L14: Musculo-neuro-vascular systems of gluteal region (hip and buttock)

Question 1

gluteal surface anatomy :
bony landmarks:

Answer 1

• anterior superior iliac spine ASIS
• pubic tubercle
• posterior superior iliac spine PSIS
• iliac crest
• greater trochanter

Question 2

gluteal surface anatomy:
soft tissue features:

Answer 2

• gluteal cleft
• gluteal fold
• gluteal maximus
• gluteal medius

Question 3

ligaments of pelvis

Answer 3

sacrospinous ligament:
- from sacrum to ischial spine
- stabilises sacroiliac joint

sacrotuberous ligament:
- from sacrum to ischial tuberosity
- stabilises sacroiliac joint

Question 4

sacrospinous ligament and sacrotuberous ligament form

Answer 4

these ligaments from part of the perimeter the greater sciatic foramen and lesser sciatic foramen

Question 5

movements of hip joint

Answer 5

Flexion and Extension
Abduction and Adduction
External and Internal Rotation
Circumduction

Question 6

gluteal muscles (9)
superficial (4)=

Answer 6

1. gluteus maximus
2. gluteus medius
3. gluteus minimus (deep to gluteus medius)
4. tensor fasciae latae

Question 7

gluteal muscles (9)
deep muscles (5) =

Answer 7

1. piriformis
2. superior gemellus
3. obturator internus
4. inferior gemellus
5. quadratus femoris

Question 8

gluteus maximus
origin:
insertion:

Answer 8

• most superficial muscle. covers most of other muscles. Usually covered by a thick layer of adiposity

Origin=
- ilium posterior to posterior gluteal line
- lateral part of posterior sacrum and coccyx
- sacrotuberous ligament

insertion=
- illiotibial tract
- gluteal tuberosity on posterolateral femur

Question 9

gluteus maximus
innervation=
actions=

Answer 9

innervation:
- inferior gluteal nerve (L5, S1, S2)

Actions:
- inferior part: extends thigh at hip joint
- external (lateral) rotation of femur at hip joint

Question 10

gluteus medius
origin=
insertion=

Answer 10

lies deep to gluteus maximus

origin:
- external iliac surface, between anterior and posterior gluteal lines

insertion:
- lateral surface of greater trochanter of femur

Question 11

gluteus medius
innervation=
actions=

Answer 11

innervation:
- superior gluteal nerve (L5, S1)

actions:
- abducts femur at hip joint
- internally rotates femur at hip joint
- stabilises pelvis in coronal plane

Question 12

gluteus minimus
origin=
insertion=

Answer 12

lies deep to gluteus maximus

origin:
- external iliac surface, between anterior and inferior gluteal lines

insertion:
- anterior surface of greater trochanter

Question 13

gluteus minimus
innervation=
actions=

Answer 13

innervation:
- superior gluteal nerve (L5, S1)

actions:
- abducts femur at hip joint
- internally rotates femur at hip joint
- stabilises pelvis in coronal plane

Question 14

trendelenburg sign

Answer 14

caused by a weakness of hip abductors

Question 15

Tendelenburgs gait

Answer 15

*When standing on one leg, hip abductors are unable to counteract gravity.
*Opposite side of pelvis tilts inferiorly.
*This means the other leg does not have sufficient clearance to swing forward for next step.
*In order to compensate and provide additional clearance for leg swing, patient leans to same side as the weak hip abductors.
*This elevates the pelvis and allows the leg clearance to swing for next step.
*In addition, often patients will swing their leg out and forward in order to achieve greater clearance.

Question 16

Tensor Fasciae Latae
origin=
insertion=

Answer 16

Origin: ASIS + Anterior Iliac crest

Insertion: illiotibial tract (which inserts into lateral tibial condyle)

Question 17

Tensor Fasciae Latae
Innervation=
Actions=

Answer 17

Innervation: Superior Gluteal Nerve (L5-S1)

Actions:
- abduct, flexes, internally rotates thigh at hip joint
- tightens iliotibial tract which stabilises knee while leg is extended
- keeps pelvis level when standing on ipsilateral limb

Question 18

Piriformis
Origin=
insertion=

Answer 18

origin:
- anterior surface of sacrum
- sacrotubureous ligament

Insertion:
- exits pelvis through greater sciatic foramen
- superior border of greater trochanter

Question 19

Piriformis
innervation=
actions=

Answer 19

innervation:
- nerve to piriformis (S1/S2)

Actions:
- externally rotates an extended thigh
- abducts a flexed thigh
- stabilises femoral head in acetabulum

Question 20

Superior Gemellus
origin=
insertion=

Answer 20

origin: ischial spine

insertion: medial surface of greater trochanter of femur

Question 21

Superior Gemellus
Innervation=
Actions=

Answer 21

innervation: nerve to obturator internus (L5,S1)

Actions:
- externally rotates an extended thigh
- abducts a flexed thigh
- stabilises femoral head in acetabulum

Question 22

Obturator internus
origin=
insertion=

Answer 22

Forms triceps coxae with gemelli muscles

Origin: inner surface of obturator membrane and its bony boundaries

Insertion: medial surface of greater trochanter of femur

Question 23

Obturator internus
Innervation=
Actions=

Answer 23

innervation: Nerve to obturator internus (L5,S1)

Actions:
- externally rotates an extended thigh
- abducts a flexed thigh
- stabilises femoral head in acetabulum

Question 24

Inferior Gemellus
origin=
insertion=

Answer 24

origin: ischial tuberosity

insertion: medial surface of greater trochanter of femur

Question 25

Inferior Gemellus innervation= actions=

Answer 25

Innervation: nerve to quadratus femoris (L5,S1) Actions: - externally rotates an extended thigh - abducts a flexed thigh - stabilises femoral head in acetabulum

Question 26

Quadratus Femoris origin= insertion=

Answer 26

Origin: lateral border of ischial tuberosity Insertion: quadrate tubercle on intertrochanteric crest of femur

Question 27

Quadratus femoris innervation= actions=

Answer 27

innervation: nerve to quadratus femoris (L5,S1) Actions: - external rotation of thigh at hip joint - stabilises femoral head in acetabulum

Question 28

Cutaneous Nerves of the gluteal region

Answer 28

superior, middle and inferior clunial (cluneal) nerves: - superior: posterior rami of L1-3 - middle: posterior rami of S1-3 - inferior: anterior rami of S2-3 lateral branch of the iliohypogastric Nerve also supplies part of the lateral buttocks

Question 29

The sciatic nerve

Answer 29

- is the continuation of the lumbrosacral plexus and is the major nerve of the lower limb - carries motor signals to muscles - carries sensory signals from skin - is vulnerable to compression which causes sciatica

Question 30

Sciatica

Answer 30

can be understood as sciatic nerve impingement (compression) patients will report a shooting pain that shoots down the back of their leg Treated with: generally with rest, anti-inflammatories, muscle relaxants

Question 31

Sciatic nerve - anatomical variation

Answer 31

- sciatic nerve spits into tibial and fibular nerves before exiting the greater sciatic foramen - 12.2% of people have common fibular nerve passing through piriformus - 0.5% of people have common fibular nerve passing superior to piriformis - vulnerable to injury

Question 32

arterial supply to lower limb

Answer 32

Heart, Descending Aorta, Common Iliac Artery - internal iliac artery > supplies gluteal region and pelvis region - external iliac artery > goes on to become femoral artery and supply thigh, leg, foot

Question 33

arterial supply to gluteal region

Answer 33

heart, descending aorta, common iliac artery, internal iliac artery, - superior gluteal artery - inferior gluteal artery superior and inferior gluteal arteries supply the superior / inferior gluteal region respectively

Question 34

Venous drainage of the lower limb

Answer 34

right atrium of heart ^ inferior vena cava ^ common iliac vein ^ ^ internal iliac vein external iliac vein ^^ ^ superior gluteal common femoral vein and inferior vein (main thigh gluteal vein vein)

Question 35

venous drainage of the gluteal region

Answer 35

The gluteal region is drained by the Superior and Inferior Gluteal Veins. These run beside the Superior and Inferior Gluteal Arteries but carry deoxygenated blood in the opposite direction. The Superior and Inferior Gluteal veins pass through the greater sciatic foramen on either side of piriformis and drain into the Internal Iliac Vein. The Internal Iliac Vein drains into Common Iliac Vein which subsequently drains into the Inferior Vena Cava.