforating artery
 INJURY TO SUPERIOR GLUTEAL NERVE
• Injury to this nerve results in a characteristic motor loss, resulting in a
disabling gluteus medius limp, to compensate for weakened
abduction of the thigh

• Medial rotation of the thigh is also severely impaired.

• When a person who has suffered a lesion of the superior gluteal

nerve is asked to stand on one leg, the pelvis on the unsupported side
descends indicating that the gluteus medius and minimus on the
supported side are weak or non-functional.
 Intragluteal Injections
• The gluteal region (buttocks) is a common site for intra muscular (IM)
injection of drugs.
• Gluteal IM injections penetrate the skin, fascia, and muscles. The gluteal
region is a common injection site because the muscles are thick and large;

• It is important to be aware of the extent of the gluteal region and the safe
region for giving injections. Some people restrict the area of the buttocks
to the most prominent part. This misunderstanding may be dangerous
because the sciatic nerve lies deep to this area.

• Injections into the buttocks are safe only in the superolateral quadrant of
the buttocks or superior to a line extending from the PSIS to the superior
border of the greater trochanter
 PIRIFORMIS SYNDROME
• Compression of the sciatic nerve by the piriformis muscle.

• Piriformis syndrome causes pain that radiates down

the back of the leg along the sciatic nerve.

• Piriformis syndrome is an uncommon cause of pain

and other symptoms in the buttocks and/or lower back
that can radiate down the leg to the foot

• Symptoms may include pain and numbness

in the buttocks and down the leg. Often
symptoms are worsened with sitting or
running