Gluteal Region

Objectives
• At the end of the lecture the students would be able to —
• List the bony landmarks of Gluteal region
• Describe the Hip Bone & components of Pelvic Girdle
• Describe the Gluteus Maximus muscle & its Actions (Origin, Insertion,
Nerve Supply)
• List the structures under cover of Gluteus Maximus (Diagram)
• Explain the Trendeleneburg Sign of Hip with actions of Gluteus Medius
& Minimus
• Describe the Sciatic Nerve under Root value, Course, Distribution &
Relations
• Describe the Arteries of the Gluteal Region & Back of Thigh and
explain the collateral circulation
 Bony Landmarks
• Ischial Tuberosity: Large bony prominence 5 cm
from median plane, 5 cm above Gluteal fold
• Greater Trochanter of Femur: Laterally, about a
hand breadth below the tubercle of iliac crest
• Iliac Crest: Thick curved bony ridge in the lower
margin of the waist Iliac
• Hand spanning the waist often supported on iliac Crest
crest
• Highest Point of Iliac Crest: Horizontally Greater
corresponds to L4 (helpful to find out location of Trochanter Ischial
Lumbar puncture—L3/L4 spine junction) Tuberosity
• Anterior Superior Iliac Spine (A.S.I.S): Anterior end
of Iliac crest, line from here to greater trochanter
(Bryant’s Triangle in hip examination), also Lateral
end of Inguinal Ligament attached here
• Posterior Superior Iliac Spine: at level of S2 spine
in the floor of dimple of venus, 5 cm from median
plane
• Sacrotuberous ligament
 PELVIC GIRDLE
Bony Ring FORMED BY
2 HIP BONES—joined at PUBIC
SYMPHYSIS & at SACRUM

2 PUBIS CONNECTED BY A
SECONDARY (Symphysis)
CARTILAGINOUS TYPE OF JOINT-A
FIBROCARTILAGE DISC IN
BETWEEN

SACRUM+ILIUM= SACROILIAC JOINT,

A Plane TYPE SYNOVIAL JOINT-
TRANSMIT WEIGHT OF TRUNK TO
EACH FEMUR

INGUINAL LIGAMENT--Bet ANT.SUP.ILIAC SPINE &

PUBIC TUBERCLE--FOLD OF GROIN
GREATER SCIATIC NOTCH-- LESSER SCIATIC
converted to foramen by SACRO-TUBEROUS LIG-- FORAMEN-
SCIATIC NERVE passes down into back of thigh PUDENDAL NERVE-main
with SUPERIOR, INFERIOR GLUTEAL NERVES & nerve supplying PERINEAL
PUDENDAL NERVE through the Greater Sciatic Foramen ORGANS
RE-ENTERS PELVIS
Superficial Fascia of Gluteal Region

• Heavily laden with fat, particularly

in females
• In Ischial tuberosity, MORE FAT
to support BODY WEIGHT during
sittng
• Cutaneous nerves
• Anterior part: Lumbar L1,2,3
• Posterior part: sacral S1, 2, 3
• Name of nerves:
• POSTERIOR CUTANEOUS
Nerve of Thigh
• Lataeral Cutaneous nerve of thigh
• Lymphatics
• To supeficial inguinal lymph nodes
 Gluteus maximus
• Origin: Ilium bone behind posterior gluteal line,
back of Sacrum, Coccyx, sacrotuberous
ligament, part of iliac crest
• One of the largest muscle of body
• Insertion: Greater part inserted to Iliotibial tract
• Small part inserted to Gluteal tuberosity
(posterior surface of femur)
• Actions: Chief Extensor of HIP, Rising from
sitting position, Lateral rotator of hip
• Stabilizes the knee via Iliotobial tract (Anti-Gravity
Muscle)
• Maintains erect posture
• Nerve supply: Inferior Gluteal Nerve

Ilio-tibial tract: Deep Fascia of Thigh is FASCIA LATA

Ilio-Tibial tract is CONDENSED Deep fascia with muscles (Gluteus
Maximus + Tensor Fascia Lata) attached from Iliac crest above to Tibial
Medial condyle below. Stabilizes knee both in extension and in partial
flexion, and used constantly during walking and running. In leaning
forwards slightly flexed knee it is the main support of knee against
gravity.
Intramuscular Injection
Divide by a horizontal & vertical line into 4
quadrants. Choose UPPER & LATERAL to
prevent damage to Sciatic Nerve & Superior
Gluteal artery
 Structures under Gluteus Maximus

1. Muscles: Gluteus Medius, Gluteus Minimus

2. Structures passing via GREATER SCIATIC
FORAMEN
Above Priformis: Superior Gluteal Vessels
Superior Gluteal Nerve
Below Piriformis: Sciatic Nerve
Inferior Gluteal Vessels, Inferior Gluteal Nerve
Posterior Cutaneous Nerve of Thigh Underneath Sciatic Nerve:
Nerve to Quadratus Femoris Obturator Internus (above it Gamellus Superior, Below it
Re-enteringPelvis : Internal Pudendal Vessels Gamellus Inferior)
(via lesser Sciatic foramen) Internal Pudendal nerve Quadratus Femoris
3. Bursa: 3 in no. 4. Ligaments: Sacrotuberous Origin of 4 Hamstring muscles (Ischial Tuberosity)
Sacrospinous
 Gluteus Medius & Minimus
Gluteus Medius:
Origin: Outer surface of Ilium area between anterior
& Posterior Gluteal line
Insertion: Greater Trochanter
Nerve supply: Superior Gluteal
Nerve (L4,L5, S1)
Gluteus Minimus:
Origin: Outer surface of Ilium between anterior &
inferior gluteal line
Insertion: Greater Trochanter
Nerve supply: Superior Gluteal
Nerve (L4,L5, S1) Significance of +ve sign
result
Actions: •Weak Gluteus
Both muscles Powerful Abductors of Hip Medius/minimus of
& Medial Rotators STANCE (STATIC)
Most important: Maintain balance of the side
body when opposite foot is elevated above •Poliomyelitis induced
the ground (does not allow the opposite paralysis
•Superior Gluteal Nerve
Pelvis from falling downwards under gravity)
injury (L4, L5)
Essential movements for WALKING & TRENDELENBURG’S
•Fracture neck femur or TRENDELENBURG’S
RUNNING dislocation hip Sign -ve Sign +ve
 Sciatic Nerve
• Thickest nerve of the body
• Root value: from Sacral Plexus: L4,L5, S1, S2, S3
• Surface marking:
• 1st point: 2.5 cm lateral to midpoint between Posterior superior iliac spine & Ischial
tuberosity
• 2nd point: Just medial to midpoint between Ischial tubersoity & Greater trochanter
• Last ponit: Apex of Popliteal fossa (junction of upper 2/3rd & lower 1/3rd midline at
back of thgh)
• Course:
• Enters gluteal region via Greater Sciatic foramen
• Usually below Piriformis (can be above or pierce)
• Between Greater Trochanter & ischial Tuberosity enters back of thigh
• Lies under cover of Gluteus Maximus, separated from hip joint by 4 LATERAL
ROTATORS (Obturator Internus with Gamelli, Quadratus femoris)
• In Thigh: Beneath it: Adductor Magnus, Crossed by: Biceps Femoris, Medially:
Semimembranosus, Semitendinosus, Posterior Cutaneous nerve of thigh
• End: Upper angle POPLITEAL FOSSA  2 branches-TIBIAL & COMMON
PERONEAL NERVE
• Branches:
• Articular to Hip Joint
• Tibial part of it supply ALL HAMSTRING muscles, all CALF muscles
• Common peroneal supply short head BICEPS FEMORIS, Anterior & Lateral
Compartment muscles of leg
• Accompanied by : Branch from Inferior Gluteal Artery which forms Cruciate
Anastomiosis with perforating branches of Profunda Femoris artery at back of
thigh
Arteries of Gluteal Regions
• Superior Gluteal artery
• Inferior Gluteal artery
Both are branches from INTERNAL ILIAC
ARTERY in pelvic cavity
• Comes out in gluteus region via GREATER SCIATIC
FORAMEN
• Superior gluteal---above Piriformis, accompanies Superior
Gluteal Nerve, Divides into Superficial (to Gluteus
Maximus) & Deep branch(along gluteal lines BETWEEN
Gluteus Medius & Minimus---forms TROCHANTERIC
ARETRIAL ANSATOMOSIS with Medial Circumflex &
Lateral Circumflex—supply HEAD of Femur)
• Inferior Gluteal—below Piriformis, accompanies Inferior
Gluteal nerve,
• Gives branch to Sciatic nerve (Arteria Nervi Ischia Disi)
• Supply gluteus maximus & skin of buttock
• Forms CRUCIATE ANASTOMOSIS at back of Femur(with
medial circumflex, Perforating Branches of PROFUNDA
FEMORIS Artery) Connecting Internal Iliac artery with
arteries of thigh
• Cruciate Anastomosis communicate below with Popliteal
Artery. In case of Injury to Femoral artery this
COLLATERAL CIRCULATION supply the LOWER LIMB
BELOW KNEE