Presentation is loading. Please wait.

Presentation is loading. Please wait.

GLUTEAL REGION Cutaneous nerve supply. Cutaneous nerve supply. Fascia. Fascia. Ligaments. Ligaments. Muscles. Muscles. Nerves. Nerves. Important Arterial.

Similar presentations


Presentation on theme: "GLUTEAL REGION Cutaneous nerve supply. Cutaneous nerve supply. Fascia. Fascia. Ligaments. Ligaments. Muscles. Muscles. Nerves. Nerves. Important Arterial."— Presentation transcript:

1 GLUTEAL REGION Cutaneous nerve supply. Cutaneous nerve supply. Fascia. Fascia. Ligaments. Ligaments. Muscles. Muscles. Nerves. Nerves. Important Arterial Anastomoses. Important Arterial Anastomoses.

2 CUTANEOUS NERVES The gluteal region is divided into four quadrants. Each has its own nerve supply The gluteal region is divided into four quadrants. Each has its own nerve supply (1) Upper medial (1) Upper medial Supplied by the posterior rami of the upper three lumbar and the upper three sacral nerves. Supplied by the posterior rami of the upper three lumbar and the upper three sacral nerves.

3 CUTANEOUS NERVES (2) Lower medial: (2) Lower medial: Posterior cutaneous nerve of the thigh (S1,2 &3). Posterior cutaneous nerve of the thigh (S1,2 &3).

4 CUTANEOUS NERVES (3) Upper lateral : (3) Upper lateral : Lateral branches of Iliohypogastric (L1) and Subcostal (T12). Lateral branches of Iliohypogastric (L1) and Subcostal (T12). (4) Lower lateral : (4) Lower lateral : Lateral cutaneous nerve of the thigh (L2&3). Lateral cutaneous nerve of the thigh (L2&3).

5 FASCIA Superficial Fascia : Superficial Fascia : Is thick especially in females and contains large quantities of fat to give the characteristic shape of the buttocks. Is thick especially in females and contains large quantities of fat to give the characteristic shape of the buttocks. Deep Fascia : Deep Fascia : Continuous inferiorly with the deep fascia of the thigh (fascia lata). Continuous inferiorly with the deep fascia of the thigh (fascia lata).

6 FASCIA Superiorly it splits to enclose the gluteus maximus muscle. Superiorly it splits to enclose the gluteus maximus muscle. It covers the gluteus medius and is attached to the iliac crest. It covers the gluteus medius and is attached to the iliac crest.

7 LIGAMENTS 1. Iliotibial tract. 1. Iliotibial tract. 2. Sacrotuberous. 2. Sacrotuberous. 3. Sacrospinous. 3. Sacrospinous.

8 ILIOYIBIAL TRACT It is a vertical thickened band of the deep fascia on the lateral side of the thigh. It is a vertical thickened band of the deep fascia on the lateral side of the thigh. Attachment : Attachment : Above : tubercle of the iliac crest. Above : tubercle of the iliac crest. Below : Below : 1.Lateral condyle of the tibia. 1.Lateral condyle of the tibia. 2.Capsule of the knee joint. 3.Patella. 2.Capsule of the knee joint. 3.Patella.

9 MUSCLES INSERTED It is reinforced by fibers from: It is reinforced by fibers from: 1. Superficial (3/4) of gluteus maximus. 1. Superficial (3/4) of gluteus maximus. 2. Tensor fascia latae. 2. Tensor fascia latae.

10 FUNCTION Contraction of these two muscles tighten the tract and it acts as a splint for the knee. Contraction of these two muscles tighten the tract and it acts as a splint for the knee. It helps to make the lower limb works as a rigid column. It helps to make the lower limb works as a rigid column.

11 LIGAMENTS 2.Sacrotuberous: 2.Sacrotuberous: It connects the back of the sacrum to the ischial tuberosity. It connects the back of the sacrum to the ischial tuberosity. 2. Sacrospinous : 2. Sacrospinous : It connects the back of the sacrum to the ischial spine. It connects the back of the sacrum to the ischial spine.

12 LIGAMENTS Function : Function : They stabilize the sacrum and prevent its mobility at the sacroiliac joint by the weight of the vertebral column. They stabilize the sacrum and prevent its mobility at the sacroiliac joint by the weight of the vertebral column.

13 MUSCLES (1) Three Glutei : (1) Three Glutei : Maximus. Maximus. Medius. Medius. Minimus. Minimus. (2) Tensor Fascia latae. (2) Tensor Fascia latae. (3) Six Lateral Rotators. (3) Six Lateral Rotators.

14 THREE GLUTEAL MUSCLES The gluteus maximus covers the gluteus medius and the (6) lateral rotators. The gluteus maximus covers the gluteus medius and the (6) lateral rotators. The gluteus medius covers the gluteus minimus. The gluteus medius covers the gluteus minimus. The gluteus minimus rests immediately upon the iliac bone. The gluteus minimus rests immediately upon the iliac bone.

15 GLUTEUS MAXIMUS It is one of the largest, thickest and most powerful muscles of the body. It is one of the largest, thickest and most powerful muscles of the body. It has an extensive Origin : It has an extensive Origin : (1) upper part of the ileum behind the posterior gluteal line. (1) upper part of the ileum behind the posterior gluteal line. (2) back of the sacrum. (2) back of the sacrum. (3) sacrotuberous ligament. (3) sacrotuberous ligament.

16 GLUTEUS MAXIMUS Insertion : Insertion : Superficial ¾ to the iliotibial tract. Superficial ¾ to the iliotibial tract. Deep ¼ to the gluteal tuberosity of the femur. Deep ¼ to the gluteal tuberosity of the femur. Nerve supply : Nerve supply : Inferior gluteal nerve. Inferior gluteal nerve.

17 ACTION (1) It is the main extensor of the hip. (1) It is the main extensor of the hip. It is used only when the thigh has to be extended with Force : It is used only when the thigh has to be extended with Force : (a) Rising from a sitting position. (a) Rising from a sitting position. (b) Climbing a hill. (b) Climbing a hill. C. Running. C. Running. It is not used in walking on a level. It is not used in walking on a level.

18 ACTION (2) A powerful lateral rotator of the hip (when the thigh is extended) (2) A powerful lateral rotator of the hip (when the thigh is extended) (3) Its contraction makes the iliotibial tract tense. (3) Its contraction makes the iliotibial tract tense.

19 INTRAMUSCULAR INJECTION The great thickness of gluteus maximus makes it ideal for intramuscular injection. The great thickness of gluteus maximus makes it ideal for intramuscular injection. The injection should be given on the upper outer quadrant of the buttock to avoid injury of the following nerves: sciatic, tibial, common peroneal and inferior gluteal. The injection should be given on the upper outer quadrant of the buttock to avoid injury of the following nerves: sciatic, tibial, common peroneal and inferior gluteal.

20 BURSAE RELATED Three bursae lie under the gluteus maximus : Three bursae lie under the gluteus maximus : 1. A bursa between the lower edge of the muscle and the ischial tuberosity. 1. A bursa between the lower edge of the muscle and the ischial tuberosity. 2. A large bursa separating the muscle from the greater trochanter. 2. A large bursa separating the muscle from the greater trochanter. 3. A large bursa between the aponeurotic part of the muscle and vastus lateralis. 3. A large bursa between the aponeurotic part of the muscle and vastus lateralis.

21 GLUTEUS MEDIUS It is a large thick powerful fan shaped muscle. It is a large thick powerful fan shaped muscle. Origin : Origin : A large area between the iliac crest and the middle gluteal line. A large area between the iliac crest and the middle gluteal line.

22 GLUTEUS MEDIUS Insertion : Insertion : In the postero superior angle of the greater trochanter and the oblique line on its lateral surface. In the postero superior angle of the greater trochanter and the oblique line on its lateral surface.

23 GLUTEUS MEDIUS Nerve supply : Nerve supply : Superior gluteal nerve. Superior gluteal nerve. Action : Action : 1. Abduction of the thigh. 1. Abduction of the thigh. 2. Medial rotation of the thigh (anterior fibers ). 2. Medial rotation of the thigh (anterior fibers ).

24 GLUTEUS MEDIUS In standing, if the support of one limb is suddenly removed, the gluteus medius of the other side contracts to prevent the pelvis from falling on the unsupported side. In standing, if the support of one limb is suddenly removed, the gluteus medius of the other side contracts to prevent the pelvis from falling on the unsupported side. The alternative action of the gluteus medius on both sides is responsible for keeping the pelvis level during walking. The alternative action of the gluteus medius on both sides is responsible for keeping the pelvis level during walking. Without the gluteus medius of both sides the gait becomes rolling on a broad base. Without the gluteus medius of both sides the gait becomes rolling on a broad base.

25 GLUTEUS MINIMUS It is a fan shaped muscle that lies deep to the anterior part of gluteus medius. It is a fan shaped muscle that lies deep to the anterior part of gluteus medius. Origin : Origin : From the ilium between the middle and inferior gluteal lines. From the ilium between the middle and inferior gluteal lines.

26 GLUTEUS MINIMUS Insertion : Insertion : Anterior surface of greater trochanter. Anterior surface of greater trochanter. Nerve supply : Nerve supply : Superior gluteal nerve. Superior gluteal nerve. Action : Action : same as gluteus medius. same as gluteus medius.

27 TENSOR FASCIA LATAE It is a short thick muscle that lies at the junction of the gluteal region and the upper part of the front of the thigh. It is a short thick muscle that lies at the junction of the gluteal region and the upper part of the front of the thigh. Origin : Origin : From the extreme anterior part of the iliac crest (just behind the anterior superior iliac spine). From the extreme anterior part of the iliac crest (just behind the anterior superior iliac spine).

28 TENSOR FASCIA LATAE Insertion : Insertion : In the iliotibial tract. In the iliotibial tract. Nerve supply: Nerve supply: Superior gluteal nerve. Superior gluteal nerve.

29 TENSOR FASCIA LATAE Action : Action : It tightens the knee so that in walking the knee can take the weight of the body while the other foot is off the ground. It tightens the knee so that in walking the knee can take the weight of the body while the other foot is off the ground. The extension of the knee is made through tightening of the iliotibial tact with the help of gluteus maximus. The extension of the knee is made through tightening of the iliotibial tact with the help of gluteus maximus.

30 SIX LATERAL ROTATORS Piriformis. Piriformis. Obturator internus. Obturator internus. Gemelli (superior and inferior ). Gemelli (superior and inferior ). Obturator externus. Obturator externus. Quadratus femoris. Quadratus femoris.

31 SIX LATERAL ROTATORS These muscles pass behind the hip joint. These muscles pass behind the hip joint. They lie below and behind gluteus minimus. They lie below and behind gluteus minimus. They are covered by gluteus maximus. They are covered by gluteus maximus.

32 ORIGIN 1. Piriformis 1. Piriformis Inside the pelvis mainly from the middle (3) pieces of the anterior surface of the sacrum. Inside the pelvis mainly from the middle (3) pieces of the anterior surface of the sacrum. It leaves the pelvis through the GSF which it fills almost completely. It leaves the pelvis through the GSF which it fills almost completely.

33 ORIGIN 2. Obturato Internus: 2. Obturato Internus: Inside the pelvis from the obturator membrane and the surrounding bones. Inside the pelvis from the obturator membrane and the surrounding bones. It leaves the pelvis through the LSF. It leaves the pelvis through the LSF.

34 ORIGIN 3 & 4. Gemellus superior and Gemellus inferior : 3 & 4. Gemellus superior and Gemellus inferior : From the upper and lower margins of the LS Notch respectively. From the upper and lower margins of the LS Notch respectively. They are inserted into the tendon of obturator internus. They are inserted into the tendon of obturator internus. 5. Quadratus femoris : 5. Quadratus femoris : From the ischial tuberosity. From the ischial tuberosity.

35 SIX LATERAL ROTATORS Insertion : Insertion : The tendons are inserted into the greater trochanter. The tendons are inserted into the greater trochanter. Action : Action : Lateral rotation of the hip joint. Lateral rotation of the hip joint.

36 SIX LATERAL ROTATORS Nerve supply : Nerve supply : Each of these muscles (Except obturator externus) has its own nerve supply from the sacral plexus or from the sacral nerves. Each of these muscles (Except obturator externus) has its own nerve supply from the sacral plexus or from the sacral nerves.

37 ORIGIN 6. Obturator externus 6. Obturator externus Outside the pelvis from the obturator membrane and the medial and lower margins of the obturator foramen. Outside the pelvis from the obturator membrane and the medial and lower margins of the obturator foramen. It is inserted in the trochanteric fossa. It is inserted in the trochanteric fossa.

38 NERVES 1. Sciatic nerve. 1. Sciatic nerve. 2. Posterior cutaneous nerve of thigh. 2. Posterior cutaneous nerve of thigh. 3. Superior and Inferior Gluteal nerves. 3. Superior and Inferior Gluteal nerves. 4. Nerve to Quadratus Femoris. 4. Nerve to Quadratus Femoris. 5. Nerve to Obturator Internus. 5. Nerve to Obturator Internus. 6. Pudendal nerve. 6. Pudendal nerve.

39 SCIATIC NERVE It is the largest nerve in the body. It is the largest nerve in the body. It is the larger of the two terminal branches of the sacral plexus. It is the larger of the two terminal branches of the sacral plexus. It is flat and broad near its origin and becomes rounded downwards. It is flat and broad near its origin and becomes rounded downwards.

40 SCIATIC NERVE It is composed of two components : It is composed of two components : (a) Tibial nerve : (a) Tibial nerve : It arises from the ventral divisions of all components of the sacral plexus. It arises from the ventral divisions of all components of the sacral plexus. (b) Common peroneal verve : (b) Common peroneal verve : It arises from the dorsal divisions of all components of the sacral plexus. It arises from the dorsal divisions of all components of the sacral plexus.

41 COURSE It leaves the pelvis through the lower part of the GSF below the piriformis. It leaves the pelvis through the lower part of the GSF below the piriformis. As it descends it lies on: As it descends it lies on: 1.Root of ischial spine. 1.Root of ischial spine. 2.Gemelli. 2.Gemelli. 3.Obturator internus. 3.Obturator internus. 4.Quadratus femoris. 4.Quadratus femoris. 5.Adductor magnus. 5.Adductor magnus.

42 COURSE It is related posteriorly to : It is related posteriorly to : 1.Posterior cutaneous nerve of the thigh. 1.Posterior cutaneous nerve of the thigh. 2.Gluteus maximus. 2.Gluteus maximus. It enters the back of the thigh by passing deep to the long head of biceps femoris. It enters the back of the thigh by passing deep to the long head of biceps femoris. Branches : Branches : Usually it has No branches in the gluteal region. Usually it has No branches in the gluteal region.

43 TERMINATION About the middle of the thigh it divides into its terminal branches :Tibial and Common Peroneal. About the middle of the thigh it divides into its terminal branches :Tibial and Common Peroneal.

44 POSTERIOR CUTANEOUS N. OF THE THIGH ORIGIN : ORIGIN : Sacral plexus. Sacral plexus. COURSE : COURSE : It leaves the pelvis through the lower part of the GSF below piriformis. It leaves the pelvis through the lower part of the GSF below piriformis. It descends on the posterior surface of the sciatic nerve till the popliteal fossa. It descends on the posterior surface of the sciatic nerve till the popliteal fossa.

45 POSTERIOR CUTANEOUS N. OF THE THIGH BRANCHES : BRANCHES : 1. Gluteal : to the lower medial quadrant of the buttock. 1. Gluteal : to the lower medial quadrant of the buttock. 2. Perineal : to the skin of the back of scrotum (or labia majora). 2. Perineal : to the skin of the back of scrotum (or labia majora). 3. Cutaneous : to the back of the thigh and upper leg. 3. Cutaneous : to the back of the thigh and upper leg.

46 SUPERIOR GLUTEAL NERVE ORIGIN : ORIGIN : From the sacral plexus (L4,5 & S1). From the sacral plexus (L4,5 & S1). COURSE : COURSE : It leaves the pelvis through the upper part of the greater sciatic foramen above piriformis. It leaves the pelvis through the upper part of the greater sciatic foramen above piriformis. It passes between gluteus medius and minimus. It passes between gluteus medius and minimus.

47 SUPERIOR GLUTEAL NERVE BRANCHES BRANCHES It gives motor supply to: It gives motor supply to: 1. Gluteus medius. 1. Gluteus medius. 2. Gluteus minimus. 2. Gluteus minimus. 3. Tensor fascia latae. 3. Tensor fascia latae.

48 INFERIOR GLUTEAL NERVE Origin: Origin: Sacral plexus (L5, S1 &S2). Sacral plexus (L5, S1 &S2). Course : Course : It leaves the pelvis through the lower part of the (GSF) below piriformis. It leaves the pelvis through the lower part of the (GSF) below piriformis. Branches: Branches: It gives motor supply to : It gives motor supply to : Gluteus maximus. Gluteus maximus.

49 NERVE TO QUADRATUS FEMORISN It arises from the sacral plexus. It arises from the sacral plexus. It leaves the pelvis through the lower part of the GSF below piriformis. It leaves the pelvis through the lower part of the GSF below piriformis. It supplies : It supplies : (1) Quadratus femoris. (1) Quadratus femoris. (2) Inferior gemillus. (2) Inferior gemillus.

50 PUDENDAL N. & N. TO OBTURATOR INTERNUS Both arise from the sacral plexus. Both arise from the sacral plexus. They Leave the pelvis through the lower part of GSF below piriformis. They Leave the pelvis through the lower part of GSF below piriformis. They reenter the pelvis through the LSF with the pudendal vessels by crossing the ischial spine. They reenter the pelvis through the LSF with the pudendal vessels by crossing the ischial spine.

51 PUDENDAL N. & N. TO OBTURATOR INTERNUS Nerve to obturator internus Nerve to obturator internus Supplies : Supplies : 1. Obturator internus. 1. Obturator internus. 2. Superior gemellus. 2. Superior gemellus. Pudendal Neve Pudendal Neve Supplies the structures in the perineum. Supplies the structures in the perineum.

52 SUPERIOR & INFERIOR GLUTEAL ARTERIES They arise from the internal iliac artery. They arise from the internal iliac artery. They leave the pelvis through the GSF above and below the piriformis muscle respectively in company with the corresponding nerves. They leave the pelvis through the GSF above and below the piriformis muscle respectively in company with the corresponding nerves. They distribute into many branches and share in the anastomoses in the gluteal region and back of the thigh. They distribute into many branches and share in the anastomoses in the gluteal region and back of the thigh.

53 TROCHANTERIC ANASTOMOSIS Position : Position : Near the trochanteric fossa. Near the trochanteric fossa. Arteries sharing : Arteries sharing : (1) Superior gluteal. (1) Superior gluteal. (2) Inferior gluteal. (2) Inferior gluteal. (3) Medial circumflex femoral. (3) Medial circumflex femoral. (4) Lateral circumflex femoral. (4) Lateral circumflex femoral. Function : Function : It is the main source of arterial supply of the head of the femur. It is the main source of arterial supply of the head of the femur.

54 CRUCIATE ANASTOMOSIS Position : Position : On the upper part of the back of the thigh. On the upper part of the back of the thigh. Arteries sharing : Arteries sharing : (1) Inferior gluteal. (1) Inferior gluteal. (2) Medial circumflex femoral. (2) Medial circumflex femoral. (3) Lateral circumflex femoral. (3) Lateral circumflex femoral. (4) First perforating. (4) First perforating. Function : Function : It provides connection between internal iliac and femoral arteries. It provides connection between internal iliac and femoral arteries.


Download ppt "GLUTEAL REGION Cutaneous nerve supply. Cutaneous nerve supply. Fascia. Fascia. Ligaments. Ligaments. Muscles. Muscles. Nerves. Nerves. Important Arterial."

Similar presentations


Ads by Google