(11 M) The Gluteal Region: Landmarks, Vessels, and Nerves

Dr. LAYGO| MAR 25, 2015

ANATOMY

GLUTEAL REGION
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Quadrilateral in shape
Covers the:
o Iliac crest (at the level of L4): highest point
of the iliac bone
o Anterior Superior Iliac Spine (ASIS)
o Posterior Superior Iliac Spine (PSIS)
o Greater sciatic notch
o Lesser sciatic notch
o Ischial tuberosity

Buttocks/
Natis

Natal
cleft

Gluteal
fold
CUTANEOUS NERVES
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Derived from posterior primary rami and partly

from anterior primary rami of spinal nerves
Three twigs from first 3 lumber nerves and 3 from
first sacral nerves
***MEMORIZE!!!
Anterior primary rami of spinal nerve is derived
from:
Lateral cutaneous branch of iliohypogastric
nerve
Lateral cutaneous branch of lateral cutaneous
nerve of the thigh
Posterior branch of lateral cutaneous nerve of
thigh
Perforating cutaneous branch of S4
SUPERFICIAL LYMPH VESSELS

Usually goes in the lateral lymph glands of the

superficial inguinal group
FASCIA OF THE BUTTOCK

BOUNDARIES
Above: Iliac crest
Below: Gluteal maximus
Medial: Lateral margin of the sacrum and the coccyx
Lateral: *Tensor fascia latae muscle
SURFACE ANATOMY
Buttock (*Natis)
- Smooth rounded elevation
- More developed in females especially in pregnancy
stage. The more developed it is the sexier you are.
Natal cleft
- Deep fissure dividing the 2 buttocks
- Boundary between your 2 buttocks
Fold of the buttock
- Equivalent of *Inferior groove of gluteus maximus.
Due to bulging of the gluteus maximus and fatty
maximus

*Superficial fascia
- Thick, especially in women, and impregnated with
large quantities of fat
- Loaded with fat and numerous small cutaneous
nerves
- Thickens over lower and upper margins of gluteus
maximus. It actually covers gluteus maximus
- Rough and stingy over ischial tuberosity: cushion in
sitting position. The more developed it is the more
comfortable you are in sitting.
*Deep fascia
- Attached to the iliac crest
Gluteus Medius - dense, opaque, pearly
white deep fascia
Gluteus Maximus - thin, transparent
- More developed covering the gluteus medius
although it also goes upward and covers the gluteus
maximus

GLUTEAL MUSCLES: GLUTEUS MAXIMUS

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Rhoimboid; most massive structure in the human

body
Bulging of the buttock
ORIGINS:
Posterior gluteal surface of the ileum
Dorsal aspect of sacrum and coccyx
Posterior surface of sacrotuberous ligament
INSERTIONS:
Upper part of femoral shaft
Iliotibial tract (3/4: majority attachment)
Gluteal tuberosity
UPPER BORDER:
o Landmark: Line which runs parallel with
lower border; exits from PSIS to a point 2
inches above the greater trochanter
ACTION: *Great extensor of the thigh

Refer to the preceding image

THE GLUTEAL REGION, POSTERIOR ASPECT.
a. The deep relations of the Gluteus Maximus. The Sciatic
nerve usually emerges inferior to the piriformis and lies
on a succession of lateral rotators.
b. Intramuscular injection. An intragluteal injection may be
made safely in the area between the second and third
fingers.
PIRIFORMIS
-

One of the doors/gateways to the gluteal region.

The other door is the greater sciatic foramen.
Most obvious/unique muscle of the gluteal region
ORIGINS:
Anterior surface of S2, S3, and S4 vertebra
In between sacral foramena
Upper part of the greater sciatic notch and
sacrotuberous ligament
INSERTION:
Highest point of greater trochanter
ACTION: *Extensor and lateral rotator of the femur
INNERVATION: *S1

*Synovial bursae: underneath G.maximus

1. Located between muscle and ischial
tuberosity
2. Between muscle and greater trochanter
3. Between gluteus and upper vastus lateralis

2 SPACES:
Infrapiriformic space: structures that exits from
this space (lateral to medial)
Structures that pass through:
1. Sciatic nerve
2. *Inferior gluteal nerve
3. Posterior cutaneous nerve of thigh
4. Inferior gluteal artery
5. Nerve to obturator internus
6. Internal pudendal vessels
7. Internal pudendal nerve to the alcocks
canal
Suprapiriformic space: above the piriformis in the
greater sciatic foramen

 Structures that pass through:

1. Superior gluteal vessels
a. *Superior gluteal artery
- branches into superficial and deep
branches:
i. *Superficial branch - supplies gluteus
maximus

Other gluteal muscles (See table on the next page):

***READ!!!
Gluteus medius
Gluteus minimus
Gemelli muscles
Obturator internus
Quadratus femoris
Obturator externus

ii. *Deep branch - supplies gluteus medius

and gluteus minimus
b. *Superior gluteal vein
2.

Superior gluteal nerves

- innervates the 3 abductors and medial
rotators of the hip joint: gluteus
medius, gluteus minimus and tensor
fascia latae

The arrangement of the structures emerging from the

GREATER SCIATIC FORAMEN. The foramen gives exit to the
Piriformis, to SEVEN NERVES (sciatic, posterior femoral
cutaneous, superior gluteal, inferior gluteal, pudendal, nerve
to the obturator internus, and nerve to the quadratus
femoris), and to THREE GROUPS OF VESSELS (internal
pudendal, superior gluteal, and inferior gluteal)
***MINI QUIZ ON LAST PAGE

GOOD LUCK AND GOD BLESS

MINI QUIZ!

NOTE TAKERS:

1. This nerve innervates the gluteus maximus muscle.

2. The deep branch of the superior gluteal artery supplies
this 2 muscles: ___a___ and ___b___?
3. The fold of the buttock is equivalent to the
______________ internally.
4. It is the lateral boundary of the gluteal region.
5. Nerve supply of piriformis is derived from what vertebral
level?
6. SPECIFIC artery that supplies the gluteus maximus muscle.

BELINGON, SARAH KATE

CAPISTRANO, VON EAGAN

PROOF READER:
-

CRUZ, GINO MIGUEL F.

Theres no such thing as a painless lesson. They just dont

exist. Sacrifices are necessary. You cant gain anything
without losing something first although if you can endure that
pain and walk away from it, youll find that you now have a
heart strong enough to overcome any obstacle. Yeah, a heart
made fullmetal.

7. Origin of Quadratus Femoris muscle.

~Edward Elric, Full Metal Alchemist
8. Insertion of Tensor Fasciae Latae muscle.

10. Fill in the blanks: The following muscles ( ___a___,

Superior Gemellus, ___b__, Obturator Externus, __c__,
Obturator Internus) exert their action by? ___d____

ANSWER KEY: 1. INFERIORGLUTEALNERVE 2. GLUTEUSMAXIMUS&MINIMUS 3.

INFERIORGROOVEOFGLUTEUSMAXIMUS 4. TENSORFASCIAELATAEMUSCLE 5. S1 6.
SUPERFICIALBRANCHOFTHESUPERIORGLUTEALARTERY 7. ISCHIALTUBEROSITY 8.
ILIOTIBIALTRACT 9. EXTENSIONOFTHETHIGH 10. PIRIFORMIS, INFERIORGEMELLUS,
QUADRATUSFEMORIS. LATERALROTATIONOFTHETHIGH

9. Action of Gluteus Maximus muscle

//TEAMANATOMY
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