GLUTEAL REGION
It helps to maintain the erect the position of the body and sport the
trunk against gravity
SURFAC E LANDMARKS
1. ButtockIt is a rounded budge in the lower part and two
buttock are separated by natal cleft and gluteal fault is the
transverse skin Greece at this region
2. Ischial tubero It can be felt by placing the fingers in the
medial part of the gluteal failed and pressing them upward
3. Greater trochanter it is below the tubercle of iliac crest
4. Iliac crest It is a thick curved Bony ridge felt in a groove in the
lower margin of the waist. It has anterior superior illiac spine
and posterior superior Elliot spine
5. Sarum it presents posteriorly between two hip bones
6. Coc live behind just the anus
7. Sacrotuberous ligament lying deep to the lower border of
glucose Maximus can be felt by a firm pressure between the
lower part of sacrum and ischial tuberosity
SUPERF ICIAL AND DE EP FACIAL
Superficial fascia
• It is heavily laden with fat more in females and tough and stringy over
the ischial tuberosity
• Cutaneous nerves
1. Subcostal T12 and illiohypogastricL1 nerve supplied to upper anterior
2. L1 L2 L3 and S1 S2 S3 supply super posterior
3. Posterior division of lateral cutaneous nerve of thigh L2L3 supply
lower anterior part
4. Posteriors nerve of the thigh S1,2,3 and the perforating cutaneous
nerve S2,3 supply the lower posterior part
• Cutaneous vessels
• The blood supply of skin on sub continuous tissue is dry from the
branches of the superior and inferior gluteal arteries
• Lymphatics
• Drain into the superficial inguinal lymph nodes
DEEP FACIAL
The deep fascia above an in front of the gluteus Maximus that
is over medias is thick dense and opaque and pearly white.
Over the glutiest Maximus however it is thin and transparent
MUSCLES OF GLUTEAL REGION
• Gluteus Maximus:
• Origin: Posterior gluteal line of the ilium, sacrum, coccyx,
Sacrotuberous ligament
• Insertion: Gluteal tuberosity of the femur, iliotibial tract
• Function: Hip extension, external rotation, assists in abduction
(superior fibers)
• Innervation: Inferior gluteal nerve (L5, S1, S2)
• Gluteus medias:
• Origin: Gluteal surface of the ilium, between anterior and
posterior gluteal lines
• Insertion: Lateral surface of the greater trochanter
• Function: Hip abduction, medial rotation, pelvic stabilization
• Innervation: Superior gluteal nerve (L4, L5, S1)
•Tensor fasciae latae:
•Origin: Anterior superior iliac spine, anterior part of the iliac
crest
•Insertion: Iliotibial tract (lateral condyle of the tibia)
•Function: Hip flexion, knee extension, stabilization of the hip
•Innervation: Superior gluteal nerve
•Gluteus minimus:
•Origin: Gluteal surface of the ilium, between anterior and inferior
gluteal lines
•Insertion: Anterior surface of the greater trochanter
•Function: Hip abduction, medial rotation
•Innervation: Superior gluteal nerve (L4, L5, S1)
Quadratus Femoris
•Origin: Ischial tuberosity
•Insertion: Intertrochanteric crest
•Nerve Supply: Nerve to quadratus femoris (L5, S1)
•Action: Lateral rotation, hip stabilization
• Piriformis:
• Origin: Anterior surface of the sacrum, sacrotuberous
ligament
• Insertion: Superior border of the greater trochanter Obturator Externus
•Origin: Outer surface of obturator membrane
• Function: External rotation of the hip •Insertion: Trochanteric fossa of femur
• Innervation: Nerve to piriformis (from sacral plexus) •Nerve Supply: Obturator nerve (L3, L4)
Superior Gemellus •Action: Lateral rotation, hip stabilization
•Origin: Ischial spine Obturator Internus
•Insertion: Medial surface of the greater trochanter of the femur •Origin: Inner surface of obturator membrane
(via the tendon of the obturator internus) •Insertion: Medial greater trochanter
•Nerve Supply: Nerve to obturator internus (L5, S1) •Nerve Supply: Nerve to obturator internus (L5, S1)
•Action: •Action: Lateral rotation, abduction (flexed hip),
• Laterally rotates the thigh when the hip is extend stabilization
Inferior Gemellus
•Origin: Ischial tuberosity
•Insertion: Medial surface of the greater trochanter of the femur
(via the tendon of the obturator internus)
•Nerve Supply: Nerve to quadratus femoris (L5, S1)
•Action:
• Laterally rotates the thigh when the hip is extended
NERVE OF GLUTEAL REGION
Superior Gluteal Nerve (L4, L5, S1) Sciatic Nerve (L4, L5, S1, S2, S3)
Path: Passes below the piriformis, runs down the
Path: Passes through the greater sciatic foramen above the posterior thigh
piriformis
Supplies: Posterior thigh muscles (hamstrings) and all
Supplies: leg & foot muscles
Gluteus medius Function: Hip extension, knee flexion, leg & foot
movements
Gluteus minimus
Nerve to Obturator Internus (L5, S1)
Tensor fasciae latae
Function: Hip abduction & medial rotation Path: Passes through the greater sciatic foramen
Supplies:
Inferior Gluteal Nerve (L5, S1, S2) Obturator internus
Superior gemellus
Path: Passes through the greater sciatic foramen below the Function: Lateral rotation of the hip
piriformis
Supplies: Gluteus maximus
Function: Hip extension & lateral rotation
NERVES OF GLUTEAL REGION
• Nerve to Quadratus Femoris (L4, L5, S1)
• Pudendal Nerve (S2, S3, S4)
• Path: Passes through the greater sciatic foramen
Path: Passes through the greater sciatic foramen, re-enters via
• Supplies: the lesser sciatic foramen
Supplies: Perineum muscles & skin
• Quadratus femoris
Function: External anal & urethral sphincter control
• Inferior gemellus
• Function: Lateral rotation & hip stabilization Perforating Cutaneous Nerve (S2, S3)
•Path: Emerges from the sacral plexus and passes through the
sacrotuberous ligament
Posterior Cutaneous Nerve of Thigh (S1, S2, S3) •Supplies: Skin over the inferior part of the gluteal region
•Function: Sensation to the gluteal skin
Path: Runs beneath gluteus maximus
Supplies: Skin of posterior thigh & gluteal region
Function: Sensation
ARTERIES OF GLUTEAL REGION
• Superior Gluteal Artery: Inferior Gluteal Artery:
•
Course: Arises from the anterior division of the internal iliac artery,
• Course: Originates from the posterior division passes through the greater sciatic foramen below the piriformis muscle.
of the internal iliac artery. It exits the pelvis Distribution:
through the greater sciatic foramen, usually Gluteus maximus.
above the piriformis muscle. Posterior thigh muscles (e.g., hamstrings).
• Distribution: Hip joint.
Internal Pudendal Artery:
• Gluteus maximus, gluteus medius, gluteus
•Course: Also arises from the anterior division of the internal iliac
minimus.
artery. It passes through the greater sciatic foramen, then re-enters the
• Tensor fasciae latae. pelvis through the lesser sciatic foramen.
• Hip joint. •Distribution:
• Perineum.
• Some portions of the deep gluteal muscles • External genitalia.
• Anal canal.
• Part of the gluteal region (especially around the inferior part of
the gluteus maximus).
CLINIC AL ANATOMY
Clinical Anatomy
• Sciatic nerve block is performed by injecting an
The Trendelenburg sign is used to assess the strength of the hip
anesthetic 1.5 cm below the midpoint of a line
abductors, primarily the gluteus medius and minimus muscles. It
connecting the posterior superior iliac spine
is tested by asking the patient to stand on one leg. A negative
and the upper border of the greater
Trendelenburg sign means the pelvis remains level, indicating
trochanter
normal hip abductor strength. A positive Trendelenburg sign
• Piriformis syndrome occurs when the sciatic
occurs when the pelvis drops on the unsupported side,
nerve is compressed by the piriformis muscle,
suggesting weakness or dysfunction of the hip abductors on the
causing pain in the buttock region.
weight-bearing side.
•Intramuscular Injections:
Given in the upper outer quadrant of the gluteal region (gluteus
medius and minimus) to avoid large nerves and vessels. The
gluteal region extends over the iliac bone, not just the buttock.
•Gluteus Medius and Minimus Paralysis:
When paralyzed on one side, the patient develops a lurching
gait, bending to the affected side to lift the opposite foot. If both
sides are paralyzed, it causes a waddling gait.
