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Muscles of the Gluteal Region DR. NIVIN SHARAF MD LMCC.

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Presentation on theme: "Muscles of the Gluteal Region DR. NIVIN SHARAF MD LMCC."— Presentation transcript:

1 Muscles of the Gluteal Region DR. NIVIN SHARAF MD LMCC

2 Objectives Identify the bony landmarks of the pelvis and hip on the articulated skeleton and bones. Include: pelvis (ilium, ischium, pubis, iliac crest, iliac fossa, anterior superior iliac spines, pubic tubercle, pubic crest, acetabulum, obturator foramen, greater and lesser sciatic notches, ischial spine, sacroiliac joint, greater and lesser sciatic foramina, ischial tuberosity), femur (head, neck, shaft, greater and lesser trochanters, intertrochanteric line and crest, linea aspera). Explain how the anatomical position affects the muscle function.. Locate the piriformis muscle and the suprapiriform and the infrapiriform spaces. Identify the superior gluteal nerve in the suprapiriform space and the sciatic and inferior gluteal nerves emerging via infrapiriform space.. Summarize the muscles of gluteal region and thigh in terms of their location, origin, insertion, nerve supply and actions.

3 Bony Skeleton

4

5 FYI

6 Anterior. Posterior. Proximal: -head, -fovea -neck, -greater + lesser trochanters, -intertrochanteric line + crest -gluteal tuberosity -linea aspera. Distal: -supracondylar lines -epicondyles, -condyles -adductor tubercle FEMUR greater trochanter head neck lesser trochanter intertrochanteric line lateral epicondyle medial epicondyle lateral condyle medial condyle intertrochanteric crest linea aspera gluteal tuberosty adductor tubercle supracondylar lines

7 Sciatic foramen

8 Movements of Hip Joint Internal rotation External rotation

9 Gluteal region Gluteal muscles: a-Gluteus maximus b-Gluteus medius c-Gluteus minimus Tensor fasciae latae -iliotibial tract. Small lateral rotators of thigh. Sciatic and posterior cutaneous nerve of thigh. Superior and inferior gluteal ARTERIES.

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11 Gluteal region: -Gluteus maximus (most powerful extensor, also lateral rotator) Insertion: Gluteal tuberosity + Iliotibial tract (band) gluteus maximus iliotibial tract Tensor Fasciae Latae Gluteus maximus Gluteus Maximus Lateral ViewPosterior View

12 Gluteus Maximus Gluteus Maximus and Tensor Fascia Lata insert into Iliotibial Tract - Iliotibial tract is a thickening of the deep fascia (fascia lata) that extends from the ilium to the tibia. - Tension from contraction of gluteus maximus and tensor fasciae latae stabilizes the lower limb as a weight-bearing column. FYI

13 Tensor Fascia Lata Posterior Lateral

14 Illio Tibial Tract (Band) Is the thickened lateral part of fascia latae. Receive insertions of: 1- tensor fasciae l. 1- tensor fasciae l. 2- superf ¾ of gluteus maximus. 2- superf ¾ of gluteus maximus. Attached to oblique ridge on the front of lat condyle of tibia. Stabilize femur on tibia during standing.

15 Gluteus Medius helps to keep the pelvis level when the opposite leg is raised during activities such as running, Walking, or standing on one leg Extends, Abducts and Medial and Lateral rotations (Ant and posterior fibers)

16 Gluteus Minimus Posterior View Small Lateral Rotators of Thigh 1.Piriformis. 2.Obturator internus. 3.Superior gemillus 4.inferior gemillus 5.Quadratus femoris.

17 Action Gluteus maximus:1- main extensor of hip. 2- lateral rotation of hip 3- Maintain knee joint in Extension through the iliotibial tract. gluteus medius, gluteus minimus, tensor fascia latae : 1- extension of hip 2- abduction of hip 3-medial rotation (anterior fibers) 4-contract during walking to prevent tilting of pelvis.

18 Nerve supply Inferior gluteal nerve → gluteus maximus. Superior gluteal nerve →gluteus medius. gluteus minimus. tensor fascia latae

19 Intrinsic muscles Infra and supra Piriformis space

20 Superior gluteal nerve

21 Deep to gluteus maximus: -abductors: gluteus medius gluteus minimus (anterior fibres medially rotate) -lateral (external) rotators: piriformis obturator internus (associated gemelli) quadratus femoris [obturator externus is also a lateral rotator] inferior gamellus superior gamellus gluteus medius gluteus minimus piriformis obturator internus quadratus femoris gluteus maximus Lateral and Medial Rotation of the hip

22 Gluteus medius and minimus: abduction of femur and stabilization of pelvis

23 Trendelenburg Sign. Loss of abductor function (gluteus medius & minimus) causes the pelvis to tilt down when supporting the body on the affected side (*). (I.e. damage to superior gluteal nerve). This function of these muscles is called “stabilization of the pelvis”. NormalPositive sign *

24 Superior and Inferior Gluteal Nerves Superior: Gluteu Medius Gluteus Minimus Inferior Gluteus Maximus

25 QUIZ

26 Intragluteal Injections What? Why?

27 Avoid Sciatic Nerve Injury

28 Sciatic Nerve (L4-S3) Thickest nerve in the body About 2cm in diameter L4, L5, S1, S2, and S3 Inside the pelvis Leave through greater sciatic Foramen, below piriformis.

29 FYI!

30 Sciatic Nerve Variations!

31 Action N supply InsertionOriginMuscleLateralrotationS1,2 Upp border of g trochanter 3 middle Sacral peices Piriformis Lateralrotation N to obturator int T of obt. int Spine of ischium Sup gemillus Lateralrotation N to quadratus f T of obt. int Upp margin of ischial tuberosity. Inf gemillus Lateralrotation N to obturator int Med surf of g trochanter ObturatorMembrane Obturator internus Lateralrotation N to quadratus f Quadrate t Ischial tuber Quad fem

32 QUIZ

33

34 References Gray’s Anatomy for students


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