Gluteal region IN 10 QUESTIONS Kaan Yücel M.D., Ph.D. 25.April.2014 Friday

Anterior superior iliac spine 1. What is gluteal region? (G. gloutos, buttocks) transitional region between trunk & lower limbs . Anterior superior iliac spine

2. How are the muscles of the gluteal region organized? Deep lateral rotators of the femur @ hip joint piriformis, obturator internus, gemellus superior, gemellus inferior, and quadratus femoris Superficial abduct and extend the hip gluteus minimus, gluteus medius, and gluteus maximus .

Gluteus medius et minimus Gluteus maximus Powerful extensor of (especially) flexed femur at hip joint; lateral stabilizer of hip joint and knee joint; laterally rotates and abducts thigh; steadies thigh and assists in rising from sitting position. Gluteus medius et minimus Abduct and medially rotate thigh; keep pelvis level when ipsilateral limb is weight-bearing and advance opposite (unsupported) side during its swing phase

Gluteus medius paralysis

3...deep muscles of the gluteal region?

Piriformis Anterior surface of sacrum Sacrotuberous ligament Superior border of greater trochanter of femur

Medial surface of greater trochanter (trochanteric fossa) of femur Superior gemellus-Obturator internus-Inferior gemellus Ischial spine Pelvic surface of obturator membrane and surrounding bones Ischial tuberosity Medial surface of greater trochanter (trochanteric fossa) of femur

Quadratus femoris Ischial tuberosity Quadrate tubercle on intertrochanteric crest of femur and area inferior to it

4...superficial muscles in the gluteal region? External surface of ilium between anterior and posterior gluteal lines . External surface of ilium between anterior and inferior gluteal lines Ilium posterior to posterior gluteal line; dorsal surface of sacrum and coccyx; sacrotuberous ligament Lateral surface of greater trochanter of femur Anterior surface of greater trochanter of femur Iliotibial tract & gluteal tuberosity of femur

5...functions of the gluteal region muscles? Muscles in the gluteal region mainly abduct, extend, and laterally rotate the femur relative to the pelvic bone. .

6....innervation of the gluteal region muscles? Superior gluteal nerve Gluteus minimus & medius Tensor fascia latae Inferior gluteal nerve Gluteus maximus . Nerve to the quadratus femoris Quadratus femoris Gemellus inferior Nerve to the obturator internus Obturator internus Gemellus superior Nerve to the piriformis Piriformis

G L U T E A BURSAE Between gluteus maximus & greater trochanter Present @ birth

greater sciatic foramen 7....nerves of the gluteal region? Superior gluteal nerve Inferior gluteal nerve Sciatic nerve Nerve to the quadratus femoris Nerve to the obturator internus Posterior cutaneous nerve of the thigh Pudendal nerve greater sciatic foramen .

Superior & inferior gluteal nerves * Above the piriformis . tensor fasciae latae Posterior to

Sciatic nerve lies just deep to gluteus maximus Superficial muscles Deep muscles . lies just deep to gluteus maximus midpoint between ischial tuberosity & greater trochanter Enters thigh

Nerve to Quadratus Femoris Inferior to piriformis Deep to sciatic nerve * anterior to the plane of the deep muscles .

Nerve to Obturator Internus between posterior cutaneous nerve of thigh & pudendal nerve . + GS

Posterior Cutaneous Nerve of Thigh Medial to sciatic nerve . Medial to sciatic nerve Skin over the gluteal fold

Pudendal nerve .

Sensory Innervation of the Gluteal Region Nerve Origin (Contributing spinal nerves) Course Distrubition Superior clunial nerves   L1-L3 posterior rami Penetrate thoracodorsal fascia; course laterally and inferiorly in subcutaneous tissue Skin overlying superior and central parts of buttock Medial clunial nerves S1-S3 posterior rami Emerge from dorsal sacral foramina; directly enter overlying subcutaneous tissue Skin of medial buttock and intergluteal cleft Inferior clunial nerves Posterior cutaneous nerve of thigh (S2-S3) Arise deep to gluteus maximus; emerge from beneath inferior border of muscle Skin of inferior buttock (overlying gluteal fold) Subcostal T12 anterior ramus Courses along inferior border of 12th rib; lateral cutaneous branch descends over iliac crest Lateral cutaneous branch supplies skin of hip region inferior to anterior part of iliac crest and anterior to greater trochanter Iliohypogastric Lumbar plexus (L1; occasionally T12) Parallels iliac crest; divides into lateral and anterior cutaneous branches Lateral cutaneous branch supplies superolateral quadrant of buttock . Lateral cutaneous nerve of thigh skin overlying the lower lateral quadrant of the buttock. Perforating cutaneous nerve skin over the medial aspect of the gluteus maximus.

8...arteries in the gluteal region?

9...veins in the gluteal region? Internal iliac veins Femoral vein

10...lymphatics of the gluteal region? Lymph from deep tissue superior & inferior gluteal lymph nodes internal,external,common iliac lymph nodes lateral lumbar (aortic/caval) lymph nodes . Lymph from superficial tissue superficial inguinal lymph nodes external iliac lymph nodes