GLUTEAL REGION

Skeleton of the Gluteal Region

Gluteal Lines

Anterior
Middle curved line Longest of the three gluteal lines Begins at the crest (about 4 cm) behind its anterior extremity Ends at the upper part of the greater sciatic notch

Posterior
Superior curved line Shortest of the three gluteal lines Begins at the iliac crest Ends at greater sciatic notch

Inferior
Inferior curved line Least distinct of the three gluteal lines Begins in front at the notch on the anterior border Ends near the middle of the greater sciatic notch

Greater Sciatic Notch

Located above the ischial spine Transmits

Piriformis, Superior and inferior gluteal vessels and nerves

 Sciatic and posterior femoral cutaneous nerves Internal pudendal vessels Nerves to the Obturator internus and Quadratus femoris

Lesser Sciatic Notch

Smaller notch below the ischial spine Smooth Surface of which presents two or three ridges corresponding to the subdivisions of the tendon of the Obturator internus, which winds over it.

Greater Sciatic Foramen

Major foramen within the pelvis Boundaries

greater sciatic notch (anterolaterally) sacrotuberous ligament (posteromedially)

 sacrospinous ligament and ischial spine (inferiorly) anterior sacroiliac ligament (superiorly)

Lesser Sciatic Foramen

Opening between the pelvis and the posterior thigh Formed by the sacrotuberous ligament and the sacrospinous ligament

Boundaries
Anterior: the tuberosity of the ischium Superior: the spine of the ischium and sacrospinous ligament Posterior: the sacrotuberous ligament

Ischial Spine
Thin and pointed triangular eminence More or less elongated Serve as a landmark in pudendal anesthesia

Ischial Tuberosity
Sitz bone or pair the sitting bones Marks the lateral boundary of the pelvic outlet

Sacrotuberous Ligament
Runs from the sacrum to the ischial tuberosity. Prevents the lower part of the sacrum tilting upwards and backwards under the weight of the rest of the vertebral column

Forms part of the boundary of both the greater and lesser sciatic foramina Forms an attachment for several muscles (most notably it is part of the origin of gluteus

maximus)

Sacrospinous Ligament
Small or anterior sacrosciatic ligament Thin, triangular ligament Attached by its

Apex to the ischial spine Medially to the lateral margins of the sacrum and coccyx In front of the sacrotuberous ligament

Greater Trochanter
Large, irregular, quadrilateral eminence and a part of the skeletal system Directed a little lateralward and backward Greater distance between the greater trochanters in the female

Intertrochanteric Crest
Bony ridge located on the posterior side of the head of the femur Stretches obliquely downward and medially from the summit of the greater trochanter to the lesser trochanter

Trochanteric Fossa

Point of insertion of four muscles

Inferior-most to the superior-most
Tendon of the obturator externus muscle Obturator internus Superior gemellus Inferior gemellus

Skin of the Buttock

Cutaneous Nerves
Derived from posterior and anterior rami of spinal nerves

 Upper medial quadrant upper 3 lumbar and upper three sacral nerves Upper lateral quadrant iliohypogastric (L1) and 12th thoracic nerves Lower lateral quadrant lateral cutaneous nerve (L2 and L3) Lower medial

Fascia of the Buttock

Superficial Fascia
Thick and impregnated with large quantities of fat Responsible for prominence of buttock

Deep Fascia
Continuous with deep fascia of thigh Encloses gluteus maximus muscle

Muscles of Gluteal Region

Gluteus Maximus
Largest muscle in the body Lies superficial in the gluteal region Largely responsible for the prominence of buttock

 Origin: outer surface of ilium, sacrum, coccyx, sacrotuberous ligament Insertion: iliotibial tract and gluteal tuberosity of femur Nerve Supply: inferior gluteal nerve Action: extends and laterally rotates hip joint

Gluteus medius
Thick fan-shaped muscle Its posterior part is covered by gluteus maximus

 Origin: Outer surface of ilium Insertion: Lateral surface of greater trochanter of femur Nerve supply: Superior gluteal nerve Action: Abducts thigh at hip joint; tilts pelvis when walking

Gluteus Minimus
Fan-shaped muscle Lies deep to the gluteus maximus

 Origin: outer surface of ilium Insertion: anterior surface of greater trochanter of femur Nerve supply: superior gluteal nerve Action: Abducts thigh at hip joint; tilts pelvis when walking

Tensor Fascia Latae

Origin: Iliac crest Insertion: Iliotibial tract Nerve supply: Superior gluteal nerve Action: Assists gluteus maximus in extending the knee joint

Piriformis
Lies partly within the pelvis Separates superior gluteal vessels and nerves from inferior gluteal vessels and nerves

 Origin: anterior surface of sacrum Insertion: upper border of greater trochanter of femur Nerve supply: First and second sacral nerve Action: Lateral rotator of hip at thigh joint

Gemellus Superior
Origin: spine of ischium Insertion: upper border of greater trochanter of femur Nerve supply: sacral plexus Action: lateral rotator of thigh at hip joint

Gemellus Inferior
Origin: ischial tuberosity Insertin: upper border of greater trochanter of femur Nerve supply: sacral plexus Action: lateral rotator of thigh at hip joint

Obturator Internus
Fan-shaped muscle Lies partly within pelvis Origin: inner surface of obturator membrane Insertion: upper border of greater trochanter of femur Nerve supply: sacral plexus Action: lateral rotator of thigh at hip joint

Quadratus Femoris
Quadrilateral-shaped muscle Origin: lateral border of ischial tuberosity Insertion: quadrate tubercle of femur Nerve supply: sacral plexus Action: lateral rotator of thigh at hip joint

Nerves of Gluteal Region

Branches of the lumbosacral plexus Arise in the pelvis and pass through the greater sciatic foramen to reach the gluteal region Piriformis muscle separates the greater sciatic foramen into superior and inferior parts Branches either come through the superior part or the inferior part

Superior Gluteal Nerve

Branch of sacral plexus Leaves pelvis through the upper part of the greater sciatic foramen above piriformis Supplies gluteus medius and minimus, and tensor fasciae latae

Inferior Gluteal Nerve

Branch of sacral plexus Leaves pelvis through the lower part of the greater sciatic foramen below piriformis Supplies gluteus maximus muscle

Nerve to Quadratus Femoris

Branch of sacral plexus Leaves pelvis through the lower part of the greater sciatic foramen Supplies quadratus femoris and inferior gemellus

Pudendal Nerve and the Nerve to the Obturator Internus

Branch of sacral plexus Leaves pelvis through the lower part of the greater sciatic foramen below piriformis Supplies structures in perineum (pudendal) Supplies obturator muscle on its pelvic surface (nerve to the obturator internus)

Arteries of the Gluteal Region

Superior Gluteal Artery

Branch from the internal iliac artery Enters the gluteal region through the upper part of the greater sciatic foramen above piriformis Divided into branches distributed throughout gluteal region

Inferior Gluteal Artery

Branch from the internal iliac artery Enters the gluteal region through the lower part of the greater sciatic foramen below piriformis Divided into numerous branches distributed throughout gluteal region

Trochanteric Anastomosis
Provides main blood supply to the head of femur Arteries taking part in anastomosis:
Superior gluteal artery Inferior gluteal artery Medial femoral circumflex artery Lateral femoral circumflex artery

Cruciate Anastomosis
Situated at the level of lesser trochanter of femur Arteries taking part in anastomosis:
Inferior Gluteal artery Medial femoral circumflex artery Lateral femoral circumflex artery First perforating artery (branch of profunda artery)

Posterior Compartment of Thigh

Skeleton of Posterior Thigh

Pelvis

Ischial Tuberosity

Femur
Lateral lip of linea aspera
Gives attachment to the lateral intermuscular septum and the short head of the biceps femoris muscles

 Lateral supracondylar line

A crest on the lateral aspect of the back of the femur which delimits the popliteal surface laterally Provides attachment for the vastus lateralis

 Medial Condyle
Inner side of the lower extremity of the femur

 Lateral Condyle
Outer side of the lower extremity of the femur

 Popliteal Surface
Posterior surface of the lower end of the femur between the diverging lips of the linea aspera

Fibula - calf bone is a bone located on the lateral side of the tibia
Apex Head Neck

Tibia
Shinbone, or shankbone Connects the knee with the ankle bones Commonly recognized as the strongest weight bearing bone in the body

Muscles (Hamstring Muscles)

Biceps femoris
Forms part of the hamstrings muscle group Has 2 heads (short and long)

Semimembranosus
Most medial of the three hamstring muscles

Semitendinosus
Remarkable for the great length of its tendon of insertion Situated at the posterior and medial aspect of the thigh