1. Following a car accident in which the patient received a deep laceration on the medial side of his right knee, the patient notices numbness along the lateral side of his right leg and foot. He has no motor deficit. The nerve which appears to have been injured is the:
femoral nerve saphenous nerve sural nerve superficial fibular nerve

2. Competency of venous valves in a patient with severe crural varicose veins was tested as follows: The superficial veins were emptied by elevating the limb and then they were compressed with a band just below the saphenous opening in the proximal thigh. When the patient quickly stood up, filling of the superficial veins took more than 30 seconds. The delayed filling of the superficial veins demonstrates that the valves of the:
deep (central) veins are competent deep (central) veins are incompetent perforating veins are competent perforating veins are incompetent superificial veins are competent

3. lower limb
Gluteal region
DR.RAJ
ANATOMY DEPT, WUSM

4. Gluteal Region
The gluteal region lies posterolateral to the bony pelvis and proximal end of the femur.
Muscles in the region mainly abduct, extend, and laterally rotate the femur relative to the pelvic bone.

5. Ligaments of the Gluteal Region
Sacrotuberous Ligament: sacrotuberous ligament connects the back of the sacrum to the ischial tuberosity
Sacrospinous Ligament: sacrospinous ligament connects the back of the sacrum to the spine of the ischium.

7. Foramina of the Gluteal Region
Greater Sciatic Foramen:The greater sciatic foramen is formed by the greater sciatic notch of the hip bone and the sacrotuberous and sacrospinous ligaments.
It provides an exit from the pelvis into the gluteal region.

8. Structures passing through greater sciatic foraman
Superior gluteal artery and nerve
Superior gluteal artery
Piriformis
Inferior gluteal artery and nerve
Nerve to quadratus femoris
Nerve to obturator internus
Pudendal nerve
Internal pudendal artery and vein
Sciatic nerve
Posterior cutaneous nerve of thigh

9. Lesser Sciatic Foramen:
Formed by the lesser sciatic notch of the hip bone and the sacrotuberous and sacrospinous ligaments.
It provides an entrance into the perineum from the gluteal region.

10. Structures passing through lesser sciatic foramen
Tendon of obturator internus
Nerve to obturator internus
Pudendal nerve
Internal pudendal artery and vein

11. Nerves of the Gluteal Region
Sacral Plexus:
The sacral plexus lies on the posterior pelvic wall in front of the piriformis muscle .
It is formed from the anterior rami of the lumbar nerves and the anterior rami of the sacral nerves.

12. Posterior wall of the pelvis

13. Branches
Branches to the lower limb that leave the pelvis through the greater sciatic foramen .
1. Sciatic (L4, L5, S1, S2, S3): Articular branches to hip joint and muscular branches.
It is the largest nerve in the body and consists of the tibial and common peroneal nerves bound together with fascia.
Innervates all muscles in the posterior compartment of the thigh that flex the knee and all muscles that work the ankle and foot. llmusclein leg and foot

15. 2. Superior gluteal (L4, L5, S1) : Gluteus medius and gluteus minimus muscles
3. Inferior gluteal (L5, S1, S2): Gluteus maximus

16. 4. Nerve to obturator internus ( L5, S1, S2) : Obturator internus and superior gemellus muscles
5. Nerve to quadratus femoris (L4, L5, S1) : Quadratus femoris and inferior gemellus muscles
6. Posterior cutaneous nerve of the thigh(S2, S3) : Cutaneous branches to buttock and uppermost medial and posterior surfaces of thigh.

17. Branches to the pelvic muscles, pelvic viscera, and perineum:
1. Pudendal (S2, S3, S4) : Structures in perineum: sensory to genitalia; muscular branches to perineal muscles, external urethral sphincter, and external anal sphincter
2. Nerve to piriformis (S1, S2) : Piriformis muscle

19. Muscles of the Gluteal Region
Muscles of the gluteal region are mainly in two groups:
Superficial group of larger muscles:
Gluteus minimus, gluteus medius, and gluteus maximus-and tensor fasciae latae.
2. Deep group of small muscles:
Piriformis, obturator internus, gemellus superior, gemellus inferior, and quadratus femoris.

20. Muscles of Gluteal Region (Superficial group)
Extensor of hip
Gluteus maximus (also helps in lateral rotation)
Abductors of hip (help in Medial rotation)
Gluteus medius
Gluteus minimus
Tensor Fascia lata (also stabilizes knee in extension)
Function of all 3
Contract to prevent sagging of unsupported side of hip during locomotion, enabling opposite foot to swing through (e.g., Trendelenburg test)

22. Gluteus maximus
Origin : Outer surface of ilium, sacrum, coccyx, sacrotuberous ligament
Insertion :Iliotibial tract and gluteal tuberosity of femur
N. supply: Inferior gluteal nerve
Action :Extends and laterally rotates hip joint

23. 23

24. Gluteus medius Origin : Outer surface of ilium
Insertion :Lateral surface of greater trochanter of femur
N. supply: Superior gluteal nerve
Action :Abducts thigh at hip joint; tilts pelvis when walking to permit opposite leg to clear ground

25. Gluteus minimus Origin : Outer surface of ilium
Insertion :Anterior surface of greater trochanter of femur
N. supply: Superior gluteal nerve
Action :Abducts thigh at hip joint; tilts pelvis when walking to permit opposite leg to clear ground

26. Positive Trendelenburg's sign
If right gluteus medius and minimus muscles are paralyzed, the unsupported left side of the pelvis falls (sags) instead of rising; normally, the pelvis rises.

27. Tensor fasciae latae Origin : Iliac crest Insertion :Iliotibial tract
N. supply: Superior gluteal nerve
Action :Assists gluteus maximus in extending the knee joint

28. Deep group of small muscles
Lateral Rotators of the Hip.
Small Muscles
Mostly attach near or on greater trochanter
All but one innervated by named nerves specific to one or two of them
The exception is the obturator externus – innervated by posterior branch of obturator n.

29. PYRIFORMIS N. supply: 1st & 2nd Sacral nerves
Origin :
Anterior surface of sacrum; sacrotuberous ligament
Insertion : Upper border of
Greater trochanter of femur
N. supply: 1st & 2nd Sacral nerves
Action : Lateral rotation of thigh at
hip joint

30. OBTURATOR INTERNUS Obturator membrane Greater trochanter of femur
Origin : Inner surface of
Obturator membrane
Insertion : Upper border of
Greater trochanter of femur
N. supply: Nerve to obturator internus
Action : Lateral rotation of thigh
at hip joint

31. SUPERIOR GEMELLUS N. supply: Nerve to obturator internus
Origin : Spine of ischium
Insertion : Upper border of Greater trochanter of femur
N. supply: Nerve to obturator internus
Action : Lateral rotation of thigh at hip joint

33. INFERIOR GEMELLUS Greater trochanter of femur
Origin : Ischial tuberosity
Insertion : Upper border of
Greater trochanter of femur
N. supply: Nerve to quadratus femoris (L5, S1)
Action :
Lateral rotation of thigh at hip joint

34. QUADRATUS FEMORIS ischial tuberosity femur
Origin : Lateral border of
ischial tuberosity
Insertion : Quadrate tubercle of
femur
N. supply: Nerve to quadratus femoris (L5, S1)
Action :
Lateral rotation of thigh at hip joint

36. Intramuscular injections
The safest place to inject is the upper outer quadrant of either gluteal region.

38. Arteries of the Gluteal Region
1. Superior Gluteal Artery
2. Inferior Gluteal Artery

40. Posterior compartment of thigh
Muscles:
Biceps femoris, semitendinosus, semimembranosus, and a small part of the adductor magnus (hamstring muscles)
Blood supply: Branches of the profunda femoris artery
Nerve supply: Sciatic Nerve

42. Biceps femoris
Origin : Long head: Ischial tuberosity
Short head: linea aspera, lateral supracondylar ridge of shaft of femur
Insertion : Head of fibula
N. supply: Long head: tibial portion of sciatic nerve
Short head: common peroneal portion of sciatic nerve
Action : Flexes leg at knee joint; long head also extends thigh at hip joint

43. Semitendinosus N. supply: Tibial portion of sciatic nerve
Origin : Ischial tuberosity
Insertion : Upper part of medial surface of shaft of tibia
N. supply: Tibial portion of sciatic nerve
Action : Flexes leg at knee joint; extends thigh at hip joint

44. Semimembranosus N. supply: Tibial portion of sciatic nerve
Origin : Ischial tuberosity
Insertion : Medial condyle of tibia
N. supply: Tibial portion of sciatic nerve
Action : Flexes leg at knee joint; extends thigh at hip joint

45. Adductor magnus (hamstring portion)
Origin : Ischial tuberosity
Insertion : Adductor tubercle of femur
N. supply: Tibial portion of sciatic nerve
Action : Extends thigh at hip joint

46. Posterior compartment
Hamstrings
Together extend hip (except short head of biceps femoris) and flex knee (except add mag)

47. Blood Supply of the Posterior Compartment of the Thigh
The four perforating branches of the profunda femoris artery provide a rich blood supply to this compartment