GLUTEAL REGION

OBJECTIVES
Boundaries
MUSCLES-gluteus maximus,
gluteus medius,
gluteus minimus
Greater & lesser sciatic foramina
Trocanteric & cruciate anastomosis
 BOUNDARIES

Superiorly - Iliac crests

Inferiorly - Inferior gluteal Folds
Laterally - Sides of thigh
Medially - Internatal cleft
 CUTANEOUS NERVES

Subcostal nerve (T12),

Iliohypogastric nerve (LI)

Dorsal rami of lumbar nerves (L1,

L2, L3)
Dorsal rami of sacral nerves (S1, S2,
S3)

Posterior cutaneous nerve of thigh

(S1, S2 , S3).
Perforating cutaneous nerve (S2,S3)

Posterior branch of lateral

cutaneous nerve of thigh (L2)
 Deep Fascia
Is attached to iliac crest above
sacrum behind and is continuous
with iliotibial tract laterally

Along its attachment to iliac crest

,deep fascia split to enclose tensor
fascia lata and gluteus maximus
and forms a thickend sheet in
between which covers gluteus
medius called gluteal aponeurosis
 Gluteal region-MUSCLES

1. Gluteus maximus
2. Gluteus medius
3. Gluteus minimus
4. Piriformis
5. Superior gemellus
6. Inferior gemellus
7. Obturator internus
8. Obturator externus
9. Quadratus femoris
10.Tensor fasciae latae
 1.GLUTEUS MAXIMUS
ORIGIN
Outer surface of ilium behind
posterior gluteal line
Posterior third of iliac crest
Sacrum & coccyx
Sacrotuberous ligament

INSERTION
Deepest fibres into gluteal
tuberosity of femur(1/4th )
Greater part of muscle into
iliotibial tract
 GLUTEUS MAXIMUS
ACTION
Chief extensor and lateral
rotator of hip.
Maintains extension of knee
through iliotibial tract

NERVE
Inferior gluteal nerve (L5, S1,2)

Applied anatomy
Intramuscular injections.
 Structures under cover of gluteus
maximus
Bone:gluteal surface of
ilium, ischial tuberosity,
sacrum, coccyx, greater
trochanter, sacrotuberous
ligament

Bursae: Trochanteric
bursa, gluteofemoral
bursa, Ischial bursa
 Structures under cover of gluteus
maximus
Muscles: Gluteus medius,
gluteus minimus,Pyriformis,
Tricipital tendon, Quadratus
femoris, Origin of hamstrings

Blood vessels and nerves:

Above piriformis Superior
gluteal vessels and nerves

Below piriformis Sciatic

nerve, nerve to quadratus
femoris, Posterior femoral
cutaneous nerve ,Inferior
gluteal nerves and vessels,
PIN structures
 Applied Anatomy

Intra muscular Injection

 2.GLUTEUS MEDIUS
ORIGIN
Outer surface of ilium between
posterior and anterior
gluteal lines

INSERTION
Lateral surface of greater
trochanter of femur

NERVE SUPPLY
Superior gluteal nerve (L4,5,S1)

ACTION
Abducts and medially rotates hip
 3.GLUTEUS MINIMUS

ORIGIN
Outer surface of ilium between
anterior and inferior gluteal lines

INSERTION
Anterior surface of greater
trochanter of femur

NERVE SUPPLY
Superior gluteal nerve (L4, 5, S1)

ACTION
Abducts and medially rotates hip
 Applied anatomy - Trendelenburg's sign

Trendelenburg's sign is positive

with an absent or weakened hip
abductor mechanism.
patient stands on affected
limb, with paralysis of gluteus
medius & minimus muscles,
pelvis sinks on unsupported
side.
Paralysis of abductors of hip
Unilateral Lurching gait
Bilateral Waddling gait
SACROTUBEROUS
LIGAMENT
- posterior iliac spine, lower
sacrum & coccyx
- Ischial tuberosity
- forms medial border of
greater & lesser sciatic
foramen
SACROSPINOUS LIGAMENT
- sacrum & coccyx
- Ischial spine
- separates greater sciatic
foramen from lesser sciatic
foramen
GREATER SCIATIC FORAMEN

Structures above piriformis

Superior gluteal nerve & vessels

Piriformis Passes through it

Structures below piriformis -PINS & PIN

Posterior cutaneous nerve of thigh -P
Inferior gluteal nerve & vessels -I
Nerve to quadratus femoris -N
Sciatic Nerve -S

Pudendal Nerve -P
Internal Pudendal Artery -I Lesser Sciatic
Nerve to Obturator internus -N foramen
 4.PIRIFORMIS-key muscle

ORIGIN
Anterior surface of sacrum

INSERTION
Apex of greater trochanter of
femur

NERVE SUPPLY
Anterior primary rami of S1, 2

ACTION
Laterally rotates and stabilizes hip
 5.OBTURATOR INTERNUS
ORIGIN
Pelvic surface of Obturator membrane
Ischiopubic rami
Body of ischium
INSERTION
Medial aspect of greater trochanter of
femur

NERVE SUPPLY
Nerve to obturator internus (L5, S1,2)

ACTION
Laterally rotates and stabilizes hip
 6.GEMELLUS SUPERIOR

ORIGIN
Spine of ischium

INSERTION
Tendon of obturator internus

NERVE SUPPLY
Nerve to obturator internus (L5, S1, 2)

ACTION
Laterally rotates and stabilizes hip
 7.GEMELLUS INFERIOR

ORIGIN
Upper border of ischial tuberosity

INSERTION
Tendon of obturator internus

NERVE SUPPLY
Nerve to quadratus femoris (L4, 5, S1)

ACTION
Laterally rotates and stabilizes hip
 8.QUADRATUS FEMORIS
ORIGIN
Outer border of ischial tuberosity

INSERTION
Quadrate tubercle of femur and
a vertical line below this to level of
lesser trochanter

NERVE SUPPLY
Nerve to quadratus femoris (L4, 5, S1)

ACTION
Laterally rotates and stabilizes hip
 9.Obturator Externus
ORIGIN
Anterior surface of Obturator membrane
Bony margins around obturator foramen

INSERTION
Into trochanteric fossa of femur

NERVE SUPPLY
Posterior division of obturator nerve
(L2,3,4)

ACTION
Laterally rotates hip
 10.TENSOR FASCIA LATA

ORIGIN
Outer lip of iliac crest between
tubercle of the iliac crest and
anterior superior iliac spine
INSERTION
Iliotibial tract

NERVE SUPPLY
Superior gluteal nerve (L4, 5, S1)

ACTION
Maintains extended knee
Abducts hip and medially rotates
 TO SUM UP
Gluteus maximus
Action : Extension & lateral rotation of hip
Nerve : Inferior gluteal nerve

Gluteus medius
Gluteus minimus
Tensor fasciae latae

Action: Abduction and medial rotation of hip

Nerve: Superior gluteal nerve
Piriformis : S1 & S2 of Sacral Plexus

Obturator internus
Gemellus superior Nerve to Obturator internus
Gemellus inferior
Nerve to Quadratus femoris
Quaratus femoris
Obturator externus Obturator nerve

Common Action:
Short lateral rotators of hip
 NERVES - derived from Lumbosacral Plexus
(L4, L5, S1, S2, & S3)

SUPERIOR GLUTEAL NERVE

(L4, L5 & S1)
- emerges through
greater sciatic foramen above
piriformis muscle
- runs between gluteus
medius & minimus with
superior gluteal artery
supplies: Gluteus medius &
minimus, Tensor facsiae latae
& Hip joint
INFERIOR GLUTEAL NERVE
(L5, S1 & S2)
- emerges through
greater sciatic foramen
below piriformis muscle
- runs along with
inferior gluteal artery
supplies: only gluteus
maximus
SCIATIC NERVE
(L4, L5, S1, S2, & S3)

-emerges through greater

sciatic foramen below
piriformis muscle
-largest branch of
lumbosacral plexus &
Thickest nerve in the body
*NO BRANCHES ARE GIVEN
IN GLUTEAL REGION
Branches: Terminates as
tibial nerve & common
peroneal nerve
?
NERVE TO OBTURATOR INTERNUS (L5, S1 & S2)
- emerges through greater sciatic foramen below
piriformis muscle
- supplies: Gemellus superior & Obturator internus

NERVE TO QUADRATUS FEMORIS (L4, L5 & S1)

- emerges through greater sciatic foramen below
piriformis muscle
- supplies: Gemellus inferior & Quadratus femoris
PUDENDAL NERVE (S2, S3, & S4)
- emerges through greater
sciatic foramen below piriformis
muscle
- Passes into lesser sciatic
foramen
- no branch in gluteal region
- Branches - inferior rectal nerves
perineal nerve
dorsal nerve of the penis
?
 BLOOD VESSELS of Gluteal region

SUPERIOR GLUTEAL ARTERY

- largest branch of Internal Iliac Artery
- emerges through greater sciatic foramen above
piriformis muscle
Branches: Supplies gluteus maximus , gluteus medius
& minimus and joins trochanteric anatomosis

INFERIOR GLUTEAL ARTERY

- from Internal Iliac Artery
- emerges through greater sciatic foramen below
piriformis muscle
- Muscular, Cutaneous, Articular branches, branch
to cruciate anatomosis
INTERNAL PUDENDAL ARTERY
- emerges through greater sciatic foramen below
piriformis muscle
- No branch given in gluteal region
- Passes into lesser sciatic foramen

GLUTEAL VEINS
- accompany corresponding artery
- drains into internal iliac veins
- communicates with tributaries of femoral vein
 Applied Anatomy

Piriformis Syndrome - a neuromuscular

disorder that occurs when sciatic
nerve is compressed or otherwise
irritated by piriformis muscle.
Pain, tingling and numbness in
buttocks and along course of sciatic
nerve
Result in sciatica symptoms
 Trochanteric Anastomosis
anastomotic ring of arteries found
in trochanteric fossa and around
neck of femur.
Formed by union of branches
from:
1) ascending branch of medial
circumflex femoral artery.
2) ascending branch of the lateral
circumflex femoral artery.
3) descending branch of superior
gluteal artery.
4) inferior gluteal artery.
 CRUCIATE ANASTOMOSIS
Formed by union of branches from:
1) Transverse branch of medial circumflex
femoral artery.
2) Transverse branch of lateral circumflex
femoral artery.
3) inferior gluteal artery.
4) Ascending branch of first perforating
artery.
CRUCIATE ANASTOMOSIS
 Summary of applied Anatomy

Intramuscular Injections Gluteus

maximus

Paralysis of Gluteus maximus

Piriformis Syndrome - a neuromuscular disorder that

occurs when the sciatic nerve is compressed or
otherwise irritated by the piriformis muscle.
Pain, tingling and numbness in the buttocks and along
the course of the sciatic nerve
Result in sciatica symptoms
 Trendelenburg's gait
Trendelenburg's gait is a gait
adopted by someone with an
absent or weakened hip
abductor mechanism.
During the step, instead of
pelvis being raised on the side of
the lifted foot, it drops.
lesion is on contralateral side
to sagging hip.
Pudendal nerve block
THANK U