Lecture 44: Gluteal Region Flashcards by E B

when and from which regions does the upper limb develop?

4th week

C5-T1 levels

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when and from which regions does the lower limb develop?

5th week

L2-S2 levels

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where is the primitive great toe/thumb located?

superior aspect of the buds

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which direction are the soles/palms directed?

medially

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when does the opposite direction torsion of limbs occur?

7th week

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the lower limbs rotate…

the upper limbs rotate….

lower: rotate medially
upper: rotate laterally

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2 hip bones together

pelvic girldle

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pelvic girdle, sacrum and coccyx bound together by ligmanents

bony pelvis

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how far up does the iliiac crest reach on the spine

reaches superiorly up to the 4th lumbar vertebra (disc between 4th and 5th L) and extends from ASIS to PSIS

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attachment site for posterior sacroiliac ligament

PIIS

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location of articulation with sacrum

auricular surface

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between the greater and lesser sciatic notches

ischial spine

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formed by the greater sciatic notch and sacrospinous and sacrotuberous ligaments

greater sciatic foramen

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passes through both the greater and lesser sciatic foramen

internal pudendal vessels and pudendal nerve

- goes out the greater and back in the lesser

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structures that traverse greater sciatic foramen

Piriformis muscle
Superior gluteal vessels and nerve
Inferior gluteal vessels and nerve
Internal pudendal vessels and pudendal nerve
Sciatic nerve
Posterior femoral cutaneous nerve
Nerve to quadratus femoris and inferior gemellus
Nerve to obturator internus and superior gemellus

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structures that traverse lesser sciatic foramen

internal pudendal vessels and pudendal nerve
tendon of obturator internus
nerve to obturator internus

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

lesser sciatic foramen

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ischial tuberosity to sacrum

sacrotuberous ligament

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sacrospinous ligament

ischial spine to sacrum

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gluteus maximus O

sacrotuberous ligament
ilium (behind posterior gluteal line)
sacrum
coccyx

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gluteus maximus I

gluteal tuberosity
iliotibial tract (IT band)

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gluteus maximus A

extend and lateral rotate thigh
rise from sitting position
running

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gluteus maximus N

inferior gluteal n.

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gluteus maximus B

superior and inferior gluteal a.

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gluteus medius O

ilium between anterior and posterior gluteal line (below iliac crest)

gluteus medius I

greater trochanter of femur

gluteus medius A

abduction and medial rotation thigh | stops hip from sagging on unsupported side

gluteus medius N

superior gluteal n.

gluteus medius B

superior gluteal a.

gluteus minimus O

ilium between anterior and inferior gluteal lines

gluteus minimus I

greater trochanter of femur

gluteus minimus A

abduction and medial rotation

gluteus minimus N

superior gluteal n.

gluteus minimus B

superior gluteal a.

positive trendelenburg sign

damage to superior gluteal n. - observe waddling gait/ high steppage gait/ swing out gait - side opposite of damage will sag down

piriformis O

anterior surface of sacrum (inside pelvis)

piriformis I

greater trochanter (located partly in pelvis and partly in gluteal region)

piriformis N

S1, S2

piriformis A

lateral rotation of thigh

obturator internus O

obturatior membrane and surrounding bone

obturator internus I

greater trochanter

obturator internus N

nerve to obturator internus (L5, S1, S2)

obturator internus A

lateral rotation, extension and abduction of flexed thigh

superior gemellus O

ischial spine

superior gemellus I

tendon of obturator internus

superior gemellus N

nerve to obturatior internus (L5,S1,S2)

superior gemellus A

lateral rotation, extension, and abduction of flexed thigh

inferior gemellus O

ischial spine

inferior gemellus I

tendon of obturator internus

inferior gemellus N

nerve to quadratus femoris (L5, S1)

inferior gemellus A

lateral rotation, extension, and abduction of flexed thigh

quadratus femoris O

ischial tuberosity

quadratus femoris I

intertrochanteric crest

quadratus femoris N

nerve to quadratus femoris (L5,S1)

quadratus femoris A

laterally rotate thigh

artery branches covering the sacral plexus

the plexus as a whole is covered by branches of the internal iliac a.

the major part of the sacral plexus lies on ....

the anterior surface of the piriformis muscle

how do the large branches of the sacral plexus enter the gluteal region?

pass through the greater sciatic foramen

spinal contribution to sacral plexus

L4-5 and S1-4

EVERY plexus in the body is ___________ primary rami

ventral

sympathetics in the sacral plexus?

each nerve contributing to sacral plexus receives postganglionic sympathetic fibers from the lower end of the sympathetic chain

nerves originating from the posterior division of the sacral plexus (5)

C-PINS ``` common peroneal n. posterior femoral cutaneous* n. inferior gluteal n. n. to piriformis superior gluteal n. ```

nerves origination from the anterior division of the sacral plexus (5)

TNNNP ``` tibial n. n. to obturator internus n. to quadratus femoris n. to levator ani pudendal n. ```

extensor nerves v. flexor nerves

``` extensor = posterior division of sacral plexus flexor = anterior division of sacral plexus ```

true or false: pelvic splanchnic n. (parasympathetics) are not a part of the sacral plexus

TRUE

where does the superior gluteal n. exit

through the greater sciatic foramen above the piriformis muscle ***ALL OTHER branches of the sacral plexus that leave the pelvis do so below the piriformis muscle

what muscles would be affected by injury to the superior gluteal n?

gluteus medius gluteus minimus tensor fasciae latae

injury to this nerve would affect gluteus maximus muscle

inferior gluteal n.

anterior division of sciatic nerve

tibial (L4-S3)

posterior division of sciatic nerve

common peroneal (L4-S2)

will injury to the sciatic nerve affect any muscles in the gluteal region?

what is the cutaneous innervation of the gluteal region?

cluneal n.

superior and medial cluneal nerves are branches of.... inferior cluneal is a branch of...

superior and inferior cluneal= dorsal primary rami | inferior cluneal = ventral primary rami (branch of post. femoral cutaneous)

gluteal arteries originate from

internal iliac a.

how do gluteal arteries enter the gluteal region

through the greater sciatic foramen

what a. supplies the gluteus maximus, medius, minimus and the tensor fasciae latae

superior gluteal a.

what a. supplies the gluteus maximus and the short lateral rotators of the thigh?

inferior gluteal

what a. supplies the perineal region?

internal pudendal

veins in the gluteal region are tributaries of what?

internal iliac vein

what area is best for intragluteal injections?

superior lateral portion of butt