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Flashcards in Gluteal Region Deck (58):

What is the anatomic position of the hip bone?

ASIS and pubic tubercle are in the same vertical plane


What are the 3 parts of a hip bone?

1. ilium
2. ischium
3. pubis


What is the pelvic girdle?

2 hip bones together


What makes up the bony pelvis?

1. pelvic girdle
2. Sacrum
3. Coccyx
All bound together by ligaments


Ligaments of the bony pelvis?

1. Anterior Sacroiliac Ligament
2. Sacrospinous Ligament
3. Sacrotuberous Ligament


Anterior Sacroiliac Ligament job

1. Between the iliac fossa and sacrum
2. Keeps vertebral body and hip bone together


Sacrospinous Ligament

1. Inferior to anterior sacroiliac ligament
2. Joins the PIIS and lower sacrum together


Sacrotuberous Ligament

1. Sacrum to ischial tuberosity
2. Attaches all along sacrum and narrows down to attach to ischial tuberosity


Where do the gluteal muscles attach?

1. Gluteus maximus attaches behind the posterior gluteal line
2. Gluteus medius attaches between the posterior and anterior gluteal lines
3. Gluteal minimus attaches between anterior and inferior gluteal lines


Characteristics of iliac crest

1. Reaches superiorly up to L4
2. Extends from ASIS to PSIS


Characteristics of the Acetabulum

1. Superior 2/5 on ilium
2. Posterior 2/5 on ischium
3. Anteromedial 1/5 on pubic ramus
4. Where the head of the femur articulates


Characteristics of Ala

1. Part of ilium
2. Attachment site for gluteal muscles laterally and iliacus muscle on medial side
3. Contains the iliac fossa - where the iliacus muscle attaches


What does the body of the ischium contain?

1. Ischial tuberosity
2. Ischial spine
3. Lesser sciatic notch- formed by ischial spine
4. Greater sciatic notch- formed by ilium and ischium


What does the superior ramus of the pubis fuse?

Ischium and ilium within the acetabulum forms the pectin line


What does the inferior ramus of the pubis contain?

1. Obturator crest
2. Obturator foramen
3. Acetabulum


Characteristics of the greater sciatic foramen

1. Passageway for all lower limb nerves and arteries
2. Formed by greater sciatic notch, sacrospinous ligament and sacrotuberous ligament
3. Filled with piriformis muscle


Characteristics of lesser sciatic foramen

1. Formed by lesser sciatic notch, sacrospinous and sacrotuberous ligaments
2. Filled with obturator internus muscle


What structures pass through the lesser sciatic notch?

1. Tendon to obturator internus muscle
2. Internal pudendal vessels
4. Pudendal nerve
5. Nerve to obturator internus


Characteristics of obturator foramen

1. Covered by obturator membrane
2. Useless foramen- makes the hips lighter
3. Obturator nerve and artery only things to pass through


How are the gluteal muscles organized?

1. superficial layer
2. Deep layer


Superficial gluteal muscles

1. Gluteus maximus
2. Gluteus medius
3. Gluteus minimus


Characteristics of gluteus maximus

O: sacrotuberous ligament, ilium, sacrum, coccyx
I: gluteal tuberosity and IT band
A: extend and laterally rotate thigh, aids in rising from sitting positions
N: Inferior Gluteal
Blood vessels: superior and inferior gluteal arteries


Characteristics of gluteus medius

O: ilium between anterior and posterior gluteal line
I: Greater trochanter
A: A-Bduction and medial rotate thigh, aids hip from sagging
N: Superior gluteal
Blood Vessel: Superior gluteal artery


Characteristics of gluteus minimus

O: Ilium between anterior and inferior gluteal lines
I: Greater trochanter
A: A-Bduction amd medial rotation
Blood vessel: Superior gluteal
Nerve: Superior gluteal


What is positive trendelenburg sign?

-damage to superior gluteal nerve
-causes waddling gait, hip steppage gait, swinging gait, clapping foot


What muscles make up the deep layer of gluteal region?

1. Piriformis
2. Obturator internus
3. Levator ani
4. Superior and Inferior Gemmellus
5. Quadratus femoris


What is the main action of the deep muscles?

Stabilize hip joint and laterally rotate the thigh


Characteristics of Piriformis

O: Anterior surface of sacrum (inside the pelvis)
I: Greater trochanter
A: lateral rotation of thigh
N: S1, S2


Characteristics of Obturator Internus

O: obturator membrane
I: Greater trochanter
A: Lateral rotation, extension, A-Bduction of flexed thigh
N: nerve to obturator internus (L5,S1,S2)
Comes through lesser sciatic foramen


Characteristics of Levator Ani

Has 3 muscles:
1. puborectalis
2. pubococcygeus
3. Iliococcygeus


Characteristics of Superior Gemellus

O: Ischial spine
I: Tendon of obturator internus
A: Lateral rotation, extension, A-Bduction of flexed thigh
N: nerve to obturator internus


Characteristics of Inferior Gemellus

O: Ischial tuberosity
I: Tendon of obturator internus
A: Lateral rotation, extension, A-Bduction of flexed thigh
N: nerve to quadratus femoris


Characteristics of Quadratus Femoris

O: Ischial tuberosity
I: Intertrochanteric crest
A: Laterally rotate thigh
N: Nerve to quadratus femoris (L4-S1)


What is the sacral plexus formed by?

Ventral primary rami of lumbosacral trunk (L4-S4) which exit the greater sciatic foramen


What do the nerves of the sacral plexus innervate?

1. Gluteal region
2. Posterior thigh
3. Entire leg
4. Entire foot


What are the nerves originating from the posterior division of the sacral plexus?

1. Common peroneal/fibular nerve
2. superior gluteal
3. Inferior gluteal
4. Posterior femoral cutaneous
5. Nerve to piriformis


What are the nerves originating from the anterior division of the sacral plexus?

1. Tibial nerve
2. Nerve to obturator internus
3. Nerve to quadratus femoris
4. Pudendal nerve
5. Nerve to levator ani


What is unique about the nerve to the piriformis?

Only nerve to not leave the pelvis


Characteristics about the superior gluteal nerve

L4-S1 posterior division
1. Exits the greater sciatic foramen ABOVE the piriformis muscle
2. Innervates the gluteas medius and minimus muscles


Characteristics about the Inferior Gluteal nerve

L5-S2 posterior division
1.Innervates the gluteus maximus
2. Exits the greater sciatic foramen below the piriformis muscle


Characteristics about the Sciatic Nerve

L4-S3 posterior division
1. Leaves below the piriformis muscle
2. Has its own blood supply
3. Consists of 2 nerves- Tibial and Common Peroneal
4. Damage to this nerve will cause the back of the leg to hurt not the gluteal region


Characteristics of the tibial nerve

1. One part of the sciatic nerve
2. Part of the anterior division
3. L4-S3
4. Inside a sheath


Characteristics of the common peroneal nerve

1. One part of the sciatic nerve
2. Part of the posterior division
3. L4-S2
4. Can sometimes come out through the piriformis muscle causing problems


Characteristics of the posterior femoral cutaneous nerve

1. Innervates skin on back of the thigh
2. Made up of both anterior and posterior division


Characteristics of the nerve to the piriformis

S1-S2 posterior division
1. Only nerve to not leave the pelvis
2. Muscular nerve


Characteristics of the nerve to the quadratus femoris

L4-S1 anterior division
1. supplies quadratus femoris and inferior gemellus


Characteristics of the nerve to the obturator internus

L5-S2 anterior division
1. Innvervates obturator internus and superior gemellus


Characteristics of the pudendal nerve

S2-S4 anterior division
1. Comes out the ischiorectal fossa
2. Comes into gluteal region via greater sciatic foramen and goes back through the lesser sciatic foramen
3. Gives inferior rectal nerve branch


What do the arteries of the gluteal region originate from?

Mostly the internal iliac artery which breaks up into anterior and posterior divisions
2 branches come from the external iliac artery


Superior gluteal artery

Supplies gluteus medius and minimus, tensor fascia latae


Inferior gluteal artery

1. anterior division
2. Supplies gluteus maximus and the short lateral rotators of the thigh


Internal pudendal artery

1. There is also an external pudendal
2. supplies the perineal region


What are the 2 branches of the external iliac artery in this region?

1. Inferior epigastric artery
2. Obturator artery


Cutaneous innervation of the gluteal region comes from what 3 branches?

1. Superior clunial nerve
2. Medial clunial nerve
3. Inferior clunial nerve


Superior clunial nerve levels

L1, L2, L3
Dorsal primary rami


Medial clunial nerve levels

S1, S2, S3
Posterior rami


Inferior clunial nerve levels

From the sacral plexus- posterior femoral cutaneous nerve


Where should someone do a gluteal injection?

Superior lateral quadrant