1. Gluteal region
D.Rania Gabr
D.Sama.
D.Elsherbiny

2. Objectives
Identify the bony landmarks of the pelvis and hip on the articulated skeleton and bones.
Enlist the prominent bony features of the femur.
Identify the muscles of the gluteal region in terms of their origin, insertion, nerve supply and actions.
Identify the superior gluteal and inferior gluteal nerves in relation to Piriformis muscle.
Explain how the anatomical position affects the muscle function.

3. Gluteal region
Popliteal fossa

4. The Gluteal Region
It extends from the iliac crest (waist) above to the gluteal fold below.
Buttock: The lower part of the gluteal region which presents a rounded bulge due to fat is called buttock.
Gluteal fold indicates the lower border of the gluteus maximus muscle (gluteal sulcus/crease is a skin crease for the hip joint)
A deep midline groove, the natal (intergluteal) cleft separates the buttocks from each other.
Hip: It is the anterosuperior part of the gluteal region.

5. Bony Pelvis

7. Hip Bone

9. Femur

10. Femur
Femur

11. Femur

13. Movements at Hip Joint

14. Movements at Hip Joint

15. Ligaments of the Gluteal Region
Sacrospinous: connecting sacrum to ischial spine
Sacrotuberous: connecting sacrum to ischial tuberosity
Function :
Stabilize the sacrum
Prevent its posterior rotation at the sacroiliac joint
N.B: They convert the greater & lesser sciatic notches into greater & lesser sciatic foramina

17. Muscles of the Gluteal Region
Gluteus medius
Gluteus minimus
Piriformis
Superior gemillus
Tendon of obturator internus
Inferior gemillus
Quadratus femoris
Adductor magnus
Muscles of the Gluteal Region

18. Gluteus Maximus
ilium S C

19. Gluteus Maximus (Chief extensor)
Most powerful & the bulkiest muscle of the body (Anti-gravity muscle)
Nerve supply
Inferior gluteal nerve (L5, S1, S2)
Actions:
Chief extensor and lateral rotator of thigh at hip.
Helps in rising from sitting, bending or squatting positions and in climbing upstairs & cycling.
Extend knee through iliotibial tract

21. Iliac tubercle
Tensor fasciae
lata
Ilio-tibial tractr

22. Gluteus Medius Origin: outer surface of ilium
Insertion: Lateral surface of greater trochanter
Nerve supply: Superior gluteal nerve (L4,5, S1)
Action:
Powerful abductor and Medially rotation of thigh.
Steady pelvis prevent the opposite side of the pelvis tilting downwards as in walking & running

23. Gluteus Minimus Origin: outer surface of ilium Insertion:
Anterior surface of greater trochanter
Nerve supply:
Superior gluteal nerve (L4,5, S1)
Action:
Abduction & medial rotatation of the thigh

24. Tensor Fascia Lata Origin: Outer edge of iliac crest
Insertion: iliotibial tract
Nerve supply:
Superior gluteal nerve (L4,5, S1)
Action:
Extension of the knee

25. Piriformis Origin: Anterior surface of S2,3,4
Insertion: Upper border of greater trochanter
Nerve supply: S1,2
Action:
Lateral rotator of thigh

26. Obturator Internus Origin: Inner surface of obturator membrane
Insertion: medial border of greater trochanter
Nerve supply: nerve to obturator internus (L4,S1)
Action:
Lateral rotator of thigh

27. Superior & Inferior Gemelli
Origin:
Superior: from ischial spine
Inferior: from ischial tuberosity
Insertion: tendon of obturator internus
Nerve supply:
Superior: nerve to obturator internus (L4, S1)
Inferior: nerve to quadratus femoris (L4, S1)
Action:
Lateral rotators of thigh

28. Quadratus Femoris Origin: Lateral border of ischial tuberosity
Insertion: Quadrate tubercle of femur
Nerve supply: nerve to quadratus femoris (L4,S1)
Action:
Lateral rotator of thigh

29. Greater and Lesser Sciatic Foramen

30. Structures passing through greater sciatic foramen
1. Piriformis Muscle
2. Above Piriformis:
Superior gluteal nerve
Superior gluteal vessels
Below Piriformis:
Inferior gluteal nerve
Inferior gluteal vessels
Sciatic nerve
Post. Cutaneous nerve of thigh
Nerve to quadratus femoris
Nerve to obturator internus
Pudendal nerve
Internal Pudendal vessels

31. Structures passing through lesser sciatic foramen
Nerve to obturator internus
Pudendal nerve
Internal Pudendal vessels
Tendon of obturator internus

32. Site for Intramuscular Injection

33. Trendelenburg Test
Observe patient from behind, ask him/her to stand on one foot and then the other
Negative test: Pelvis ‘tilts up’ on contralateral side
Positive test: Pelvis ‘sags’ on contralateral side as in:
Fracture neck of femur
Dislocation of hip joint
Nonfunctioning gluteus medius and minimus due to:
Neurological damage (L4 – 5 disc herniation)
Any disease affecting muscles (myopathy