GLUTEAL REGION,POSTERIOR THIGH
Course Lecturer: OVIOSUN, AUGUSTINE
Department of Anatomy
Faculty of Basic Medical Science
Edo State University, Uzairue.
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OVIOSUN, AUGUSTINE
LEARNING OUTCOMES
• By the end of this class, students should be able to
• 1. Describe the anatomy of the gluteal region
• 2. List and explain the muscles of the gluteal region, posterior thigh
• 3. State their point of origin, insertion, innervation and action.
• 4. Describe the anatomy of popliteal fossa
GLUTEAL REGION/BUTTOCK
• Prominent area posterior to the pelvis
(the buttocks).
• Extends from the iliac crests down to the
gluteal fold.
• The intergluteal cleft separates the
buttocks from each other.
3
GLUTEAL MUSCLES
• Muscles in the gluteal region are
organized into two layers
• SUPERFICIAL LAYER – (abduct and
extend the hip)
Gluteus Maximus, Minimus and
Medius, tensor fasciae latae
• DEEP LAYER – (laterally rotates the
femur at the hip joint)
Piriformis, Obturator internus,
superior and inferior Gamelli,
Quadratus femoris.
4
GLUTEUS MAXIMUS
• It is quadrangular in shape
• It is the largest and most superficial
muscle in the gluteal region
• Overlies most of the other gluteal
muscles.
• Extends thigh (especially
from flexed position) and assists in its
lateral rotation;
5
GLUTEUS MAXIMUS CONTD…
ORIGIN
• Ilium posterior to posterior gluteal line;
dorsal surface of sacrum
INSERTION
• Most fibers end in iliotibial tract that inserts
into the lateral condyle of femur
• Innervation: Inferior gluteal nerve
• Action: Extends thigh and assists lateral
rotation
6
GLUTEUS MEDIUS AND MINIMUS
• The gluteus medius and gluteus
minimus, are fan shaped muscles
• The gluteus minimus and most
of the gluteus medius lie deep to the gluteus
maximus on the external surface of the ilium.
• They share the same actions, nerve supply
and are supplied by the same blood vessel
,the superior gluteal nerve and
superior gluteal artery . 7
GLUTEUS MEDIUS AND MINIMUS
• ORIGIN
• Gluteus medius and minimus:
Lateral surface of ilium, between the inferior
and anterior gluteal line.
• INSERTION
Gluteus Medius:
Lateral border of the greater
trochanter of femur
Gluteus Minimus:
Anterior border of the greater
trochanter of femur
8
TENSOR FASCIAE LATAE
• The tensor fasciae latae is a fusiform muscle
approximately 15 cm long that is enclosed
between two layers of fascia lata.
ORIGIN
The anterior superior iliac spine
Anterior part of external lip of the crest.
INSERTION
The tensor fasciae latae and the superficial
and anterior part of the gluteus Maximus
share a common distal attachment to the
anterolateral tubercle of the tibia
9
TENSOR FASCIAE LATAE CONTD….
• INNERVATION
Superior gluteal nerve.
• ACTION
Abduct, medially rotates and flexes the
thigh.
11
DEEP LAYER OF GLUTEAL MUSCLES
• The deep layer muscles consists of
smaller muscles like:
Piriformis,
Obturator internus,
Superior gemellus,
Inferior gemellus
Quadratus femoris) covered by the
inferior half of the gluteus maximus.
43
THE PIRIFORMIS
• The most superior of the deep group of
muscles.
• Pear shaped muscle
• Origin
Anterior surface of the sacrum
Sacrotuberous ligament
• Passes laterally and inferiorly through the
greater sciatic foramen.
13
THE PIRIFORMIS
• Inserts on the superior border of the greater
trochanter of the femur.
• Action: Laterally rotates thigh and abducts the femur
at the hip joint.
• Innervated by the nerve to piriformis from S1 and S2
of the sacral plexus
14
THE PIRIFORMIS
• Piriformis is an important landmark
• It divides the greater sciatic foramen
into two regions,
one above and
one below the piriformis.
• Neurovascular structures pass between
the pelvis and gluteal region by passing
through the greater sciatic foramen
either above or below the piriformis
15
PIRIFORMIS
• Superior gluteal nerves and vessels pass
through the greater sciatic foramen
above piriformis
• Other structures like
the inferior gluteal nerve and vessels,
pudendal nerve and vessels,
sciatic nerve,
nerve to obturator internus
Nerve to quadratus femoris,
pass below the piriformis
16
OBTURATOR INTERNUS
• It is a flat fan-shaped muscle
• Origin
the pelvic surface of the
Obturator membrane
margins of the Obturator
foramen.
• The muscle fibers converge
to form a tendon
• bends 90° around the
ischium between the ischial
spine and ischial tuberosity 18
OBTURATOR INTERNUS
• Passes through the lesser sciatic
foramen to enter the gluteal
region.
• Insertion: Medial surface of
greater trochanter of the femur.
• Action: Laterally rotates and
abducts the femur at the hip joint
• Innervation: nerve to the
obturator internus.
19
SUPERIOR AND INFERIOR GEMELLI
• Gemelli is Latin for twins
• Gemelli muscles are a pair of triangular
muscles
• associated with the upper and lower
margins of the obturator internus
tendon.
• Superior gemellus originates from the
ischial spine
• Inferior gemellus originates from the
ischial tuberosity. 20
SUPERIOR AND INFERIOR GEMELLI
• Fibers of the gemelli
muscles attach along the
length of the obturator
internus tendon
• Insertion:
Medial surface of greater
trochanter of the femur.
21
SUPERIOR AND INFERIOR GEMELLI
• Gemellus superior is innervated by the nerve to the obturator
internus
• Gemellus inferior is innervated by the nerve to the quadratus femoris.
• Action: act with the obturator internus muscle to laterally rotate and
abduct the femur at the hip joint.
22
THE QUADRATUS FEMORIS
• The most inferior of the deep group of
muscles in the gluteal region.
• It is a flat rectangular muscle below the
obturator internus muscle
• Origin: The ischial tuberosity
23
THE QUADRATUS FEMORIS
• Insertion: the quadrate tubercle on the intertrochanteric crest of the
proximal femur.
• Action: laterally rotates the femur at the hip joint
• Innervation: nerve to the quadratus femoris.
24
POSTERIOR COMPARTMENT OF THIGH
• Extends from the gluteal fold to the knee.
• It is separated from the anterior compartment by the
lateral intermuscular septum.
• While posterior intermuscular septum separates it from
the medial compartment.
27
MUSCLES OF THE POSTERIOR
COMPARTMENT OF THIGH
• There are three long muscles in this
compartment collectively called the
'hamstring muscles'.
• They include
• Biceps femoris,
• Semitendinosus, and
• Semimembranosus
28
MUSCLES OF THE POSTERIOR
COMPARTMENT OF THIGH
• All except the short head of biceps femoris
Originate from the ischial tuberosity
Cross both the hip and knee joints
Innervated by tibial division of the sciatic nerve
29
THE BICEPS FEMORIS MUSCLE
• Lateral in the posterior compartment of
the thigh and has two heads.
• LONG HEAD originates from the upper
and medial part of the ischial tuberosity;
• SHORT HEAD arises from
the lateral lip of the linea aspera on the
shaft
Upper part of lateral supracondylar line
of femur
30
THE BICEPS FEMORIS MUSCLE
• Insertion
Both long and short heads
insert on the lateral side of
head of fibula
• Innervation
• The long head: by the tibial
division of the sciatic nerve
• Short head: by the common
fibular division of the sciatic
nerve.
31
THE SEMITENDINOSUS MUSCLE
• Medial to the biceps femoris muscle.
• Origin:
the upper and medial area of the ischial
tuberosity.
Has a spindle-shaped belly that ends in
the lower half of the thigh
Insertion:
Medial surface of superior part of tibia
32
THE SEMI MEMBRANOSUS MUSCLE
• Lies deep to the semitendinosus muscle.
• Origin: the upper and lateral ischial
tuberosity
• Insertion: to the posterior surfaces of
the medial tibial condyle.
• Expansions from the tendon also insert
into, and contribute to the formation of
ligaments and fascia around the knee
joint.
33
THE SEMIMEMBRANOSUS MUSCLE
• Actions:
flexes the leg at the knee joint
extends the thigh at the hip joint
• Innervation: by the tibial division of the sciatic
nerve.
34
NERVES OF THE GLUTEAL AND POSTERIOR
THIGH REGION
• Sciatic Nerve
• Posterior cutaneous nerve of the thigh
• Superior gluteal nerve
• Inferior gluteal nerve
• Nerve to quadratus femoris
• Nerve to obtruator internus
ARTERIES OF THE POSTERIOR THIGH AND
GLUTEAL REGION
• Superior gluteal artery
• Inferior gluteal artery
• Internal pudendal artery
• Perforating artery
INJURY TO SUPERIOR GLUTEAL NERVE
• Injury to this nerve results in a characteristic motor loss, resulting in a
disabling gluteus medius limp, to compensate for weakened
abduction of the thigh
• Medial rotation of the thigh is also severely impaired.
• When a person who has suffered a lesion of the superior gluteal
nerve is asked to stand on one leg, the pelvis on the unsupported side
descends indicating that the gluteus medius and minimus on the
supported side are weak or non-functional.
Intragluteal Injections
• The gluteal region (buttocks) is a common site for intra muscular (IM)
injection of drugs.
• Gluteal IM injections penetrate the skin, fascia, and muscles. The gluteal
region is a common injection site because the muscles are thick and large;
• It is important to be aware of the extent of the gluteal region and the safe
region for giving injections. Some people restrict the area of the buttocks
to the most prominent part. This misunderstanding may be dangerous
because the sciatic nerve lies deep to this area.
• Injections into the buttocks are safe only in the superolateral quadrant of
the buttocks or superior to a line extending from the PSIS to the superior
border of the greater trochanter
PIRIFORMIS SYNDROME
• Compression of the sciatic nerve by the piriformis muscle.
• Piriformis syndrome causes pain that radiates down
the back of the leg along the sciatic nerve.
• Piriformis syndrome is an uncommon cause of pain
and other symptoms in the buttocks and/or lower back
that can radiate down the leg to the foot
• Symptoms may include pain and numbness
in the buttocks and down the leg. Often
symptoms are worsened with sitting or
running
