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

Gluteal region

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? The transitional area between the trunk and

the lower extremity.

? The gluteal region includes the rounded,

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posterior buttocks and the laterally placed hip
region.

Bony framework

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L4

? S2

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Greater sciatic foramen

Lesser sciatic
foramen

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Gluteal Aponeurosis

? This is attached to the

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lateral border of the
iliac crest superiorly,
and

? splits anteriorly to

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enclose tensor fasciae
latae and posteriorly
to enclose gluteus
maximus.

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Muscles of Gluteal region

Superficial Layer

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? Gluteus maximus

? Tensor fasciae latae

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Muscles of Gluteal region

Intermediate layer

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

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internus.

? Inferior gemellus
? Quadratus femoris
? Upper part of

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Adductor magnus

? And Hamstrings

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Muscles of Gluteal region

Deep layer

? Gluteus minimus

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? Reflected head of

rectus femoris

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? Tendinous insertion

of obturator
externus

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Gluteus Maximus

Origins: posterior end of the iliac crest,

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posterior surface of the sacrum, coccyx and
sacrotuberous ligament.

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

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tuberosity.(1/4 )

Innervation: inferior gluteal nerve - [ Ventral

rami of L5, S1,2] - emerges below the

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piriformis muscle to penetrate the deep
surface of the gluteus maximus with
accompanying vessels.

Actions

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? Extensor at hip joint during

running and climbing upstairs.

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? Chief antigravity muscle in the

standing up from a seated position.

? Strong lateral rotation of the thigh.

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

? It is a tensor of the fascia lata, and

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

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Tensor Fascia Lata

Small muscle close to the anterior

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border of the gluteus medius, at the dorsal

surface of the ASIS.

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Origin: outer lip of iliac crest from ASIS to

tubercle of iliac crest.

Insertion: ilio-tibial tract.

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Innervation - superior gluteal nerve.

Action - helps in flexion and abduction of the

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thigh. Maintains extension of knee joint.

Structures under cover of gluteus maximus

? Bones

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? Ligaments
? Bursae

Trochanteric

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Gluteofemoral

Ischial

? Muscles

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? Blood vessels and
? Nerves
? Arterial Anastomosis

Trochanteric

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cruciate


PIN structures

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GLUTEUS MEDIUS

Covered partially by Gluteus maximus

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Origins: dorsal surface of the ilium

between the anterior and posterior
gluteal lines and from the gluteal

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aponeurosis.

Insertion: lateral surface of the greater trochanter on an

oblique ridge.

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GLUTEUS MINIMUS

Covered completely by Gluteus

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medius.

Origins: gluteal surface of the ilium

between the anterior and inferior

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gluteal lines upto margin of greater
sciatic notch.

Insertion: lateral part of anterior surface of the greater

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trochanter.
? Innervation of Gluteus medius and minimus:

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

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

? Actions

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Abduction of the thigh and medial rotation.

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

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Lurching Gait

The Trendelenburg's Sign
? Trendelenburgs sign is positive in

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

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Piriformis

Origin: antero-lateral

surface and border of the

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sacrum.

Insertion: the fibers are emerge laterally through the
greater sciatic foramen as a narrow tendon attached to

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the posterior inturned upper border of the greater
trochanter.

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

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Obturator internus and externus

Obturator internus

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? Origin : inner surface

of obturator membrane and

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Adjoining ischio-pubic ramus.

? Insertion: Tendon makes a right

angle bend at lesser sciatic foramen

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to insert to the medial surface of
greater trochanter above and in
front of the trochanteric fossa

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Obturator internus

? It is accompanied by Superior and

Inferior Gemelli and insert at

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superior and inferior margin of
the insertion of obturator
internus.

? Superior Gemellus from ischial

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spine.

? Inferior Gemellus from lower

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margin of lesser sciatic notch.

Obturator internus

? Nerve supply :

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

Inf. Gemellus is supplied by nerve

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to Quadratus femoris (L4,L5,S1)

? Action:

Lateral rotation at Hip joint

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Quadratus Femoris

? Origin:

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Linear origin from external surface
of ischial tuberosity.

? Insertion:

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Quadrate tubercle near middle of
intertrochanteric crest.

? Innervation: nerve to Quadratus

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femoris (L4,L5,S1)

? Action: Lateral rotation of hip

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SACROSPINOUS
LIGAMENT

SACROTUBEROUS
LIGAMENT

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Above piriformis
? Superior gluteal nerve

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and vessels

Below piriformis
? Sciatic nerve
? Posterior femoral

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cutaneous nerve

? Inferior gluteal nerve

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and vessels

? Nerve to obturator

internus

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? Internal pudendal

vessels

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? Pudendal nerve


Sciatic nerve

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Tibial component

V (L4-S3)

Common peroneal

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Component

D (L4-S2)

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Course

Branches

? Muscular

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branches to
hamstrings.
(medially)

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? Articular

branches to Hip
joint

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Superior gluteal nerve
Ventral rami of

L4, L5, S1

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Inferior gluteal nerve
Ventral rami of

L5, S1, S2

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Pudendal nerve
Ventral rami of
S2, S3, S4

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Posterior femoral cutaneous nerve

D (S1, S2)

V (S2, S3)

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It descends on the back of

the thigh, and in the popliteal

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

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Branches:

a)

Gluteal

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b) Perineal

c)

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Perforating


? Nerve to obturator

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internus

Ventral rami of

V (L5, S1, S2)

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? Nerve to quadrator

femoris

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Ventral rami of

V (L4, L5, S1)

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? Superior gluteal

artery

Branch of posterior

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division of Internal
Iliac artery.

? Superior gluteal artery divides into
Superficial branch

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Deep branch- upper branch and lower branch

SPINOUS ANASTOMOSIS
1. Upper branch of Superior

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gluteal artery

2. Superficial and deep

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circumflex iliac arteries

3. Ascending branch of lateral

circumflex femoral artery

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4. Iliac branch of ilio-lumbar

artery.

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? Superior gluteal artery

Branch of posterior division of Internal Iliac artery.

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Branches:-

a) Muscular branches

b) Anastomotic branches

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c) Arteria nervi ischiadici

? Internal pudendal artery
Branch of anterior

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division of Internal Iliac artery


CRUCIATE ANASTOMOSIS

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?Descending branch of inferior

gluteal artery

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?Ascending branch of 1st

perforating artery

?Medially- transverse branch of

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medial circumflex femoral

artery

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?Laterally- transverse branch of

lateral circumflex femoral artery

? Collateral circulation

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between branches of
iliac arteries and
profunda femoris
arteries in case of

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ligature of femoral
artery


TROCHANTERIC ANASTOMOSIS

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Trochanteric anastomosis

Descending branch of superior gluteal artery

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ascending branches of medial & lateral

circumflex femoral artery

Branch from inferior gluteal artery

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situated near the trochanteric fossa of the

femur & supplies the head of femur and

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retinacular fibers of neck


Hamstring muscles

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These are:

Semi-membranosus

Semi-tendinosus

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Biceps femoris (long head )

Adductor Magnus (ischial part)

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Hamstring Muscles

Common name applied to the muscles in the

Posterior compartment.

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They have a common origin from the ischial

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

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They are innervated by the tibial component of

sciatic nerve.

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They also have a common primary function of

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

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Their blood supply comes principally from the

perforating branches of the deep femoral artery.

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adductor magnus

long head of biceps femoris

gracilis

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semitendinosus

semimembranosus

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short head of biceps femoris

popliteal vessels in the

sartorius

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popliteal fossa

Origin - Common from Ischial tuberosity.

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Insertion - One of the leg bones.

Nerve supply-Tibial part of sciatic nerve.

Common action

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Extensors of hip joint.

Flexors of knee joint.

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True hamstrings-

? Semimembranosus

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? Semitendinosus

Modified hamstrings

?Long head of biceps femoris-

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?Sacrotuberous ligament morphologically
degenerated part.

?Ischial head of adductor magnus-

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Tibial collateral ligament represents the

morphological degenerated part of adductor magnus

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Biceps Femoris - most lateral muscled with

a "long head" from the ischial tuberosity,

and a "short head" from the middle of the

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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

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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

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in the lateral rotation of the leg.


Semitendinosus - usually fusiform tapering
distally into a long cylindrical tendon at the

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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

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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,

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which reinforces the posterior capsule of the
joint.

POPLITEAL FOSSA

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Boundaries of popliteal
fossa

MEDIAL

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LATERAL

Adductor magnus

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Gracilis

Semitendinosus

Biceps femoris

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Semimembranosus

Plantaris

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Sartorius

Lateral head of gastrocnemius

Medial head of

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gastrocnemius

CONTENTS OF POPLITEAL FOSSA

? POPLITEAL ARTERY AND ITS BRANCHES

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

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? POPLITEAL FAT