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MBCHB MSS > Lecture 23: Gluteal Region and Posterior Thigh > Flashcards

Lecture 23: Gluteal Region and Posterior Thigh Flashcards

1
Q

gluteal region boundaries

A

The gluteal region lies:
* Posterior to the pelvis
* Bounded superiorly by the iliac crests
* Inferiorly by the gluteal sulcus created by the Gluteus Maximus muscles

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2
Q

what is the orientation of the pelvis?

A

tilted anteriorly so that ASIS is in the same plane as the symphysis pubis!

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3
Q

what does pelvis comprise?

A
  • Pelvis comprises of 2 hip
    bones ( ischium, ilium,
    pubis) + the sacrum +
    coccyx
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4
Q

need to know these

A
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5
Q

what ligaments hold the pelvis together?

A

-sacrospinous
-sacrotuberous(continuous with the posterior
sacroiliac ligament )

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6
Q

what does the crossing over of the sacrospinous and sacrotuberous ligaments form?

A

greater and lesser sciatic foramina

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7
Q

the greater sciatic foramen function

A
  • Allows passage to all the lower limb
    arteries and nerves OUT from the
    pelvis and into the gluteal region e.g.Sciatic Nerve
    (7 nerves, 3 arteries, 1
    muscle)
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8
Q

the lesser sciatic foramen function

A

Is the passageway for structures
entering or leaving the perineum.
e.g. Pudendal Nerve (supplies groin
region)

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9
Q

Gluteal muscles

A

Glut max
Med
Min

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10
Q

Gluteus maximus: O, I, Nerve, Action

A

O: superior portion of illium & sacrotuberous lig( + posterior sacrum, coccyx)

I: ITB, gluteal tuberosity of femur

Action: extends and laterally rotates thigh
Extends hip - Critical for going from sitting
to standing up

Nerve: inferior gluteal n ( L5, S1, S2 from sacral plexus)
Artery: inferior gluteal a

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11
Q

gluteus medius : O, I, Nerve, Action

A

O: posterior surface of illium
I: greater trochanter of femur
Action: abducts and internally rotates thigh + steadies pelvis when walking
Nerve: superior gluteal nerve( L4, L5, S1)
Artery: superior gluteal a

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12
Q

gluteus minimus: O, I, Nerve, Action

A

O: posterior surface of illium
I: greater trochanter of femur
Action: abducts and internally rotates thigh
Nerve: superior gluteal nerve( L4, L5, S1)
Artery: superior gluteal a

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13
Q

piriformis: O, I, Nerve, Action

VERY IMPORTANT IN HAL(PST)

A

O: anterior surface of sacrum, sacrotuberous lig
I: greater trochanter
Action: externally rotates thigh
Nerve: sacral plexus

(exits pelvis via greater sciatic foramen)

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14
Q

obturator internus: O, I, Nerve, Action

A

O: obturator foramen and membrane
I: greater trochanter
Action: externally rotates thigh
Nerve: nerve to OI (sacral plexus)

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15
Q

superior and inferior gemelli: O, I, Nerve, Action

A

O: ischial spine( s) and ischial tuberosity(i)
I: greater trochanter
Action: externally rotate thigh
Nerve: nerve to OI (s), nerve to QF(i)

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16
Q

quadratus femoris: O, I, Nerve, Action

A

O: ischial tuberosity
I: quadrate tubercle( intertrochanteric creast of femur)
Action: externally rotates thigh
Nerve: nerve to QF( sacral plexus)

17
Q

tensor fascia lata: O, I, Nerve, Action

A

O: ASIS, iliac creast
I: ITB
Action: abducts thight, dynamis stabilizer
Nerve: superior gluteal

18
Q

gluteus medius, minimus, TFL function

A

Function - Abductors of thigh - that function
to stabilize pelvis when walking
When raising leg to take a step, weight of
body shifts to standing leg. To prevent pelvis
tilting to side of raised leg the opposite side
abductors need to be very powerful

19
Q

posterior thigh muscles

A

-biceps femoris
-semitendinosus
-semimebranosus
-adductor magnus

20
Q

biceps femoris: O, I, Nerve, Action

A

O: Long head: ischial tuberosity. Short head: posterior femur( linea aspera)
I: head of fibula
Action: Dynamic support for lateral side of knee = important for knee stability. Flexes and externally rotates the leg at knee, extends thigh at hip.
Nerve: Sciatic:
long head: tibial.
Short: peroneal( L4-S2)

21
Q

semitendinosus : O, I, Nerve, Action

A

O: ischial tuberosity
I: superior part of medial tibia( pens anserinus)
Nerve: sciatic( tibial n) L5, S1, S2
Action: flexes and internally rotates leg, extends thigh

22
Q

semimebranosus: O, I, Nerve, Action

A

O: ischial tuberosity
I: medial condyle of tibia
Nerve: sciatic nerve( tibial n) L5, S1, S2
Action: flexes and internally rotates leg, extends thigh

23
Q

adductor magnus-hamstring part:
O, I, Nerve, Action

A

O:
hamstring part: ischial tuberosity
adductor part: inferior pubic ramus
I: adductor tubercle on femur.
Nerve: sciatic( tibial n)
Action: extends thigh

24
Q

what is the importance of periformis as a landmark

A
  • Arteries and nerves arising above piriformis
    = superior gluteal A+N
  • Arteries and nerves arising below piriformis
    = inferior gluteal A+N+ Sciatic
25
Q

nerves of the gluteal region

A
  • Nerves to gluteal region are from sacral plexus (L4-S4)
  • Superior gluteal nerve(L4, L5, S1) supplies gluteus medius and minimus
  • Inferior gluteal nerve(L5, S1, S2) supplies gluteus maximus
  • Other muscles have own nerves (quad femoris, obturator internus, piriformis)
  • Post femoral cutaneous n S1-3. supplies skin of lower buttock and post compartment of thigh
  • Sciatic N (L4,5,S1,2,3) has no branches in gluteal region
  • Pudendal nerve supplies perineal structures
26
Q

vessels of the gluteal region. Where do they arise from?

A
  • The gluteal arteries arise from the Internal Iliac Arteries
  • The Superior and Inferior Gluteal arteries leave the pelvis through the Greater Sciatic Foramen and, along with their corresponding nerves, pass superior and inferior to Piriformis
  • The Internal Pudendal Artery also leaves the
    pelvis via the Greater Sciatic Foramen, but then hooks around the Ischial spine to enter the pelvis via the Lesser Sciatic Foramen
  • The Superior and Inferior Gluteal Arteries
    anastomose then further anastomose with the circumflex arteries (branches of the Profunda Femoris that supply femoral head)
27
Q

where is it safe to give intra-gluteal injections?

A
  • The gluteal region is a common
    site for intra-muscular injections
    as it provides a large muscular
    area for venous absorption.
  • With respect to the Sciatic nerve,
    the buttock has a ‘safe’ side; the
    lateral side.
  • The safe area to give these
    injections is therefore the
    superolateral part of the buttock.( upper lateral quadrant)
    *cannot inject into the upper medial quadrant because sometimes the sciatic nerve can emerge superior to periformis( or tibial and peroneal part can be split up)
28
Q

Clinical Applications -Trendelenburg Gait

A
  • Gluteus Medius has an important role in
    pelvic stabilization, particularly when
    walking.
  • Injury to this muscle (or the the Superior
    Gluteal Nerve) results in a characteristic
    stance and gait pattern. Thigh abduction
    on the affected side is weakened and the
    resulting gait is referred to as a Gluteal
    or Trendenlenburg gait
  • When asked to stand on one leg, Gluteus
    Medius usually contracts to support the
    pelvis and stop it from tilting to the lifted
    side.
  • When a person with a non-functioning
    Gluteus Medius stands on the affected leg,
    the pelvis will tilt down on the unaffected
    side (the ‘sound side sags’).
  • As this person walks, to clear the leg on the
    unaffected side they must lean over to the
    side with the Glut Med insufficiency- giving
    the characteristic Trendelenburg gait.
29
Q

Clinical Applications:
Avulsion of insertion of gluteus medius

A

-snapped tendon
-muscle not used= becomes fatty
degenerated
->abnormal gate

30
Q

Clinical Applications- Hamstring
Injuries( causes, what happens)

A
  • Usually due to kicking or running
    sports.
  • Hamstring injuries can be muscle
    strains or tears or can avulse the
    ischial tuberosity completely.
  • Rx conservative or surgery

MBCHB MSS (28 decks)

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