Gluteal region and back of the thigh Musculoskeletal Block - Lecture 14 Objective: ✓ Contents of the gluteal region: 3 Glutei muscles: Gluteus maximus, medius and minimus. Other 5 Small muscles: Piriformis, Obturator internus, Superior gemellus, Inferior gemellus and Quadratus femoris. ✓ Nerves & vessels. ✓ Foramina: 1-GreaterSciaticForamen. 2-Lesser Sciatic Foramen. ✓ Back of the thigh: Hamstring muscles. Color index: Important In male’s slides only In female’s slides only Extra information, explanation Editing file Contact us: [email protected] Contents Of Gluteal Region: Glutei: 1. Gluteus maximus 2. Gluteus medius 3. Gluteus minimus Muscles Small Muscles (Lateral Rotators): 1. Piriformis 2. Superior gemellus 3. Obturator internus 4. Inferior gemellus 5. Quadratus femoris (All from Sacral plexus): 1. Sciatic nerve 2. Superior gluteal nerve 3. Inferior gluteal nerve 4. Posterior cutaneous nerve of thigh Nerves 5. Nerve to obturator internus 6. Nerve to quadratus femoris 7. Pudendal nerve (all from internal iliac vessels) 1. Superior Gluteal vessel 2. Inferior Gluteal vessel Vessels 3. Internal pudendal vessels Greater Sciatic Foramen: Pictures Greater Sciatic notch of hip bone is transformed into foramen by: sacrotuberous(between the sacrum to ischial tuberosity) & sacrospinous (between the sacrum to ischial spine) ligaments. Structures passing through Greater sciatic foramen: Piriformis muscle - (Above piriformis muscle) Superior gluteal nerves and vessels - (Below Piriformis muscle) Inferior Gluteal nerves and vessels Sciatic nerve Posterior cutaneous nerve of thigh (superficialis) Nerve to quadratus femoris Nerve to obturator internus Pudendal Nerve* Internal Pudendal vessels* *go to Lesser Sciatic foramen too Lesser Sciatic foramen: Lesser Sciatic notch of hip 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 Glutei Muscles: Gluteus Gluteus Gluteus maximus Muscles Minimus medius -Posterior part of the Anterior part of gluteal surface of ilium Middle part of the gluteal -Main origin of gluteus Origin the gluteal surface of ilium maximus:Back of sacrum surface of ilium & coccyx & back of Sacrotuberous ligament -Main insertion: iliotibial tract -Other insertion: gluteal Anterior surface lateral surface of tuberosity of the femur of the greater Insertion the greater (posterior ) trochanter trochanter -Abduction & Medial rotation of hip -Extension & lateral joint. Also they prevent tilt of the rotation of the hip joint. pelvis on raising the other limb -Through its attachment Action from ground to iliotibial tract. -it stabilizes the femur on the tibia during standing. Superior gluteal nerve.L4,5,S1 Inferior gluteal Nerve nerve.L5,S1,2 Pictures Small Muscles (Lateral Rotators): Superior Obturator Inferior Quadratus Muscles PiriforImis Gemellus Internus Gemellus femoris Pelvic surface Upper part Inner Lower part Ischial of middle 3 of lesser surface of of lesser tuberosity Origin sacral sciatic the side sciatic notch vertebrae notch wall of the pelvis Greater Into tendon Into the Into tendon Quadrate trochanter of medial of obturator tubercle. obturator surface of internus Insertion internus the Greater trochanter All have SIMILAR ACTION: Action ● Lateral rotation of the hip joint. ● Control movement of the hip joint. Anterior rami Nerve to obturator Nerve Nerve to quadratus femoris of S1,2 Internus PIctures Greater trochanter Nerves: Nerve Course Branches Picture Passes through greater Muscular: to sciatic foramen, above gluteus medius, Superior piriformis, then minimus and between gluteus tensor fasciae gluteal medius and minimus lata nerve Articular: to hip joint Passes through greater Inferior sciatic foramen, below muscular to gluteal piriformis, then deep to gluteus nerve gluteus maximus maximus passes through greater Muscular: to sciatic foramen, below quadratus Nerve to piriformis femoris and inferior quadratus gemellus femoris Articular: to hip joint Passes through greater Cutaneous sciatic foramen, below branches to: Posterior piriformis, then gluteal region, cutaneous descends deep to deep back of scrotum nerve of fascia. (labium majus) thigh back of thigh & upper part of back of leg. passes through greater - No branches in sciatic foramen, below gluteal region, piriformis, then - Divides into Sciatic superficial to: ischial tibial and nerve spine, superior common (L4 and 5; gemellus, tendon of peroneal nerves, S1, 2, and obturator internus, in the lower 3) inferior gemellus, third (Middle) of quadratus femoris & back of thigh adductor magnus.(posteriorly) Back of the thigh (hamstrings) . Adductor magnus Muscles Biceps femoris Semitendinosus Semimembranosus (hamstrings part) The long head: the Ischial Ischial tuberosity Ischial ramus ischial tuberosity. tuberosity and ischial Origin The short head: the tuberosity linea aspera . Mainly into the Upper part of Posterior surface Adductor head of the fibula. the medial of the medial tubercle of the surface of the condyle of the medial condyle shaft of the tibia tibia. (forms the of the femur (SGS) oblique popliteal Insertion ligament)which SGS: same insertion and same action reinforces the (flexes knee joint ) capsule on the S: Sartorius G: Gracilis back of the knee S: semitendinosus joint. Action -Flexion of knee -Flexes and Flexes and medially Extends the thigh -Lateral rotation medially rotates rotates the leg at at the of flexed leg. the leg at the the knee joint hip joint -The long head knee joint Extends the thigh at extends the hip -Extends the of the hip. the hip joint The long head: tibial part of sciatic the short head: the Tibial portion of the sciatic Nerve common peroneal part of the sciatic. PIctures It has 4 perforating branches that provides a rich blood Profunda femoris artery supply to this compartment (go back to VASCULAR ANATOMY OF THE LOWER LIMB) It drains the greater part of the blood from the Profunda femoris vein compartment MCQs Q1: Which is NOT part of small Q2: a structure passing through Q3: a structure passing muscles of gluteal region? greater sciatic ONLY. through lesser sciatic ONLY. A. Quadratus femoris A. Pudendal nerve A. Posterior c. nerve of thigh B. Obturator internus B. Sciatic nerve B. Pudendal nerve C. Gluteus minimus C. Internal pudendal vessels C. Tendon of obturator internus D. Piriformis D. Tendon of obturator internus D. Nerve to obturator internus Q4: a common structure Q5: which one is supplied by (N to Q6: which of the following supplies between greater & lesser sciatic. obturator Internus) ? the piriformis A. Internal pudendal vessels A.Superior Gemellus A.Anterior rami of S1,2 B. Tendon of obturator internus B.Obturator Internus B. Superior gluteal nerve C. nerve to quadratus femoris C.A&B C. Sciatic nerve D. superior gluteal nerves D.Inferior Gemellus & Obturator D. Posterior rami of S1,2 Internus Q7: Nerve that supply the gluteus Q8: Gluteus maximus main insertion ? Q9: the origin of piriformis is ? Maximus muscle ? A.iliotibial tract A.Superior gluteal nerve B.Anterior surface of the greater A.Pelvic surface of middle 3 sacral B.femoral nerve trochanter vertebrae C.sciatic nerve C.Quadrate tubercle. B.Middle part of the gluteal surface of D. inferior gluteal nerve D.lesser trochanter ilium C.Ischial ramus and ischial tuberosity D.Greater trochanter Q10: Superior gemellus is supplied by Q11: which muscle inserts in the Q12: which structure passes in both ? anterior border of greater trochanter greater and lesser sciatic foramina? ? A. superior gluteal nerve A.superior gluteal nerve B.inferior gluteal nerve A.Piriformis B.piriformis C.nerve to obturator internus B.gluteus maximus C.superior gluteal vessels D.sciatic nerve C.gluteus minimus D.pudendal nerve D.gluteus medius 6)A 12)D 6)A 5)C 11)C 5)C 4)A 10)C 4)A 3)C 9)A 3)C 2)B 8)A 2)B 1)C 7) D 7) 1)C SAQs Q1: name four of the structures passing below piriformis muscle Q2: List three lateral rotators of hip joint Q3: what is the name of the nerve that supplies the hamstrings Q4: list the hamstrings muscles from lateral to medial 4) Biceps femoris, semitendinosus, semimembranosus semitendinosus, femoris, Biceps 4) peroneal (Fibular) nerve (Fibular) peroneal 3) tibial nerve except for the short head of biceps femoris which is supplied by common common by supplied is which femoris biceps of head short the for except nerve tibial 3) femoris Gemellus,Quadratus maximus,Inferior Gluteus 2) nerve 1) Sciatic nerve, inferior gluteal nerves and vessels, nerve to quadratus femoris, pudendal pudendal femoris, quadratus to nerve vessels, and nerves gluteal inferior nerve, Sciatic 1) This lecture is done by: Bader Alrayes Taif Almutairi Banan alqhadi Team leaders: Mayasem Alhazmi Fahad Alajmi.