OBJECTIVES
1. Extent of gluteal region
2. Muscles of gluteal region
3. Origin, insertion, nerve supply & actions of gluteal muscles
4. Safe site for giving IM injection
GLUTEAL REGION
Extends from
• Iliac crest superiorly
• gluteal fold inferiorly
• Natal cleft medially
• line joining ASIS to the ant edge
of greater trochanter laterally
GLUTEAL REGION
Layers :-
1. Skin
2. Superficial fascia (cutaneous
nerves & vessels)
3. Deep fascia
4. Muscles
5. Bones
6. Gluteal ligaments
Deep fascia
SKELETAL FRAMEWORK OF GLUTEAL REGION
1. Gluteal surface of ilium
2. Dorsal surface of ischium, ischial spine, ischial tuberosity
3. Dorsal surface of sacrum & coccyx
4. Upper part of the femur including the head, neck, greater trochanter & lesser
trochanter
Gluteal ligaments
1. Sacrotuberous ligament
2. Sacrospinous ligament
3. Dorsal sacro-iliac ligament
Muscle of gluteal region
1st layer
1. Gluteus maximus 3rd layer
2. Tensor fascia lata 1. Gluteus minimus
2. Reflected head of rectus femoris
2nd layer
3. Gluteus medius
4. Pyriformis
5. 3 conjoint tendons of obturator internus & 2 gamelli
6. Quadratus femoris
7. Upper most fibers of adductor magnus
MUSCLES OF GLUTEAL
REGION
GLUTEUS MAXIMUS
MUSCLE
• Largest muscle, superficial
• Coarsely fibered
• Shape : Quadrilateral
ORIGIN OF GLUTEUS MAXIMUS
1. Gluteal surface of the ilium behind PGL
2. Outer sloping surface of the dorsal
segment of iliac crest
3. Dorsal surface of sacrum & coccyx
4. Fascia covering the muscle ( gluteal
aponeurosis which covers gluteus medius)
5. Sacrotuberous ligament
6. From posterior layer of thoracolumbar
fascia ( covering erector spinae)
INSERTION OF GLUTEUS MAXIMUS
• Lower ½ of deep fibers gluteal tuberosity (1/4th
of muscle)
• Rest of muscle aponeurotic Iliotibial tract
(3/4th of muscle)
NERVE SUPPLY :- Inferior gluteal nerve (dorsal br of
ventral rami L5,S1,S2)
BLOOD SUPPLY :- superior & inferior gluteal arteries
ACTION OF GLUTEUS MAXIMUS
• Chief extensor of the hip joint
• Rising from a sitting position (Anti-gravity muscle)
• Powerful lateral rotators of the hip joint
• Abduction of hip joint only upper fibers
• Stabilizes the knee joint through iliotibilal tract
STRUCTURES UNDER COVER OF GLUTEUS MAXIMUS
STRUCTURES UNDER COVER OF GLUTEUS MAXIMUS
MUSCLES :
1. Gluteus medius
2. Gluteus minimus
3. Reflected head of rectus femoris
4. Pyriformis
5. Tendon of obturator internus
6. Superior & inferior gamelli
7. Quadratus femoris
8. Upper most fibers of adductor
magnus
STRUCTURES UNDER COVER OF GLUTEUS MAXIMUS
VESSELS & NERVE :
• Superior gluteal nv & vs Above pyriformis
• Inferior gluteal nv & vs
• Post cut nv of thigh
Below pyriformis
• Sciatic nv
• Thin nerve to quadratus femoris
• Pudendal nv
• internal pudendal vs, 3 structures passes from lesser sciatic foramen
• nv to obturator internus
STRUCTURES UNDER COVER OF GLUTEUS MAXIMUS
• BONES :- Ilium , Ischium , Coccyx , Sacrum , Upper end of femur
• LIGAMENTS :- Sacrotuberous , Sacrospinous , Iliofemoral , Dorsal
sacroiliac
• BURSAE :- trochanteric, gluteofemoral, ischial
• JOINT :- Hip joint , Sacroiliac joint
• ANASTOMOSIS :- Cruciate & Trochanteric anastomosis
STRUCTURES UNDER GLUTEUS MAXIMUS
SCIATIC NERVE
GLUTEUS MEDIUS
• Fan shaped muscle
• Post 1/3rd covered bu Glu max
• Ant 2/3rd superficial ( IM injection)
• Origin :- gluteal surface of ilium between ant & post
gluteal aponeurosis
• Insertion :- oblique ridge on the lateral surface of the
greater trochanter
• NS :- Superior gluteal nerve ( dorsal br of ventral rami of
L4,L5,S1)
• Action:- main abductor of the hip joint
GLUTEUS MINIMUS
• Fan shaped muscle
• Beneath gluteus medius
• Origin :- gluteal surface of ilium between ant &
inferior gluteal lines
• Insertion :- ridge in the lateral part of anterior
surface of the greater trochanter
• Nerve supply :- Superior gluteal nerve
• Action :- abductor of the hip joint
MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTIONS
TENSOR FASCIA Ant 5cm of Outer Iliotibial tract Superior gluteal Supports femur
LATA lip of iliac crest nerve (L4,L5,S1) on tibia during
standing position
PIRIFORMIS Pelvic surface of Tip of greater Ventral rami of S1, • In extended
middle 3 pieces of trochanter S2 thighLateral
sacrum rotator the
thigh at hip
joint
• In flexed thigh
acts as an
abductor
Tensor
fascia lata
MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTIONS
GAMELLUS SUPERIOR Upper margin of Trochanteric fossa Nerve to obturator Lateral rotator of the
greater sciatic notch internus (L5, S1,S2) thigh at hip joint
(GSN)
GAMELLUS INFERIOR Lower margin of GSN Trochanteric fossa Nerve to quadratus Lateral rotator of the
femoris ( L5,S1, S2) thigh at hip joint
OBTURATOR Pelvis surface of Medial surface of the Nerve to obturator Lateral rotator of the
INTERNUS obturator membrane greater trochanter internus (L5, S1,S2) thigh at hip joint
& surrounding bones (trochanteric
fossa)
QUADRATUS Lateral border of Quadrate tubercle of Nerve to quadratus Lateral rotator of the
FEMORIS ischial tuberosity femur femoris ( L5,S1,S2) thigh at hip joint
Find out
• Paralysis of gluteus medius & minimus
• Trendelenberg’s test
STRUCTURES UNDER COVER OF GLUTEUS MAXIMUS
THANK YOU
