Lower Limb: The Gluteal

Region

Pre-Medical Program 3

Human Anatomy 3 course

Dr. Sahar Mohsin

[email protected]


Aims & Objectives

• To study the extent, location and surface marking of the gluteal

region.

• To discuss the muscles its blood supply, innervation and action of the

muscles.

• To relate the clinical importance of the topic

The Gluteal Region: Extent

Illiac crest

Extent

Gluteal

• Superiorly: Illiac Crest belowthewaist

• Inferiorly: Fold of the buttock Thigh

glutealfold

Leg

Inferiortothe

glutealfold is

Foot

thethighregion


Surface Marking/Clinical Relevance

Intramuscular injection

supragisteLEusedffe

iliffuberdes

ASIS

51 52
between
index

palmon
Sciatic

onthenataldeft greftodchanter
Nerve

Upper outer quadrant or superolateral part of the

of the buttock is the safe area for intramuscular

injections to avoid damage to the Sciatic nerve.



intramuscular

injection IN

Commonsiteforinjection

muscles are
the
because
gluteal

thickandthickmuscles
are numerousand largeIMveinstorabsorption

technique
sit'attinerteinigiger

Sitesforinjection

OSuperolateralquadrantofthebuttock

identifytheboundariesoftheglutealregion

uperiorly iliac
crest
fold
anteriorly gluteal

gluteusmedius
aterallygreater trochanter

edially Interglutealcleft LocatingsiteforIM

Divide

theregionsinto
quadrants

scalingissues
th

figure but theideais
vidingthemiddleofthe into
region

quadrants T anterolateral

The lateralq uadrant is partofthethigh
upper
he

safestforanIM

Indexfinger ASIS

on

Spread theotherfingers
Hahanter

posteriorlyoveriliacorest

formoresafety Middle fingeron iliactubercle

Aline

canbedrawnfrom Palmonthegreater trochanter
hepsistothegreater

Injection inthetrianglebetween the
rochanter

fingers

aboveline safe
Belowline unsafeand

maydamagesciaticnerve

Cutaneous Innervation of the Gluteal Region

Tneotthefattyregionsinthebody

lower The abdomen isanotherone

Lateral Medial

• Upper Medial Quadrant: Posterior rami of

L1, L2, L3 & S1, S2 & S3 from

• Upper lateral Quadrant: Subcostal T12

Lumbar UMQ

and Lateral branches of illiohypogastric plexus ULQ

(anterior rami)

LLQ LMQ

• Lower Medial Quadrant: Posterior from

sacralplexus
Cutaneous nerve of the thigh S1, S2, S3

• from
Lower Lateral Quadrant: lateral cutaneous Lumberplexus

nerve of the thigh L2, L3 (anterior rami) sacral plexus

post the
IIe
cutaneous
nerve
thigh

entomursionna
n
great.su
toramentn
nanomatomisarea
mediansciatic
continues nerve
to.name.is

mmmm
mateaibranenes
tothestinot

theginteastoid

origin common
insertion
for
gluteus
maximus

andtensorfasciae lat
latathickened
fascia

laterally

Deep Fascia: The Iliotibial tract/band

fasciaofthe
Lateralthickeningoffascialatadeep thighcoveringthe thighmuscles

The deep fascia thickened on the lateral surface of

the thigh to form a strong band; Iliotibial tract/band

Gluteal

Attachments Maximus

• Above: iliac tubercle TFL

• Below the lateral condyle of tibia at

Gerdytubercle

alsocalled anterolateraltubercleofthe
tibia

Superficial

Fascia?? Iliotibial tract receives the insertion of

the Gluteus Maximus muscle and the

Subtutaneous

fat
tensor fascia lata (TFL)

Muscles of the Gluteal Region

Calledthesuperficialgroup Calledthedeepgroup

Gluteus Muscles Lateral Rotators of Hip Joint (small muscles)

• G. Maximus • Piriformis

• G.Medius • Obturator Internus

• G.Minimus • Gemellus superior

• Gemellus inferior

• Quadratus femoris

Tensor Fascia Latae

Gray has

detailed
more
proximal and distal

trochanter
toss

attachments

Tensorfasciae lataeis

a medial rotator of the

thigh

to more
according

Highlighted

partfor nervesupp

Dr Sahar used

agist

Movements at the Hip Joint

Circumductiont

movement

theheadotthe

femurlaterally

gg y p ormrotation
edially
medial
ant.su
the
bringing
a ceotthethighcioserto

the midline
Lateral the
b ringing
rotation anterior
surtaceostheethighawaytromthemialine

Decreasing
flexionabduction angleothipjoint angleofhip

extensionadduction

The Gluteus Maximus

Origin: Outer surface of ilium,

sacrum, coccyx and sacrotuberous

ligament

Insertion: Iliotibial tract & gluteal

tuberosity of femur

Damage
Nerve Supply: Inferior Gluteal N

(L5,S1,S2)

noextension standing
Gluteusmaximusgait

Powerful

Action: Extension and lateral

rotation at the hip joint and through

the iliotibial tract extends the knee

joint.dueto insertioninto tibialtract

ilio

Link thepictures withtheorigins and insertions
found on thetable

GluteusMaximus

Oneoftheantigravitymuscles

Main hip extensor

ty

Idiot

upper213mostinsert Lower3 some

ontoiliotibialtract insertingluteal

tuberosity

Extendsthighfrom

wrath.io tixd Hexedposition

gluteus

maximus can tilt the sitting
Walkingonstairs
elvis

andthusAscentanddescent
ofthe

j body
ekneeflexed

Ex

j's

exIntation

s.to

rwwIjspTg1 eMl
Abidji
controlsentaatnitdescent
 s

ILLIUM Lateral View

Middle gluteal

Line (anterior)

Posterior Gluteal

Line

II
Inferior Gluteal

Line

origin

Max n
origin

https://youtu.be/vAVCUpLa3XU

Damage to the Gluteus Maximus muscle

REMEMBERthatthecauseofthe
side Rtweakggluteus
max Rtint

weakness filterable nerve

gluteal
ison

Lfweak max Lfint

luteus gluteal
nerve Right side
When gluteus maximus is weak; damage inferior

to glutealnerve
Thebody
G. Maximus
• trunk lurches backward (maximus lurch) at heel-strike on weakened side abnormality.

lurches
backwards
•

difficulty to stand up from the sitting posture without the support

topreventthetrunk
fromfallingforward

https://youtu.be/bTQ5ID7Tpa4

Gluteus Medius and Minimus

Gluteal Medius

• Origin: Outer surface of illium

• Insertion: Lateral Surface of the greater trochanter

Gluteal Minimus

• Origin: Outer surface of illium

• Insertion: Anterior Surface of the greater

trochanter

Nerve Supply: Superior Gluteal N (L5, S1)

Main the hip at the hip joint and stabilize

Action: Abducts

the pelvis (opposite side) during walking.

Gluteus medius superficialtominimus

Glutensminmus

deeptomedius

mi

t test

Abductionotthethighathipjoint

keepspelvislevelwhen

I

contralaterallegisoff

theground

Damagetothesemuselesor

thesuperiorglutealnerves

leadstopelvicdropltrendelenburg

also
Theanteriorpartofmediuscan
signonthecontralateralside
auseslightmedial internal while

rotation Minimusandtensorfasciacan walking

alsodo
that

according
tomoore
D

Causes
Supglutealnervedamage

Trendelenburg sign to
Fracture greatertrochanterinsertions both
of muscles
aredisrupted

Dippinioneside Dislocationofhipjoint

Waddling bothsides s

Pelvisdrop

appearsinsw

Compensation ingphaseofgai

Leaningtowardweakened onetoo
When

muscle sidetoraisethe isintheair

pelvislevel

Tensor Fasciae Latae

• Origin: Iliac Crest

• Insertion: Iliotibial Tract

• Innervation: Superior Gluteal

Nerve (L4,L5)

Tensor

Fasciae

Latae
• Action: Assists gluteus

maximus in extending the

knee jointand medialrotation

iliac
tubercle

asis

É YaTat
get

in

s Insert ittibial
tract io
into


Lateral Rotators of the thigh at the hip joint

Deep glutealmuscles

• Piriformis (S1,S2)

Origin: Anterior surface of the sacrum

• Obturator Internus

Origin: Inner surface of obturator membrane

• Gamellus Superior
Insertion

Origin: Ischial spine

Upper border of the Greater

• Gemellus inferior Trochanter

Origin: Ischial tuberosity

Ifremovedextern

willbeclear
Quadratus

femoris
**Nerve to obturator internus

Origin: Lateral border of ischial tuberosity from the sacral plexus also supplies

Insertion: Quadrate tubercle of femur Superior gamellus

Both affectedincase

ofdamage

Nerve Supply: Sacral Plexus L5, S1



Order is from superiorto inferior

PiriformisCLatinforpearshaped

keymusdeoftheglutealregionas.it
divides

thegreatersciaticforamenintosuperior
and

inferior parts T

fora

twang

GemellusilatinforsmallTriceptsCOM

twins

Sup gemellusObturator internusandinfgemellus

Share a commontendon

SupandInfgemellus

Obturatorinternus manesao
turn

Quadratus femoris

Quadrangularmuscle

L i

Blood Supply and Innervation

Superior and inferior gluteal arteries are Superior and inferior gluteal veins are

branches of the internal iliac arteries.

movewith
thearteries the venæ comitantes of the superior

and inferior gluteal arteries and drain

Superior and inferior gluteal nerves in to the Internal iliac Veins

branches from the Sacral plexus

***Nerve to the quadratus

femoris from the sacral plexus

also supplies the inferior

gemellus

What are the structures that goes above & below the

piriformis??

Suprapiriformis Hiatus Infra-piriformis

A V
NNerve, artery and vein Hiatus

A
• Sup gluteal Suprapiriformis

Hiatus
(lateral to medial)

NAV

Infrapiriformis hiatus

• Sciatic N

• Posterior femoral cutaneous nerves Me

•
•
Inferior gluteal nerve, artery and vein
Internal pudendal vein, artery and pudendal beside
angartery
a
a

nerve

Revise (Self -Learning)

Sacral Plexus Lumbar Plexus

https://youtu.be/YQEIz1urnd4

https://youtu.be/dAe7GL1YoSk Best

videos

ever

10mineach

Revision
 Case Discussion
• A 40 year old patient comes to the emergency department with
Trendelenburg / Waddling gait (pelvic drop on the side of the
swinging leg and compensatory lateral trunk bending towards the
side of the standing leg) after a car accident resulting into trauma
at the hip joint.

Weakness
What could be the
possible cause of his
of opposite
gait?? left abductor
muscles
LesionofLf
supgluteal
nerve