Download MBBS Anatomy PPT 88 Gluteal Region And Back Thigh Gk Notes

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Gluteal region

? The transitional area between the trunk and

the lower extremity.

? The gluteal region includes the rounded,

posterior buttocks and the laterally placed hip
region.

Bony framework

L4

? S2

Greater sciatic foramen

Lesser sciatic
foramen


Gluteal Aponeurosis

? This is attached to the

lateral border of the
iliac crest superiorly,
and

? splits anteriorly to

enclose tensor fasciae
latae and posteriorly
to enclose gluteus
maximus.


Muscles of Gluteal region

Superficial Layer

? Gluteus maximus

? Tensor fasciae latae


Muscles of Gluteal region

Intermediate layer

? Gluteus medius
? Piriformis
? Superior gemellus.
? Tendon of obturator

internus.

? Inferior gemellus
? Quadratus femoris
? Upper part of

Adductor magnus

? And Hamstrings

Muscles of Gluteal region

Deep layer

? Gluteus minimus

? Reflected head of

rectus femoris

? Tendinous insertion

of obturator
externus


Gluteus Maximus

Origins: posterior end of the iliac crest,

posterior surface of the sacrum, coccyx and
sacrotuberous ligament.

Insertions: ilio-tibial tract( 3/4)and gluteal

tuberosity.(1/4 )

Innervation: inferior gluteal nerve - [ Ventral

rami of L5, S1,2] - emerges below the
piriformis muscle to penetrate the deep
surface of the gluteus maximus with
accompanying vessels.

Actions

? Extensor at hip joint during

running and climbing upstairs.

? Chief antigravity muscle in the

standing up from a seated position.

? Strong lateral rotation of the thigh.

Its upper fibres are active in
powerful abduction of the thigh.

? It is a tensor of the fascia lata, and

through the iliotibial tract it
stabilizes the femur on the tibia
when the extensor muscles of the
knee are relaxed.


Tensor Fascia Lata

Small muscle close to the anterior

border of the gluteus medius, at the dorsal

surface of the ASIS.

Origin: outer lip of iliac crest from ASIS to

tubercle of iliac crest.

Insertion: ilio-tibial tract.

Innervation - superior gluteal nerve.

Action - helps in flexion and abduction of the

thigh. Maintains extension of knee joint.

Structures under cover of gluteus maximus

? Bones
? Ligaments
? Bursae

Trochanteric

Gluteofemoral

Ischial

? Muscles
? Blood vessels and
? Nerves
? Arterial Anastomosis

Trochanteric

cruciate


PIN structures


GLUTEUS MEDIUS

Covered partially by Gluteus maximus

Origins: dorsal surface of the ilium

between the anterior and posterior
gluteal lines and from the gluteal
aponeurosis.

Insertion: lateral surface of the greater trochanter on an

oblique ridge.

GLUTEUS MINIMUS

Covered completely by Gluteus

medius.

Origins: gluteal surface of the ilium

between the anterior and inferior
gluteal lines upto margin of greater
sciatic notch.

Insertion: lateral part of anterior surface of the greater

trochanter.
? Innervation of Gluteus medius and minimus:

superior gluteal nerve [L4, 5, S1] ? that emerges

above the piriformis muscle, with accompanying
vessels, to penetrate the deep surface of the
muscle.

? Actions

Abduction of the thigh and medial rotation.

Preventing the unsupported side of pelvis from
sagging downward during locomotion.

Lurching Gait

The Trendelenburg's Sign
? Trendelenburgs sign is positive in

paralysis of gluteus medius & minimus,
congenital dislocation of hip joint,
fracture of the neck of femur

Piriformis

Origin: antero-lateral

surface and border of the

sacrum.

Insertion: the fibers are emerge laterally through the
greater sciatic foramen as a narrow tendon attached to
the posterior inturned upper border of the greater
trochanter.

Innervation - "nerve to the piriformis" [S1, 2.]
Action - lateral rotator and abductor of the thigh.


Obturator internus and externus

Obturator internus

? Origin : inner surface

of obturator membrane and

Adjoining ischio-pubic ramus.

? Insertion: Tendon makes a right

angle bend at lesser sciatic foramen
to insert to the medial surface of
greater trochanter above and in
front of the trochanteric fossa


Obturator internus

? It is accompanied by Superior and

Inferior Gemelli and insert at
superior and inferior margin of
the insertion of obturator
internus.

? Superior Gemellus from ischial

spine.

? Inferior Gemellus from lower

margin of lesser sciatic notch.

Obturator internus

? Nerve supply :

Nerve to obturator internus also
supplies Sup. Gemellus (L5,S1,S2)

Inf. Gemellus is supplied by nerve
to Quadratus femoris (L4,L5,S1)

? Action:

Lateral rotation at Hip joint


Quadratus Femoris

? Origin:

Linear origin from external surface
of ischial tuberosity.

? Insertion:

Quadrate tubercle near middle of
intertrochanteric crest.

? Innervation: nerve to Quadratus

femoris (L4,L5,S1)

? Action: Lateral rotation of hip

SACROSPINOUS
LIGAMENT

SACROTUBEROUS
LIGAMENT


Above piriformis
? Superior gluteal nerve

and vessels

Below piriformis
? Sciatic nerve
? Posterior femoral

cutaneous nerve

? Inferior gluteal nerve

and vessels

? Nerve to obturator

internus

? Internal pudendal

vessels

? Pudendal nerve


Sciatic nerve

Tibial component

V (L4-S3)

Common peroneal

Component

D (L4-S2)

Course

Branches

? Muscular

branches to
hamstrings.
(medially)

? Articular

branches to Hip
joint


Superior gluteal nerve
Ventral rami of

L4, L5, S1

Inferior gluteal nerve
Ventral rami of

L5, S1, S2

Pudendal nerve
Ventral rami of
S2, S3, S4

Posterior femoral cutaneous nerve

D (S1, S2)

V (S2, S3)

It descends on the back of

the thigh, and in the popliteal

fossa it pierces the deep fascia
and supplies the skin on the back
of the thigh and the upper part
of the leg

Branches:

a)

Gluteal

b) Perineal

c)

Perforating


? Nerve to obturator

internus

Ventral rami of

V (L5, S1, S2)

? Nerve to quadrator

femoris

Ventral rami of

V (L4, L5, S1)


? Superior gluteal

artery

Branch of posterior
division of Internal
Iliac artery.

? Superior gluteal artery divides into
Superficial branch

Deep branch- upper branch and lower branch

SPINOUS ANASTOMOSIS
1. Upper branch of Superior

gluteal artery

2. Superficial and deep

circumflex iliac arteries

3. Ascending branch of lateral

circumflex femoral artery

4. Iliac branch of ilio-lumbar

artery.


? Superior gluteal artery

Branch of posterior division of Internal Iliac artery.

Branches:-

a) Muscular branches

b) Anastomotic branches

c) Arteria nervi ischiadici

? Internal pudendal artery
Branch of anterior

division of Internal Iliac artery


CRUCIATE ANASTOMOSIS

?Descending branch of inferior

gluteal artery

?Ascending branch of 1st

perforating artery

?Medially- transverse branch of

medial circumflex femoral

artery

?Laterally- transverse branch of

lateral circumflex femoral artery

? Collateral circulation

between branches of
iliac arteries and
profunda femoris
arteries in case of
ligature of femoral
artery


TROCHANTERIC ANASTOMOSIS

Trochanteric anastomosis

Descending branch of superior gluteal artery

ascending branches of medial & lateral

circumflex femoral artery

Branch from inferior gluteal artery

situated near the trochanteric fossa of the

femur & supplies the head of femur and

retinacular fibers of neck


Hamstring muscles

These are:

Semi-membranosus

Semi-tendinosus

Biceps femoris (long head )

Adductor Magnus (ischial part)

Hamstring Muscles

Common name applied to the muscles in the

Posterior compartment.

They have a common origin from the ischial

tuberosity and crosses knee joint to insert on tibia
or fibula.

They are innervated by the tibial component of

sciatic nerve.

They also have a common primary function of

flexing the leg, but they also help to extend and
adduct the thigh.

Their blood supply comes principally from the

perforating branches of the deep femoral artery.


adductor magnus

long head of biceps femoris

gracilis

semitendinosus

semimembranosus

short head of biceps femoris

popliteal vessels in the

sartorius

popliteal fossa

Origin - Common from Ischial tuberosity.

Insertion - One of the leg bones.

Nerve supply-Tibial part of sciatic nerve.

Common action

Extensors of hip joint.

Flexors of knee joint.


True hamstrings-

? Semimembranosus

? Semitendinosus

Modified hamstrings

?Long head of biceps femoris-

?Sacrotuberous ligament morphologically
degenerated part.

?Ischial head of adductor magnus-

Tibial collateral ligament represents the

morphological degenerated part of adductor magnus

Biceps Femoris - most lateral muscled with

a "long head" from the ischial tuberosity,

and a "short head" from the middle of the
linea aspera and the lateral supracondylar
ridge.
*The two heads unite to form a common
tendon, which deviates lateral to its
insertion into the apex of the head of the
fibula where it is joined by an extension of
the iliotibial tract.

?The short head receives a branch from
the common peroneal nerve; it also helps
in the lateral rotation of the leg.


Semitendinosus - usually fusiform tapering
distally into a long cylindrical tendon at the
popliteal region to be inserted to the upper
medial surface of the tibia, adjacent to the
attachments of the sartorius and gracilis.

Semimembranosus - usually has a fleshy belly
that form a thick flattened tendon that inserts at
the back of the medial condyle of the tibia, the
tendon contributes to the formation of the

"oblique popliteal ligament" of the knee joint,
which reinforces the posterior capsule of the
joint.

POPLITEAL FOSSA


Boundaries of popliteal
fossa

MEDIAL

LATERAL

Adductor magnus

Gracilis

Semitendinosus

Biceps femoris

Semimembranosus

Plantaris

Sartorius

Lateral head of gastrocnemius

Medial head of
gastrocnemius

CONTENTS OF POPLITEAL FOSSA

? POPLITEAL ARTERY AND ITS BRANCHES
? POPLITEAL VEIN AND ITS TRIBUTARIES
? TIBIAL & COMMON PERONEAL NERVES
? POSTERIOR FEMORAL CUTANEOUS NERVE
? GENICULAR BRANCH OF OBTURATOR NERVE
? POPLITEAL LYMPH NODES
? POPLITEAL FAT

This post was last modified on 05 April 2022