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GLUTEAL REGION
BACK OF THIGH
By :
Prof.Saeed Abulmakarem
Dr. Sanaa Al-Shaarawi
OBJECTIVES
At the end of this lecture, the student should be able
to identify :
Contents of gluteal region: Groups of Glutei muscles and small muscles (Lateral Rotators). Nerves & vessels. Foramina and structures passing through them as: 1 - Greater Sciatic Foramen. 2 - Lesser Sciatic Foramen.
- Back of thigh : Hamstring muscles.
CONTENTS II – NERVES: (all from sacral plexus):
- Sciatic nerve.
- Superior gluteal n.
- Inferior gluteal n.
- Post. cutaneous n. of thigh.
- Nerve to obturator internus.
- Nerve to quadratus femoris.
- Pudendal nerve. 2 3 1 4 5 6 7
CONTENTS III - VESSELS: (all from internal iliac vessels):
- Superior gluteal
- Inferior gluteal
- Internal pudendal vessels. Internal pudendal
Lesser sciatic foramen Lesser sciatic notch of hip bone is transformed into foramen by Sacrotuberous & sacrospinous ligaments.
- Structures passing through
Lesser sciatic foramen :
- Tendon of obturator internus.
- Nerve to obturator internus.
- Pudendal nerve.
- Internal pudendal vessels.
- ORIGINS
- Gluteus minimus:
- Anterior part of the gluteal surface of ilium
- Gluteus medius:
- Middle part of the gluteal surface of ilium,
- Gluteus maximus:
- Posterior part of the gluteal surface of ilium,
- Main origin: Back of sacrum & coccyx & back of Sacrotuberous ligament Glutei Muscles
NERVE SUPPLY & ACTION of Gluti muscles
- Gluteus medius & minimus:
- Nerve supply:
- Superior gluteal nerve.
- Action:
- abduction & medial rotation of hip joint.
- Normally they prevent lateral tilt of the pelvis by contraction of ABDUCTORS on opposite side, on raising the other limb from ground.
- If the pelvis tilts,this is means +ve Trendlenburge’s sign.
- Right pelvic tilt (the left side of the pelvis is elevated higher than the right side) as in picture.
- This requires a muscular effort by the hip abductors (glutei medii and minimi of opposite side) to pull the pelvis up.
- Gluteus maximus:
- Nerve supply:
- Inferior gluteal nerve.
- Action:
- Extension & lateral rotation of the hip joint.
- Through its attachment to iliotibial tract, it stabilizes the femur on tibia during standing.
Small muscles (Lateral Rotators)
- Obturator Internus:
- Origin:
- Inner surface of the side wall of the pelvis.
- Insertion:
- Into the medial surface of the greater trochanter.
- Nerve supply:
- Nerve to obturator internus.
- Superior & Inferior Gemelli:
- Origin:
- Superior gemellus;
- upper part of lesser sciatic notch.
- Inferior gemellus:
- lower part of lesser sciatic notch.
- Insertion:
- Upper & lower parts into tendon of obturator internus.
- Nerve supply:
- Superior gemellus: nerve to obturator internus
- Inferior gemellus: nerve to quadratus femoris.
NERVES SUPERIOR GLUTEAL:
- Course:
- Passes through GSF, above piriformis, then between gluteus medius & minimus
- Branches:
- Muscular to gluteus medius, minimus & tensor fasciae lata
- Articular to hip joint INFERIOR GLUTERAL:
- Course:
- passes through GSF, below piriformis, then deep to gluteus maximus
- Branches: muscular to gluteus maximus NERVE TO QUADRATUS FEMORIS:
- Course:
- passes through GSF, below piriformis
- Branches:
- Muscular to quadratus femoris & inferior gemellus
- Articular to hip joint
POSTERIOR CUTANEOUS NERVE OT THIGH : Course: Passes through GSF, below piriformis, then descends deep to deep fascia. Branches: Cutaneous branches to: gluteal region, back of scrotum (labium majus) back of thigh & upper part of back of leg. SCIATIC : Course: passes through GSF, below piriformis, then superficial to: ischial spine, superior gemellus, tendon of obturator internus, inferior gemellus, quadratus femoris & adductor magnus. Branches: No branches in gluteal region, Divides into tibial & common peroneal nerves, in the middle of back of thigh NERVES
Biceps Femoris : (^) • Origin:
- The long head from the ischial tuberosity.
- The short head from the linea aspera.
- Insertion:
- Mainly into the head of the fibula. Nerve supply:
- The long head is supplied by the tibial part of sciatic;
- the short head is supplied by the common peroneal part of the sciatic. Action :
- Flexion of knee.
- Lateral rotation of flexed leg.
- Long head: extends hip.
SEMITENDINOSUS
- Origin:
- Ischial tuberosity.
- Insertion:
- Upper part of the medial surface of the shaft of the tibia (SGS).. Nerve supply:
- Tibial portion of the sciatic. Action:
- Flexes and medially rotates the leg at the knee joint;
- Extends the thigh at the hip joint.
ADDUCTOR MAGNUS (HAMSTRING PART)
- Origin:
- Ischial ramus and ischial tuberosity
- Insertion:
- Adductor tubercle of the medial condyle of the femur.
- Nerve supply:
- The tibial portion of the sciatic.
- Action:
- Extends the thigh at the hip joint.
BLOOD SUPPLY
- The four perforating branches of the profunda femoris artery (deep artery of thigh) provide a rich blood supply to this compartment.
- The profunda femoris vein drains the greater part of the blood from the compartment.