gluteal region

Question 1

what is different in terms of timing when it comes to lower and upper limb development

Answer 1

lower limb develops a week after upper (4th and 5th week)

Question 2

where do you begin to see the lower limb buds? upper limb buds? what is located on the superior aspect of these buds?

Answer 2

lower limb- L2-S2
upper- C5-T1
big toes and the thumbs

Question 3

what occurs to the upper and lower limbs in the 7th week of gestation?

Answer 3

• upper limb rotates laterally around its axis

- lower rotates medially- continues even post birth-explains why baby feet meet sole to sole

Question 4

what accounts for the barber-pole pattern of the cutaneous innervation (dermatome pattern) of the limbs?

Answer 4

the rotation of the limbs in utero

Question 5

where do the hip bones meet anteriorly and posteriorly

Answer 5

anteriorly at the pubic symphysis and posteriorly at the sacroiliac joint (meets with sacrum)

Question 6

when do the ilium, ischium and pubis fuse

Answer 6

at the end of teen yrs

Question 7

what two bones the hip bones articular with

Answer 7

sacrum and femur

Question 8

what comprises the pelvic girdle? how does the bony pelvis differ?

Answer 8

• the pelvic girdle is the two hip bones together

- bony pelvis includes sacrum and coccyx

Question 9

what it the largest of the three parts of the hip and describe some of its characteristics

Answer 9

• ilium

- ala- wing, attachment side for gluteal muscles laterally and iliacus on the medial side

Question 10

what part of the acetabulum does the ilium make up?

Answer 10

the superior 2/5

Question 11

what part of the lumbar spines does the line between the anterior superior iliac spine to the posterior superior iliac spines go thru?

Answer 11

L4-5

Question 12

what is the attachment site for the posterior sacroiliac ligament

Answer 12

posterior inferior iliac spine

Question 13

what comprises the posterior 2/5 of the acetabulum

Answer 13

the ischium

Question 14

what are the two parts of the ischium

Answer 14

-body (consists of all the good stuff IT’s etc) and the ramus(consists of just the ramus

Question 15

at the bottom of the ischium, what two things come together to fuse the pubis with the ischium

Answer 15

the ichial ramus and the inferior ramus of the pubis to form the ischiopubic ramus

Question 16

what fraction of the acetabulum does the pubis make up?? what are the three main parts of the pubis

Answer 16

• 1/5

- three parts- body, superior ramus and inferior ramus

Question 17

what part of the pubis fuses with the ischium and the ilium within the acetabulum

Answer 17

superior ramus of the pubis

Question 18

what is the greater sciatic foramen formed of? what is ita a passageway for?

Answer 18

• made up of the
  1) sacrospinous ligament- ligament that goes from sacrum to the spine of the ischium
  2) sacrotuberous ligament- ligament from the sacrum to the IT
  3) greater sciatic notch

Question 19

what muscles traverses the greater sciatic foramen? Nerves and vessels?

Answer 19

• piriformis
• internal pudendal vessels and nerve
• sciatic nerve
• posterior femoral cutaneous nerve
• nerve to quadratus femoris and inferior gemellus
• nerve to the obturator internus and superior gemellus

Question 20

what makes up the lesser sciatic foramen?

Answer 20

• formed by lesser sciatic notch and the sacrospinous and sacrotuberous ligaments

Question 21

what structures traverse the lesser sciatic foramen

Answer 21

1) the tendon of the obturator internus
2) internal pudendal vessels and pudendal nerve
3) nerve to the obturator internus

Question 22

the gluteal muscles are split into superficial and deep. what are the superficial muscles comprised of? what are their primary fxn?

Answer 22

• gluteus max, med, min- mainly extensors and abductors of the thigh

Question 23

gluteus max:
origin
insertion
action
nerve
blood supply

Answer 23

origin- (CISS my gluteus max): coccyx, ilium, sacrotuberous ligament, sacrum

insertion- (TI loves butts) gluteal tuberosity and iliotibial tract

action-extend and laterally rotate thigh, rising from sitting position and running

nerve- inferior gluteal

blood supply- superior and inferior gluteal arteries

Question 24

Gluteus medius
origin
insertion
action
nerve
blood supply

Answer 24

origin- ilium between anterior and POSTERIOR gluteal line
insertion- greater trochanter
action- abduction and medial rotation of thigh; along with gluteus min, stops the hip from sagging on the unsupported side
nerve- superior gluteal
blood supply- superior gluteal

Question 25

``` gluteus minimus origin insertion action nerve blood supply ```

Answer 25

origin- ilium between the anterior and INFERIOR gluteal lines insertion- greater trochanter action- abduction and medial rotation- stops the hip from sagging on unsupported side with the glut. med nerve- superior gluteal blood supply- superior gluteal

Question 26

what's a positive trendelenburg sign?

Answer 26

- damage to superior gluteal nerve - would cause blockage of innervation to the glut med/min - waddling gait, high stoppage gait and swing out gait

Question 27

what comprises the deep layer of the gluteal muscles

Answer 27

4 things- | piriformis, obturator internus, inferior gemellus, quadratus femoris

Question 28

``` piriformis origin- insertion- nerve- action- location- ```

Answer 28

``` origin-anterior surface of the sacrum insertion- greater trochanter (gluteal and pelvic regions) nerve-S1-2 action-lateral rotation of the thigh location is right under the glut min ```

Question 29

``` obturator internus origin- insertion- nerve- action- location ```

Answer 29

origin- obturator membrane surrounding bone insertion:-greater trochanter- LEAVES PELVIS THRU THE LESSER SCIATIC FORAMEN nerve-nerve to the obturator internus (L5, S1-2) action- lateral rotation of the thigh, extension, abduction of flexed thigh location- right under the superior gemellus and over the inferior gemellus

Question 30

``` superior gemellus origin- insertion- nerve- action- location ```

Answer 30

origin- ischial spine insertion- tendon of obturator internus nerve-nerve to the obturator internus (L5, S1-2) (same as obturator internus) action-lateral rotation of thigh, extension,. abduction of flexed thigh (same as obturator internus) location- above obturator internus

Question 31

``` inferior gemellus origin- insertion- nerve- action- location ```

Answer 31

origin- ischial tuberocity insertion-tendon to the obturator internus nerve-nerve to the quadratus femoris (L5, S1) (like QF) action- lateral rotate thigh (like QF) location -under the obturator internus

Question 32

``` quadratus femoris origin- insertion- nerve- action- location ```

Answer 32

``` origin- ischial tuberocity insertion- interotrocanteric crest nerve- nerve to the quadratus femoris (L5-S1) action-laterally rotate the thigh location- under the inferior gemellus ```

Question 33

the sacral plexus is the lower part of the ____ and is covered by branches from what artery

Answer 33

lumbosacral plexus- ventral primary rami (L4-5,s1-4) | internal iliac artery

Question 34

where does the major part of the plexus lie? what foramen does do the large branches of the sacral plexus pass thru to get to the gluteal regions

Answer 34

on top of the piriformis | they pass thru the greater sciatic foramen

Question 35

what is the sacral plexus made up of

Answer 35

-ventral primary rami of the

Question 36

where do the S1-4 nerves enter the pelvis thru?

Answer 36

the sacral formina

Question 37

what do they nerves of the sacral plexus supply the muscles and skin of?

Answer 37

gluteal region | the posterior thigh and the entire leg and foot

Question 38

__to__ divisions of the sacral plexus give rise to anterior and posterior divisions

Answer 38

L4-S4

Question 39

*what are the posterior divisions of the sacral plexus?

Answer 39

posterior- common peroneal, superior gluteal, inferior gluteal, posterior femoral cutaneous, nerve to the piriformis

Question 40

*what are the anterior divisions of the sacral plexus?

Answer 40

QPLOT: - N. to quadratus femoris - Pudendal n - Nerve to the levator ani - N. to obturator internus - Tibial nerve

Question 41

What is different about the superior gluteal nerve than all other nerves of the sacral plexus

Answer 41

- it exists the pelvis thru the greater sciatic foramen like all of them BUT DOES SO OVER THE PIRIFORMIS VS UNDER

Question 42

what spinal levels is superior gluteal? what would injury to the superior gluteal cause?

Answer 42

L4-S1 | injury- probs with tensor fasciae latae muscles and glut medius and minimus

Question 43

inferior gluteal levels? injury?

Answer 43

L5-S2 | injury gluteus max

Question 44

sciatic nerve levels? what two nerves does it give rise to? what would injury to the sciatic nerve cause?

Answer 44

L4-S3 largest branch of the plexus gives rise to Tibial and common peroneal injury will not cause any injury to the gluteal region

Question 45

what levels are the tibial and common peroneal

Answer 45

tibial L4-5, S1-4 | common peroneal L4-5, S1-2

Question 46

``` what levels are the posterior femoral cutaneous- nerve to quadratus femoris- nerve to the obturator internus- pudendal nerve- ```

Answer 46

posterior femoral cutaneous- S1-S3- post. div sacral plexus nerve to quadratus femoris- L4-S1 -ant div nerve to the obturator internus-L5-S2 pudendal nerve-(near superior gemellus) -S2-4

Question 47

what does the cutaneous innervation of the gluteal region

Answer 47

superior cuneal- dorsal primary rami medial cuneal- dorsal inferior cuneal-ventral

Question 48

what arteries supply the muscles of the gluteal region and what major artery do they stem off of and where do they enter the gluteal region

Answer 48

- they stem off of the internal iliac artery and enter the gluteal region via GREATER sciatic foramen - superior gluteal artery- glut max, med, min plus tensor facia lata - inferior gluteal- glut max and short lateral rotators of the thigh - internal pudendal- supplies perineal region

Question 49

what are the veins of the gluteal region? what do they drain into?

Answer 49

- superior and inferior gluteal veins as well as the internal pudental vein - the internal iliac vein

Question 50

what is the safe zone?

Answer 50

where you can do intragluteal injections | -near piriformis and glut med