GLUTEAL REGION
BY
F.O. OPOOLA
INTRODUCTION
It lies posterior to the pelvis between the level of the
iliac crest and inferior border of gluteus maximus
muscle.
This region is made up of the gluteal muscles,
ligaments, vessels (arteries & veins) and gluteal nerves.
The two buttocks formed mostly by the three most
prominent gluteal muscles are separated from each
other by the intergluteal cleft.
The inferior border is demarcated from the superior
border of the thigh by the gluteal sulcus
THE BUTTOCK
GLUTEAL LIGAMENTS
• Two main ligaments make up the ligament
components of the gluteal region and they include;
• Sacrotuberous and sacrospinous ligaments.
• These two ligaments converts the sciatic notch of
the hip bone into a greater and lesser sciatic
foramina.
• The greater sciatic foramen forms a passageway
through which structures entering and leaving the
pelvis passes e.g. sciatic nerve.
GLUTEAL LIGAMENTS
• The lesser foramen serves as a passageway for
structures entering and leaving the perineum.
E.g. pudendal nerve.
• It is therefore worthy of note that the
greater sciatic foramen can be likened to a
‘door’ through which all arteries and nerves
leave the pelvis to enter the gluteal region,
including the piriformis muscle which
almost fill the foramen.
GLUTEAL LIG…
GLUTEAL LIG…
GLUTEAL MUSCLES
• Muscles of the gluteal region are mainly in
two groups:
• a deep group of small muscles, which are
mainly lateral rotators of the femur at the hip
joint and include;
• piriformis, obturator internus, gemellus
superior, gemellus inferior, and quadratus
femoris.
GLUTEAL MUSCLES
• A more superficial group of larger muscles, which
mainly abduct and extend the hip and include;
• The gluteus minimus, gluteus medius, and gluteus
maximus-an additional muscle in this group, the
tensor fasciae latae.
• The tensor fasciae latae stabilizes the knee in
extension by acting on a specialized longitudinal
band of deep fascia (the iliotibial tract) that passes
down the lateral side of the thigh to attach to the
proximal end of the tibia in the leg.
Superficial group
• Gluteus maximus;
• Is the largest muscle in the gluteal region and
overlies most of the other gluteal muscles
except for the posterior 3rd of the gluteus medius
and also forms a pad over the ischial tuberosity.
• origin/proximal attachment-
ilium,posterior to the posterior gluteal line,
posterior surface of the sacrum, coccyx and
sacrotuberous ligament.
Superficial group
• Insertion/distal attachment- iliotibial tract
and gluteal tuberosity.
• Innervation- innervation is by the inferior
gluteal nerve with root values L5, S1-2.
• Action- main action is extension and lateral
rotation of the thigh.
Superficial group
Superficial group
• Gluteus medius and minimus ;
• These are fan-shaped small gluteal muscles
and their fibres passes the same direction.
• Origin- medius originates from the external
surface of the ilium between the anterior and
posterior gluteal line, while the minimus
originates from the external surface of the
ilium between the anterior and inferior
gluteal line.
Gluteus medius and minimus
• Insertion- medius inserts on the lateral surface
of greater trochanter while minimus inserts on
anterior surface of greater trochanter of femur.
• innervation- both by the superior gluteal nerve
with root values L5 & S1.
• Action- both medially rotates and abducts the
lower limb at the hip joint.
• Also keeps the pelvis at level when opposite leg
is raised.
Actions of the G. medius & minimus
Tensor fasciae latae
Tensor fasciae latae;
• The tensor fasciae latae muscle is the most
anterior of the superficial group of muscles in the
gluteal region and overlies the gluteus minimus
and the anterior part of the gluteus medius.
• Origin- Tensor fasciae latae originates from the
outer margin of the iliac crest from the anterior
superior iliac spine to approximately the tubercle
of the crest.
Tensor fasciae latae
• Insertion- anterior aspect of the iliotibial tract of
deep fascia, which runs down the lateral side of the
thigh.
• Action- Stabilizes the knee in extension.
• Working with the gluteus maximus muscle on the
iliotibial tract lateral to the greater trochanter,
Stabilizes the hip joint by holding the head of the
femur in the acetabulum.
• Innervation- superior gluteal nerve with root value
L5 & S1.
Deep group of gluteal muscles
Piriformis;
• A narrow pear-shaped muscle is the most
superior of the deep group of gluteal muscles.
• It is a muscle of the pelvic wall and of the
gluteal region.
• Origin- from the superior surface of the
sacrum and the sacrotuberous ligaments
Deep group of gluteal muscles
• Insertion- superior surface of the greater
trochanter of femur.
• Innervation- innervation is by the nerve to
piriformis which are branches from ventra
rami of S1 & S2.
• Action- acts as a stabilizer of the head of
the femur in the acetabulum and also extends
rotated thigh laterally and abducts flexed
thigh.
Piriformis (A)
Obturator internus, gamelli superior &
inferior
These three fan-shaped muscles form a tricipital
(3 heads).
• Often called triceps coxae.
• They occupy the space between the piriformis
and the quadratus femoris muscle.
Obturator internus
• Origin- pelvic surface of obturator membrane
and surrounding bone.
• Insertion- medial border of greater trochanter
of femur.
• Innervation- nerve to obturator internus with
root value L5-S2.
• Action- same as piriformis muscle.
Obturator internus (B)
Gemellus superior and inferior
• (gemelli is Latin for twins) are a pair of
triangular muscles associated with the upper
and lower margins of the obturator internus
tendon.
• Origin- superior is from ischial spine, Inferior
is from ischial tuberosity.
Gemellus superior and inferior
• Insertion- its tendons blends with that of the
obturator internus and inserts on the medial
side of the greater trochanter of femur.
• Innervation- superior gamelli is by nerve to
obturator while inferior gamelliis by nerve to
quadratus femoris.
• Action- same as obturator internus and
piriformis
Superior & inferior Gamelli (C)
Superior & inferior Gamelli (C)
• Insertion- its tendons blends with that of the
obturator internus and inserts on the medial
side of the greater trochanter of femur.
• Innervation- superior gamelli is by nerve to
obturator while inferior gamelliis by nerve to
quadratus femoris.
• Action- same as obturator internus and
piriformis
Nerves of gluteal region
Sciatic nerve
Sciatic n. • L 4, 5; S 1, 2, 3
• Curves downward midway between
Post. cut. n. of the thigh
the tuber ischii and the greater
Sup. glut. n. trochanter.
Inf. glut. n. • Has a side of danger and a side of
Nerve to Quadratus safety. Is the largest branch of the
sacral plexus and the largest nerve in
femoris body
Pudendal n. • Consists of two separate nerves, the
Nerve to obturator common peroneal nerve and the tibial
internus nerve • Leaves the pelvis through the
greater sciatic foramen below the
Intramuscular injections
• From time to time it is necessary to administer drugs
intramuscularly: that is, by direct injection into muscles.
• This procedure must be carried out without injuring
neurovascular structures.
• A typical site for an intramuscular injection is the
gluteal region.
• The sciatic nerve passes through this region and needs
to be avoided.
• The safest place to inject is the upper outer quadrant of
either gluteal region
Intramuscular injections
• It is important to remember that the gluteal region
extends as far forward as the anterior superior iliac
spine.
• The sciatic nerve curves through the upper lateral
corner of the lower medial quadrant and descends
along the medial margin of the lower lateral quadrant.
• Occasionally, the sciatic nerve bifurcates into its tibial
and common fibular branches in the pelvis, in which
case the common fibular nerve passes into the gluteal
region through, or even above, the piriformis muscle.
QUADRANT FOR INTERMUSCULAR INJECTION
GLUTEAL ARTERIES
• Two arteries enter the gluteal region from the
pelvic cavity through the greater sciatic
foramen, the inferior gluteal artery and the
superior gluteal artery.
• They supply structures in the gluteal region
and posterior thigh and have important
collateral anastomoses with branches of the
femoral artery.
GLUTEAL ARTERIES