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Gluteal Region and the Back of the Thigh

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Gluteal Region and the Back of the Thigh Gluteal region and the Back of the Thigh Lecture 17 Please check our Editing File. {وَﻣَﻦْ ﻳَﺘَﻮَﻛﻞْ ﻋَﻠَﻰ اﻟﻠﻪِ ﻓَﻬُﻮَ ﺣَﺴْﺒُﻪُ} ھﺬا اﻟﻌﻤﻞ ﻻ ﯾﻐﻨﻲ ﻋﻦ اﻟﻤﺼﺪر اﻷﺳﺎﺳﻲ ﻟﻠﻤﺬاﻛﺮة Objectives ● 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. ● Text in BLUE was found only in the boys’ slides ● Text in PINK was found only in the girls’ slides ● Text in RED is considered important ● Text in GREY is considered extra notes Contents of gluteal region A. GLUTEI - Gluteus maximus - Gluteus medius - Gluteus minimus B. GROUP OF SMALL MUSCLES Muscles (Lateral Rotators) (8 muscles) - Piriformis - Obturator internus - Superior gemellus - Inferior gemellus - Quadratus femoris Contents of gluteal region - Sciatic nerve - Superior gluteal nerve - Inferior gluteal nerve Nerves - Posterior cutaneous nerve of (7 nerves) thigh. (all from sacral plexus) - Nerve to obturator internus - Nerve to quadratus femoris - Pudendal nerve - Superior gluteal - Inferior gluteal - Internal pudendal vessels Vessels (all from internal iliac vessels) Greater sciatic foramen ● Greater sciatic notch of hip bone is transformed into foramen by Greater sciatic foramen Sacrotuberous Lesser sciatic foramen & sacrospinous ligaments. ● Structures passing through Greater sciatic foramen: - Piriformis muscle. Above piriformis: - Superior gluteal nerves & vessels. Below piriformis: - Inferior gluteal nerves & vessels. - Sciatic nerve. - Posterior cutaneous nerve of thigh. - Nerve to quadratus femoris. - Nerve to obturator internus. Pass through - Pudendal nerve both greater and lesser - Internal pudendal vessels. foramen. 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. Pass through both greater sciatic and lesser foramen: ● Nerve to obturator internus. ● pudendal nerve. ● internal pudendal vessels. Glutei muscles Name of the muscle Gluteus minimus Gluteus medius Origin Anterior part of the gluteal Middle part of the gluteal surface of ilium surface of ilium Insertion Anterior surface of greater Lateral surface of greater trochanter trochanter Nerve supply Superior gluteal nerve Abduction and medial rotation of hip joint. Normally they prevent lateral tilt of the pelvis Action by contraction ABDUCTORS of opposite side, on raising the other limb from ground. if the pelvis. tilts this is mean positive Trendlenburge's sign. Glutei muscles Action of gluteus minimus and medius Right pelvic tilt as is the right picture means : paralysis of abductor of the OPPOSITE side -the left side of the pelvis is elevated higher than the right side- ﯾﻌﻧﻲ اﻟﭘﻠﻔس اذا ﻣﺎل ﻣن ﺟﮭﺗﮫ اﻟﯾﺳﺎر ﯾﻌﻧﻲ اﻟﻌﺿﻠﺔ ﺑﺟﮭﺔ اﻟﯾﻣﯾن ﻓﯾﮭﺎ ﻣﺷﻛﻠﺔ ﻻﻧﮭﺎ ﻣﺎﺷدت ﻛوﯾس واﻟﻌﻛس Insertions Glutei muscles Gluteus maximus Posterior part of the gluteal surface of ilium origin The main origin: Back of sacrum ,coccyx and back of Sacrotuberous ligament. 1- main insertion : iliotibial tract insertion 2- other insertion : gluteal tuberosity of the femur Nerve supply Inferior gluteal nerve Extension and lateral rotation of the hip joint. Action Through its attachment to iliotibial tract, it stabilize the femur on tibia during standing. Small muscles (lateral rotators) Obturator internus Inner surface of the side wall of the pelvis origin Into the medial surface of the greater insertion trochanter Nerve to obturator internus Nerve supply Lateral rotation of the hip joint & Control Action movement of the hip joint. Small muscles (lateral rotators) Superior & inferior Gemelli Superior gemellus Inferior gemellus Upper part of lesser Lower border of lesser Superior gemellus origin sciatic notch sciatic notch Upper & lower parts into tendon of obturator insertion internus Nerve Nerve to obturator Nerve to quadratus supply* internus femoris Inferior gemellus Lateral rotation of hip Lateral rotation of hip Action joint & control joint & control movement of hip joint movement of hip joint ﻛل وﺣده ﻣﻧﮭم ﯾﻐذﯾﮭﺎ اﻟﻧﯾرڤ اﻟﻠﻲ ﯾﻐذي اﻟﻣﺳل اﻟﻠﻲ ﺗﺣﺗﮭﺎ* Small muscles (lateral rotators) Piriformis origin Pelvic surface of middle 3 sacral vertebrae It passes through GSF* to be inserted into insertion the upper border of the greater trochanter Nerve supply Anterior rami of S1, S2 Lateral rotation of hip joint & control Action movement of hip joint. *Greater sciatic foramen -almost all small muscles in the gluteal region make an insertion in greater trochanter Except, Quadratus femoris. Small muscles (lateral rotators) Quadratus femoris origin Lateral border of the ischial tuberosity. Quadrate tubercle & intertrochanteric insertion crest. Nerve supply Nerve to quadratus femoris 1. Lateral rotation of the hip joint. Action 2. Control movement of the hip joint. Nerves Course Branches Passes through GSF (greater 1. Muscular to gluteus sciatic foramen), above medius, minimus & Superior piriformis, then between tensor fasciae lata gluteal gluteus medius & minimus 2. Articular to hip joint Passes through GSF, below Muscular to gluteus Inferior piriformis, then deep to maximus gluteal gluteus maximus. Passes through GSF, below 1. Muscular to quadratus To piriformis femoris & inferior quadratus gemellus femoris 2. Articular to hip joint Only in girls slides Nerves Course Branches Passes through GSF, below Cutaneous branches to: piriformis, then descends - Gluteal region Posterior deep to deep fascia. - Back of scrotum in males cutaneous (labium majus) in females - Back of thigh & upper part of back of leg. Passes through GSF, below ● No branches in gluteal piriformis, then superficial to: region - Ischial spine ● Divides into tibial & - Superior gemellus common peroneal Sciatic - Tendon of obturator nerves, in the middle of Internus back of thigh - Inferior gemellus - Quadratus femoris - Adductor magnus. Posterior compartment of the thigh Contents Hamstring muscles: • Biceps femoris. Muscles • Semitendinosus. • Semimembranosus. • Ischial part of adductor magnus. Blood Branches of the profunda supply femoris artery Nerve Sciatic nerve supply Hamstring muscles Biceps Femoris ● The long head from the ischial tuberosity. origin ● The short head from the linea aspera . insertion Mainly into the head of the fibula ● The long head is supplied by the tibial part of Nerve sciatic; supply ● The short head is supplied by the common peroneal part of the sciatic. ● Flexion of knee. Action ● Lateral rotation of flexed leg. ● Long head: extends hip. Lateral Medial Hamstring muscles SEMITENDINOSUS origin Ischial tuberosity Upper part of the medial surface of the shaft of the insertion tibia (SGS) *SGS (semitendinosus / gracialis / sartorius):Three muscles that have the same insertions. Nerve Tibial portion of the sciatic. supply ● Flexes and medially rotates the leg at the knee Action joint; ● Extends the thigh at the hip joint. Hamstring muscles SEMIMEMBRANOSUS origin Ischial tuberosity. ● Posterior surface of the medial condyle of the tibia. insertion ● It forms the oblique popliteal ligament, which reinforces the capsule on the back of the knee joint. Nerve Tibial portion of the sciatic nerve. supply ● Flexes and medially rotates the leg at the knee joint; Action ● Extends the thigh at the hip. Hamstring muscles Adductor magnus (hamstring part) origin Ischial ramus and ischial tuberosity Adductor tubercle of the medial insertion condyle of the femur Nerve The tibial portion of the sciatic supply Extends the thigh at the hip joint Action *it doesn't reach the tibia or fibula so it can't move the knee joint. The adductor magnus has 2 parts: adductor part and hamstring part. The 2 parts have different origin, insertion, action and nerve supply. They are also in different compartments of the thigh Only in girls slides Blood supply Blood supply •The four perforating branches of the profunda femoris artery (deep artery of thigh) provide a rich blood supply to this compartment. (perforating= to pierce or to make a hole) •The profunda femoris vein drains the greater part of the blood from the compartment. perforating branches shown in green Nerve supply Nerve supply •The sciatic nerve, a branch of the sacral plexus (L4 and L5; S1, S2,and S3), leaves the gluteal region as it descends in the midline of the thigh. sciatic nerve It is overlapped the adjacent margins of the posteriorly by biceps femoris and semimembranosus muscles It lies on the posterior aspect of the adductor magnus. Sciatic nerve shown in green In the lower note : common peroneal third of the it ends by dividing into the tibial nerve, also known as and common peroneal nerves. common fibular nerve thigh MCQs (1) How many vessels are supplying the gluteal region? A- 2 B- 3 (4) If someone comes to ER with injury in his C- 4 semitendinosus muscle, Which one of these nerves may be affected? (2) Which one of the following muscles abduct A- Superior gemellus & medially rotates the hip in the gluteal B- Sciatic nerve region? C- Tibial portion of the sciatic nerve A- Gluteus medius & minimus B- Gluteus medius & maximus C- Gluteus maximus & minimus (5) Gluteal region consists of glutei and group of small muscles, Which one of the following isn’t a (3 )Sciatic nerve passes through GSF, ________ glutei muscle? piriformis? A- Gluteus maximus A- below B- Gluteus minimus B- above C- Quadratus femoris C-
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