GLUTEAL REGION

Overlies the side and back of the pelvis extending from

the iliac Crest above to the gluteal fold below.
Introduction. The lower part of the gluteal region, which presents a rounded bulge due to excessive amount of
subcutaneous fat, is known as the buttock or natis.

Anterior superior part of the region in the side view is called the hip.

Gluteus maximus and buttock covers the muscles, nose and vessels emerging from the pelvis.

Morphologically, they erect posture of man has led to extension at the hip and appearance of
gluteal fold, which is the transverse skin crease of the hip joint.

This puts greater responsibility and gluteus maximus, which makes the body erect and maintains
it in the erect posture at the hip.

This involves raising and supporting the trunk against gravity.

The gluteus maximus covering the hip joint is there for one of the most powerful and bulkiest
muscle in man.
Buttock is the rounded bulge in the lower part of the gluteal region.
• The two buttons are separated from each other in the posterior median line by the Natal cleft. Which begins at the
third Carol spine and deepens inferiorly.
• The gluteal fold marks the lower limit of the buttock.

Ischial tuberosity is a large Bony prominence which lies deep to the lower border of gluteus
maximus.
• About 5cm from the median plane and about the same distance from the gluteal fold.
• It can be felt by placing the fingers in the medial part of the gluteal fold and pressing them upwards.

Greater trochanter.
• large Bony prominence of femur situated immediately in the front of the hollow side of the hip.
• About a handbreadth below the tubercular of iliac Crest.

SURFACE LANDMARKS.
 Superficial fascia: Heavily laden with fat, more in females, tough and
stringy over the initial tuberosity where it forms a efficient cushion for
supporting the body weight in the sitting posture. It contains cutaneous
nerves, vessels and lymphatics.

Cutaneous nose converge on the gluteal

region from all directions.
The upper anterior: lateral cutaneous
branch of the subcostal T12 and
iliohypogastric L1 nerves.
Upper posterior: posterior primary Rami of
spinal nerves L1, L2, L3 and S1, S2, S3.
subcutaneous tissue derived from branches
Lower anterior: branches from the posterior
division of the lateral cutaneous nerve of
the thigh (L2, L3).
Lower posterior: branches from the
posterior cutaneous nerve of the thigh
(S1,S2,S3) and perforating cutaneous(S2,
S3).
Deep fascia
Continuous vessels and lymphatics.
Above and in front of the gluteus maximus.
The blood supply of the skin and
Over the gluteus medius thick and dense,
opaque and pearly white.
of the superior inferior gluteal arteries.
Over the gluteus maximus thin and
The lymphatics from the gluteal region
transparent.
drain into the lateral group of the
superficial inguinal lymph flow. The deep fascia splits and includes the
gluteus maximus.
 Muscles.
• Gluteus medius
• Gluteus minimus
• Reflected head of the
rectus femoris
• Piriformis
• Obturator Internus with
two Gemili
• Quadratus Femoris
• Obturator Externus
• Origin of the four
Hamstring from the
ischial tuberosity.
• Insertion of the upper or
pubic fibers of the
Adductor Magnus.
MUSCLES OF GLUTEAL REGION
STRUCTURES UNDERCOVER OF GLUTEUS
MAXIMUS
Vessels. Nerve. Bones and joints. Ligaments and Bursa.
• Superior gluteal vessels • Superior • Ilium • Sacrotuberous
• Inferior gluteal vessel gluteal(L4,L5,S1) • Ischium with ischial • Sacrospinous
• Internal pudendal • Inferior tuberosity. • iIschiofemoral.
vessels gluteal(L5,S1,S2) • Upper end of the femur • Trochanteric Bursa of
• Ascending branch of the • Sciatic(L4 TO S3) with greater trochanter. gluteus maximum
medial circumflex • Posterior Cutaneous • Sacrament & coccyx • Bursa over the ischial
femoral artery nerve of • Hip joint tuberosity
• Trochanteric. thigh(S1,S2,S3) • Sacroiliac joint. • Bursa between the
Anastomosis • Nerve to quadratus gluteus maximus and
• Cruciate anastomosis femoris(L4,L5,S1) vastus lateralis.
• The first perforating • Pudendal nerve(S2,3,4)
artery. • Nerve to the Obturator
Internus(L5,S1,S2)
• Perforating cutaneous
nerves(S2,S3)
Structures deep to the gluteus medius.
• Superior gluteal nerve
• Deep branch of the superior gluteal artery
• Gluteus minimus
• Trochanteric Bursa of the gluteus medius.

Structures deep to the gluteus minimus.

• Reflected head of the rectus femoris
• Capsule of the hip joint.

Sacrotuberous and sacrospinous ligaments.

• These two ligament convert the greater and lesser sciatic notches of the hip joint into foramina of the same name.
• The sacrotuberous ligament is a long and strong ligament extending from the medial margin of the ischial tuberosity
and the posterior iliac spine.
• It forms the posterolateral boundary of the outlet of the pelvis.
• Sacrospinous ligament is a short, thick triangular band situated deep to the sacrotuberous ligament. It is attached
laterally to the ischial spine, medially to the sacrococcygeal junction.

MUSCLES OF GLUTEAL REGION

 Clinical anatomy.
Testing gluteus maximus: patient lies prone, right hand of the physician presses the patients right leg
downwards. Patient extends his hip against resistance provided by the physicians right hand; while his left
hand feels the contracting gluteus maximus.

Normal gait depends upon the

Intramuscular injection: given in
Gluteus maximus is paralyzed as the upper lateral quadrant of the Gluteus medius and minimus proper abductor mechanism at
in muscular dystrophy. (right side), are paralyzed, both hips.
gluteal region - gluteus medius
Patient cannot stand up from a and minimus, to avoid injury to Patient cannot walk normally. This mechanism comprises:
sitting position without support. large vessels, and nerves which She bends or waddles on the The adequate power provided by
Such patient while trying to passes through the lower part of right side or paralyzed side to the gluteus medius and minimus.
stand up, rise gradually this region. clear the opposite foot. The Fulcrum provided by a
supporting their hands first on Gluteal region is not the This is known as lurching gait. normal relation of the head of the
legs and then on the thighs. prominence of the buttock only. When bilateral, it is called femur with the acetabulum.
They climb on their self. It is a very big area over the iliac Waddling Gait. The weight transmitted by the
bone.
head and neck of the femur.
 Clinical anatomy

Normally when the body weight is supported on one limb, the gluteus of the supported side raises the opposite and
unsupported side of the pelvis. However, if the abductor mechanism is defective, the unsupported side of the pelvis
drops, and this is known as a positive trendelenburg’s sign.

This sign is positive in defects Gluteus medius and gluteus

of power, -Paralysis of the
gluteus medius and minimus;
defects of the fulcrum, -
congenital or pathological
dislocation of the hip; and
defects of the weight -
Ununited fracture of the neck
of the femur.
Gluteus medius, gluteus
minimus can be tested
minimus, and tensor. Fasciae
together by doing internal
latae are Tested by abducting
rotation of thigh against
lower limb against resistance.
resistance.
The person lying supine
The person lies in supine
position and the knee is
position with the hip and knee
extended.
flexed.
THE END