The Gluteal Region Flashcards

1
Q

Outline the cutaneous innervation of the gluteal region.

A

The cutaneous innervation of the gluteal region is divided into four quadrants—upper anterior, upper posterior, lower anterior, and lower posterior:
(a) Upper anterior quadrant is supplied by the:
– lateral cutaneous branch of subcostal nerve (T12), and
– lateral cutaneous branch of iliohypogastric nerve (L1).

(b) Upper posterior quadrant is supplied by the cutaneous branches from dorsal rami of upper three lumbar nerves (L1, L2, L3) and upper three sacral nerves (S1, S2, S3).

(c) Lower anterior quadrant is supplied by the posterior division of the lateral cutaneous nerves of the thigh.

(d) Lower posterior quadrant is supplied by the:
– posterior cutaneous nerves of the thigh (S1, S2, S3), and
– perforating cutaneous nerves (S2, S3).

[Diagram 1] [Diagram 2]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

State the nerve roots of the pudendal nerve.

A

S2, S3, S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

State the nerve roots of the posterior femoral cutaneous nerve and its distribution.

A

S1, S2, S3
Distribution: lower gluteal region by inferior cluneal nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

State the pattern of blood supply to gluteus maximus.

A

Segmental blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which arteries form the spinous anastomosis?

A

The superior gluteal artery anastomoses with the deep circumflex iliac artery and the ascending branch of the lateral circumflex femoral artery at the ASIS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

State causes of Trendelenburg’s sign.

A
  1. paralysis of gluteus medius and minimus
  2. dislocation of the hip joint
  3. fractures of the neck of femur
  4. collapse of the head of femur e.g. from avascular necrosis, slipped epiphysis, tuberculosis of head of femur
  5. severe arthritis of the hip joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Comment on sciatic hernias.

A
  1. Occurs when pelvic structures protrude through the greater sciatic foramen
  2. It compresses the contents of the foramen and may present with pain, numbness and weakness in the lower limb if sciatic nerve is compressed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some clinical notes regarding the sciatic nerve?

A
  1. can be compressed at lower border of gluteus maximus by sitting on a bench with a sharp edge
  2. may be injured by misplaced deep intramuscular injections. To prevent this, the injection is usually given in the superolateral quadrant.
  3. May be injured in posterior dislocation of the hip joint.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Comment on trochanteric bursitis.

A

The bursa between the greater trochanter and the gluteal aponeurosis may be a site of infection. Symptoms:
1) pain or a burning sensation in the hip or outer edge of the upper thigh, with the feeling sometimes travelling toward the knee but rarely crossing the knee
2) tenderness over the outer hip bone area
3) pain when lying and sleeping on the affected side

NOTE: The gluteal aponeurosis is a fibrous membrane from the fascia lata, that lies between the iliac crest and the superior border of the gluteus maximus. A part of the gluteus medius arises from this membrane.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the clinical significance of the ischial spine?

A

It is used as an anatomical landmark for the administration of a pudendal nerve block.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

a) What are the root values of the perforating cutaneous nerve?
b) Which structure does it pierce?
c) What part of the skin does it supply?

A

a) S2, S3
b) lower part of sacrotuberous ligament
c) posteroinferior quadrant of gluteal region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

State the actions of tensor fascia lata.

A
  • abducts thigh
  • medially rotates thigh
  • flexes thigh
  • mainly, helps to keep knee extended
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

State the gluteal muscles involved in the following movements of the hip joint:
a) extension
b) abduction
c) internal rotation
d) external rotation

A

a) gluteus maximus
b) gluteus medius and minimus
c) gluteus medius and minimus
d) gluteus maximus and the small muscles

Notes:
- Piriformis muscle can abduct the thigh only if it is flexed.
- In paralysis of the quadriceps unit, gluteus maximus can be an active but weak knee extensor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

State the function of:
a) gluteus maximus
b) gluteus medius and minimus

A

a) Chief antigravity muscle of the hip
b) Prevents the sagging of pelvis on the unsupported side/pelvic stabilizers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of joint is the sacroiliac joint, and what ligament is mainly responsible for its static stability?

A

Synovial planar joint
Sacroiliac ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

State the innervation of piriformis.

A

Ventral rami of S1, S2/nerve to piriformis

17
Q

State the blood supply to:
1. Piriformis
2. Quadratus femoris
3. Superior gemellus
4. Inferior gemellus
5. Obturator internus
6. Obturator externus

A
  1. Superior and inferior gluteal arteries, internal pudendal artery
  2. Medial circumflex femoral artery [MCFA]
  3. Inferior gluteal artery, internal pudendal artery
  4. MCFA
  5. Internal pudendal artery, obturator artery
  6. MCFA, obturator artery
18
Q

Trochanteric anastomosis
(a) location
(b) contributing arteries

A

(a) location: trochanteric fossa
(b) contributing arteries:
✔ ascending branch of medial circumflex femoral artery
✔ ascending branch of lateral circumflex femoral artery
✔ descending branch of inferior gluteal artery
✔ descending branch of superior gluteal artery
✔ [Diagram 1] [Diagram 2]

19
Q

Cruciate anastomosis
(a) location
(b) contributing arteries

A

(a) location: posterior aspect of femur at level of lesser trochanter
(b) contributing arteries:
✔ transverse branch of medial circumflex femoral artery
✔ transverse branch of lateral circumflex femoral artery
✔ ascending branch of first perforating artery
✔ descending branch of inferior gluteal artery
✔ [Diagram 1] [Diagram 2]

20
Q

Superior gemellus
(a) Origin
(b) Insertion
(c) Innervation
(d) Action

A

(a) Origin: posterior surface of the ischial spine
(b) Insertion: medial surface of greater trochanter via the tendon of triceps coxae
(c) Innervation: nerve to obturator internus [L5, S1, S2]
(d) Action: external rotation of the thigh, stabilizes head of femur in acetabulum [also, in the flexed hip it causes thigh abduction]