Dissection 2 - Gluteal Region

Question 1

where is the gluteal region?

Answer 1

between the back and the posterior thigh

posterior to the pelvis

Question 2

what are the boundaries of the gluteal region?

Answer 2

superior = iliac crests
inferior = gluteal folds/sulcus
lateral = greater trochanter of the femur
medial = intergluteal cleft

Question 3

what are the superficial gluteal muscles?

Answer 3

gluteus maximus
gluteus medius
gluteus minimus
tensor fascia latae

Question 4

what is the most powerful extensor of the hip?

Answer 4

gluteus maximus

Question 5

where does the gluteus maximus attach and insert?

Answer 5

attachments - iliac crest, sacrum, sacrotuberous ligament and coccyx
Inserts - iliotibial tract

Question 6

where do gluteus medius and minimus attach?

Answer 6

attach - external/posterior/gluteal aspect of the ileum and anterolateral aspect of the greater trochanter of the femur

Question 7

what nerve supplies the gluteal muscles?

Answer 7

maximus = inferior gluteal

medius and minimus = superior gluteal (L5, S1, S2)

Question 8

what do the medial and minimus gluteal muscles do?

Answer 8

extend the thigh

medially rotate the thigh

Question 9

what results from damage to the superior gluteal nerve?

Answer 9

Trendelenburg gait

Question 10

what 2 neurovascular bundles exist in the gluteal region?

Answer 10

inferior gluteal neurovascular bundle

superior gluteal neurovascular bundle

Question 11

what is contained within the inferior gluteal neurovascular bundle and what does it do?

Answer 11

inferior gluteal artery, vein and nerve (L5, S1, S2)

supplies the gluteus maximus muscle (deep to gluteus maximus)

Question 12

what is contained within the superior gluteal neurovascular bundle and what does it do?

Answer 12

superior gluteal artery, vein and nerve (L5, S1, S2)

supplies gluteus medius and minimus (deep to gluteus medius)

Question 13

what are the deep gluteal muscles and what do they do?

Answer 13

piriformis
gimelli 
obturator interna
quadrator femoris
lateral rotators and stabilisers of the hip

Question 14

where are the deep gluteal muscles?

Answer 14

run transversely from medial to lateral between sacrum, ileum and ischial spine and tuberosity medially and the greater trochanter of the femur laterally

Question 15

what is the iliotibial tract?

Answer 15

thickening of deep fascia of the thigh (fascia lata)
runs from ASIS to lateral aspect of lateral tibial condyle at the gerdy tubercle
supports knee

Question 16

what is the tensor fascia latae?

Answer 16

muscular part of fascia lata (iliotibial tract)

enclosed within proximal portion of the tract

Question 17

what is the course of the sciatic nerve?

Answer 17

forms in lumbo-sacral plexus (L4-S3)
emerges into the middle of the gluteal region
then descends and leaves the region to enter the posterior compartment of the thigh
its branches then descend through the popliteal fossa and posterior and lateral compartments of the leg and foot

Question 18

what is sciatica?

Answer 18

nerve roots of the sciatic nerve are affected by lumbar slipped discs giving symptoms in the foot

Question 19

what is the course of the pudenal nerve?

Answer 19

forms in sacral plexus (S2-S4)

emerges into middle of gluteal region and supplies muscles, skin and fascia of most of perineum

Question 20

how can the pudenal nerve be used clinically?

Answer 20

pudenal nerve block is an obstetric procedure

Question 21

what is the course of the posterior cutaneous nerve of the thigh?

Answer 21

forms in sacral plexus S1-S3
emerges into middle of gluteal region and supplies skin over posterior thigh
somatic nerve

Question 22

what is a lumbar puncture and when is it used?

Answer 22

pressure measurements are recorded and samples of CSF are taken from the subarachnoid space surrounding the spinal cord
looks for evidence of conditions affecting the brain

Question 23

how is a lumbar puncture performed?

Answer 23

patient lying on left side with knees held to chin
iliac crests are identified and the plane between them visualised (level of L3/L4)
Spinal pack is used to withdraw CSF at this level

Question 24

at what level does the spinal cord end?

Answer 24

L1-L2 IV disc

Question 25

why is lumbar puncture performed at L3-4 level?

Answer 25

avoids injury to the terminal part of the spinal cord (conus medullaris)