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Gluteal Region Flashcards

(104 cards)

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1
Q

Gluteal region

A
  • Posterior to pelvis
  • Inferior to iliac crest
  • Transition point between trunk and lower extremity
  • Gluteal muscles define the region
  • Gluteal fold is inferior boundary
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2
Q

Hip region

A
  • Area over greater trochanter
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3
Q

Cutaneous nerves of gluteal region

A
  • Cluneal nerves
  • Perforating cutaneous (S2, 3)
  • Iliohypogastric nerve
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4
Q

Cluneal nerve branches

A
  • Superior
  • Middle
  • Inferior
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5
Q

Superior cluneal nerve

A
  • Branches of posterior rami of L1-3
  • Susceptible to entrapment passing through fascia
  • Can be injured during iliac crest bone harvesting
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6
Q

Middle cluneal nerve

A
  • Branches of posterior rami S1-3
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7
Q

Inferior cluneal nerve

A
  • Branches of posterior femoral cutaneous (S1-3)
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8
Q

Perforating cutaneous nerve level/pathway

A
  • S2,3

- Pierce sacrotuberous ligament

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9
Q

Perforating cutaneous nerve supplies

A
  • Small area at the inferior/medial gluteal region
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10
Q

Superficial tissue lymph drainage of gluteal region

A
  • Horizontal (superior) superficial inguinal nodes

- Lateral group

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11
Q

Deep tissue lymph drainage of gluteal region

A
  • Gluteal nodes

- Drain into internal iliac nodes

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12
Q

All gluteal muscles attach to

A
  • Hip bone/sacrum (proximal)

- Femur (distal)

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13
Q

Superficial layer gluteal muscles attach to

A
  • Posterolateral ala of ilium

- Mostly hip extensors, abductors, medial rotators

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14
Q

Deeper layer gluteal muscles attach to

A
  • Mostly hip lateral rotators, hip stabilizers
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15
Q

Fascia over gluteus maximus

A
  • Thin

- Thicker superior to gluteus maximus over gluteus medius (gluteus aponeurosis)

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16
Q

Gluteus maximus origin

A
  • External ala of ilium behind posterior gluteal line
  • Posterior iliac crest
  • Sacrotuberous ligament
  • Dorsolateral sacrum/coccyx
  • Gluteal aponeurosis
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17
Q

Gluteus maximus insertion

A
  • Iliotibial tract (superior fibers)

- Gluteal tuberosity (inferior fibers)

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18
Q

Gluteus maximus innervation

A
  • Inferior gluteal nerve (L5-S2)
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19
Q

Gluteus maximus blood supply

A
  • Superior & inferior gluteal arteries

- Perforating branches of profunda femoris

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20
Q

Gluteus maximus function

A
  • Primary thigh (hip) extensor
  • Also thigh lateral rotator
  • Trunk extension
  • (Especially when more force is needed)
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21
Q

Gluteus medius

A
  • Primary thigh abductors

- Deep to gluteus maximus

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22
Q

Gluteus medius origin

A
  • External ala between posterior and anterior gluteal lines

- Gluteal aponeurosis (fascia)

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23
Q

Gluteus medius insertion

A
  • Lateral part of greater trochanter
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24
Q

Gluteus medius innervation

A
  • Superior gluteal nerve (L4-S1)
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25
Gluteus medius blood supply
- Superior gluteal artery
26
Gluteus medius function
- Abduction of thigh | - Medial rotation and lateral rotation of thigh
27
Gluteus minimus
- Deepest gluteal muscle | - Deep to glut medius
28
Gluteus minimus origin
- External ala between anterior and inferior gluteal lines | - Superior edge of greater sciatic notch
29
Gluteus minimus insertion
- Anterior part of greater trochanter | - Hip joint capsule
30
Gluteus minimus innervation
- Superior gluteal nerve
31
Gluteus minimus blood supply
- Superior gluteal artery
32
Gluteus minimus function
- Abduction, medial and lateral rotation of thigh
33
Piriformis muscle
- Exits pelvis through greater sciatic foramen | - Important landmark for identifying superior and inferior gluteal vessels/nerves
34
Piriformis origin
- Pelvic surface of sacrum - Superior margin of greater sciatic notch - SI joint capsule - Sacrotuberous ligament
35
Piriformis insertion
- Superior greater trochanter
36
Piriformis innervation
- Nerve to piriformis (S1, S2)
37
Piriformis blood supply
- Gluteal arteries
38
Piriformis function
- Lateral rotation of thigh | - Helps with abduction (when thigh is flexed)
39
Superior gemellus origin
- Ischial spine | - Superior margin of lesser sciatic notch
40
Superior gemellus insertion
- Medial part of greater trochanter (with OI and Inf. Gem tendons)
41
Superior gemellus innervation
- Nerve to obturator internus (L5-S2)
42
Superior gemellus blood supply
- Inferior gluteal artery
43
Superior gemellus function
- Lateral rotator
44
Inferior gemelli origin
- Superior ischial tuberosity | - Inferior margin of lesser sciatic notch
45
Inferior gemelli insertion
- Medial greater trochanter (with Sup Gem and OI)
46
Inferior gemelli innervation
- Nerve to quadratus femoris (L4-S1)
47
Inferior gemelli blood supply
- Medial femoral circumflex artery | - Inferior gluteal artery
48
Inferior gemelli function
- Lateral rotation of thigh
49
Obturator internus
- Leaves pelvis through lesser sciatic foramen | - Gemelli muscles usually cover tendon of OI
50
Obturator internus origin
- Pelvic surface of obturator foramen and membrane
51
Obturator internus insertion
- Same as the gemelli | - Greater trochanter of femur
52
Obturator internus innervation
- Nerve to obturator internus (L5-S2)
53
Obturator internus blood supply
- Inferior gluteal artery | - Internal pudendal artery
54
Obturator internus function
- Lateral rotator of thigh | - Abduct thigh (when flexed)
55
Quadratus femoris
- Most inferior gluteal region muscle
56
Quadratus femoris origin
- Ischial tuberosity
57
Quadratus femoris insertion
- Quadrate tubercle of intertrochanteric crest
58
Quadratus femoris innervation
- Nerve to quadratus femoris (L4-S1)
59
Quadratus femoris blood supply
- Inferior gluteal artery | - Medial femoral circumflex
60
Quadratus femoris function
- Lateral rotator of thigh | - Adductor of thigh
61
Obturator externus
- Tendon is deep to the quadratus femoris muscle from posterior view - Deep to pectineus from anterior view
62
Obturator externus origin
- External surface of obturator foramen/membrane
63
Obturator externus insertion
- Trochanteric fossa of femur (passes below neck of femur)
64
Obturator externus innervation
- Obturator nerve (L2-4) | - This is unique for a lateral thigh rotator
65
Obturator externus blood supply
- Obturator artery | - Medial femoral circumflex artery
66
Obturator externus function
- Lateral rotator of thigh | - Also helps with adduction
67
Nerves of gluteal region and posterior thigh location
- All exit greater sciatic foramen | - Most pass inferior to piriformis
68
Nerves of gluteal region and posterior thigh location (names)
- Superior Gluteal (L4-S1) - Inferior Gluteal (L5-S2) - Nerve to Quadratus Femoris (L4-S1) - Nerve to Obturator Internus (L5-S2) - Posterior Cutaneous Nerve of Thigh (S1-3)
69
Superior gluteal nerve (L4-S1) innervates
- Gluteus medius - Gluteus minimus - TFL - Passes superior to piriformis
70
Inferior gluteal nerves (L5-S2) innervates
- Gluteus maximus
71
Nerve to quadratus femoris (L4-S1) innervates
- Quadratus femoris | - Inferior gemellus
72
Nerve to obturator internus (L5-S2) innervates
- Obturator internus | - Superior gemellus
73
Nerve to obturator internus (L5-S2) passes
- Lateral to pudendal nerve as it passes over sacrospinous ligament - Passes through lesser sciatic foramen
74
Posterior cutaneous nerve of thigh (S1-3)
- Usually medial to sciatic nerve | - Travels deep to fascia lata
75
Posterior cutaneous nerve of thigh (S1-3) branches supply
- Posterior thigh - Perineum - Gluteal region (Inferior cluneal nerves, pass around inferior edge of glut max)
76
Sciatic nerve (L4-S3) passes midway between
- PSIS and ischial tuberosity | - Greater trochanter and ischial tuberosity
77
Sciatic nerve (L4-S3) pathway
- Travels deep to long head of biceps femoris | - Usually separates in the distal thigh/popliteal fossa
78
Sciatic nerve (L4-S3) separates in
- Distal thigh/popliteal fossa - Tibial nerve (L4-S3) - Common fibular (L4-S2)
79
Tibial nerve (L4-S3)
- To the posterior leg
80
Common fibular (L4-S2)
- Passes below biceps femoris tendon | - Around head of fibula (palpable)
81
Sciatic nerve (L4-S3) innervation
- Posterior thigh, leg, and foot muscles | - Cutaneous innervation of most leg/foot
82
Sciatic nerve (L4-S3)
- Largest nerve (2cm wide) | - Variation in relationship to piriformis
83
Piriformis syndrome
- Compression of sciatic nerve due to spasm, fibrosis or hypertrophy of piriformis
84
Arteries of gluteal region and posterior thigh
- Gluteal arteries are branches of internal iliac | - Exit out greater sciatic foramen
85
Arteries of gluteal region and posterior thigh (names)
- Superior gluteal - Inferior gluteal - Internal pudendal - Perforating arteries
86
Superior gluteal artery supplies branches to
- Gluteus maximus - Gluteus medius - Gluteus minimis - TFL
87
Inferior gluteal artery
- Inferior to piriformis | - Gives off artery to the sciatic nerve
88
Inferior gluteal artery supplies branches to
- Gluteus maximus | - Deep gluteal muscles
89
Internal pudendal artery pathway
- Inferior to piriformis - Travels with pudendal nerve - Usually between nerve to OI and pudendal nerve - Passes over (posterior) sacrospinous ligament - Enters lesser sciatic foramen
90
Perforating arteries
- Branches off deep artery of thigh - Pierce adductor magnus - Supplies posterior thigh compartment
91
Superior gluteal nerve entrapment/injury can be caused by
- Trauma (fall on buttocks, intragluteal injection) - Entrapment between glut medius and minimus, superior border of piriformis - Hip surgery
92
Superior gluteal nerve entrapment/injury symptoms
- Weak hip abductors (gluteus medius and minimus, TFL) | - Trendelenburg gait
93
Trendelenburg Test purpose
- Test the hip abductors (gluteus medius and minimus, TFL) innervated by the superior gluteal nerve
94
Trendelenburg Test is performed by
- Having the patient stand on one leg | - This is the leg being tested
95
Negative Trendelenburg Test
- The pelvis remains level - Muscle contraction of the gluteus medius/minimus/TFL on the unsupported (stance) side pulls the pelvis down - This keeps the unsupported side from dropping
96
Positive Trendelenburg Test (Trendelenburg sign)
- Single leg standing on involved side - Pelvis drops on unsupported (swing) side - Test can also be positive with hip frx or dislocation
97
Trendelenburg gait (lurch)
- Excessive lateral lean to keep center of gravity over supported leg while walking
98
Intragluteal injections
- Safe area - Superolateral quadrant above line from PSIS to greater trochanter tip - Triangular area between ASIS, tubercle of crest, greater trochanter
99
Inferiorgluteal nerve entrapment/injury caused by
- Hip surgery | - Injection related injury
100
Inferiorgluteal nerve entrapment/injury symptoms
- Weak hip extension | - Gluteus maximus gait (gluteal lurch or lurch gait)
101
Gluteal lurch or lurch gait
- During gait, the trunk lurches backwards at heel-strike on the affected side - Keep center of gravity behind the hip
102
Normally the gluteus maximus contracts at heels-strike, which
- Slows the forward motion of the trunk and the flexion movement caused by the hip flexors - Keeps you upright as your center of gravity moves anterior to the hip - (Hamstrings are primary hip extensors during walking)
103
Content passing through greater sciatic foramina
``` - Piriformis muscle Above piriformis - Superior gluteal artery, vein, nerve Below pirifromis: - Inferior gluteal artery, vein, nerve - Internal pudendal artery and vein - Pudendal nerve - Sciatic nerve - Posterior femoral cutaneous nerve - Nerve to obturator internus - Nerve to quadratus femoris ```
104
Content passing through lesser sciatic foramen
- Internal pudendal artery and vein - Pudendal nerve - Nerve to obturator internus - Tendon of obturator internus

Lower Extremity Anatomy (35 decks)

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