Transcript 19-Gluteal region.ppt

Prof. Saeed Abuel Makarem
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UPPER MEDIAL QUADRANT:
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UPPER LATERAL QUADRANT:
posterior rami of
 L1,2,3 and S1,2,3
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lateral branches of
Subcostal & Iliohypogastric
nerves
LOWER MEDIAL QUADRANT:
Gluteal branches of
posterior cutaneous nerve of
the thigh
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LOWER LATERAL QUADRANT:
posterior branch of lateral
cutaneous nerve of the thigh
Prof. Saeed Abuel Makarem
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MUSCLES:
GLUTEI
Gluteus maximus
Gluteus medius
Gluteus minimus
GROUP OF SMALL
MUSCLES (Lateral rotators
of thigh)
Piriformis
Obturator internus
Gemilli (superior &
inferior)
Quadratus femoris
Prof. Saeed Abuel Makarem
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NERVES :
(FROM SACRAL PLEXUS):
Superior & inferior gluteal,
Posterior cutaneous nerve
of thigh,
Nerve to obturator internus,
Nerve to quadratus femoris,
Pudendal nerve,
Sciatic nerve.
VESSELS :
(INTERNAL ILIAC ARTERY):
Superior & inferior gluteal,
Internal pudendal vessels.
Prof. Saeed Abuel Makarem
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Gluteus maximus:
5.
Main origin:
back of sacrum & coccyx
back of sacrotuberous
ligament
Other origin:
gluteal surface of ilium,
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Gluteus minimus:
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behind posterior gluteal line
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gluteal surface of ilium,
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Gluteus medius:
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between inferior & middle
gluteal lines
gluteal surface of ilium,
between middle & posterior
gluteal lines
Prof. Saeed Abuel Makarem
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Gluteus minimus:
anterior surface of
greater trochanter
Gluteus medius:
lateral surface of greater
trochanter
Gluteus maximus:
Main insertion:
iliotibial tract
Other insertion:
gluteal tuberosity of
femur
Prof. Saeed Abuel Makarem
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Gluteus medius & minimus:
Nerve supply:
Superior gluteal nerve
Action:
Abduction & medial
rotation of hip joint
Gluteus maximus:
Nerve supply:
Inferior gluteal nerve
Main action:
Extension & lateral rotation
of hip joint
Other action:
Through its attachment to
iliotibial tract, it stabilizes
the femur on tibia during
standing
Prof. Saeed Abuel Makarem
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ALL MUSCLES
HAVE SIMILAR
ACTION:
Control
movements of the
hip join
Help in lateral
rotation of the hip
Prof. Saeed Abuel Makarem
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QUADRATUS FEMORIS
Origin:
lateral border of ischial
tuberosity
Insertion:
quadrate tubercle &
intertrochanteric crest
Nerve supply:
nerve to quadratus
femoris
Prof. Saeed Abuel Makarem
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OBTURATOR INTERNUS
Origin: inner surface of obturator
membrane, inner margin of
obturator foramen & wide area above
& behind it
Insertion: the tendon passes through
LSF to be inserted into the inner
surface of greater trochanter.
Nerve supply:
nerve to obturator internus
SUPERIOR & INFERIOR GEMILLUS
Origin: upper part & lower part of
lesser sciatic notch respectively
Insertion: upper part & lower part of
tendon of obturator internus
Nerve supply:
nerve to obturator internus supply
superior gemellus
nerve to quadratus femoris supply
inferior gemellus
Prof. Saeed Abuel Makarem
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PIRIFORMIS
Origin:
pelvic surface of
middle 3 sacral
vertebrae.
Insertion:
the msucle passes
through GSF to be
inserted into the upper
border of greater
trochanter
Nerve supply:
anterior rami of S1,2
Prof. Saeed Abuel Makarem
SUPERIOR GLUTEAL
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Course:
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passes through GSF, above
piriformis, then between
gluteus medius & minimus
Branches:
1.
Muscular to gluteus medius,
minimus & tensor fasciae latae
2.
Articular to hip joint
INFERIOR GLUTERAL
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Course:
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passes through GSF, below
piriformis, then deep to
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gluteus maximus
Branches:
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muscular to gluteus maximus
NERVE TO QUADRATUS FEMORIS
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Course:
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passes through GSF, below
piriformis
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Branches:
1.
Muscular to quadratus femoris
& inferior gemillus
2.
Articular to hip joint
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Prof. Saeed Abuel Makarem
Posterior cutaneous
nerve of the thigh
 Course:
 passes through GSF,
below piriformis,
then descends deep
to deep fascia
 Branches:
 cutaneous branches
to: gluteal region,
back of scrotum
(labium majus) back
of thigh & upper part
of back of leg.
Prof. Saeed Abuel Makarem
SCIATIC
 Course:
 passes through GSF,
below piriformis,
 then superficial to: ischial
spine,
 superior gemillus, tendon
of obturator internus,
 inferior gemillus,
quadratus femoris &
 adductor magnus
 Branches:
 no branches in gluteal
region,
 It divides into tibial &
common peroneal nerves,
in the middle of back of
thigh
Prof. Saeed Abuel Makarem
NERVE TO OBTURATOR
INTERNUS
 Course:
 passes through GSF, below
piriformis, then crosses the
base of ischial spine &
passes through LSF
 Branches:
 muscular to obturator
internus & superior
gemillus
PUDENDAL
 Course:
 passes through GSF, below
piriformis, then crosses the
sacrospinous ligament &
passes through LSF
 Branches:
 no branches in gluteal
region
Prof. Saeed Abuel Makarem
SUPERIOR GLUTEAL
 Course:
 passes through GSF, above piriformis,
 then divides into superficial branch
between gluteus maximus & medius and
deep branch between gluteus medius &
minimus
INFERIOR GLUTEAL
 Course:
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passes through GSF, below piriformis,
then deep to gluteus maximus with the
inferior gluteal nerve
 Branches of superior & inferior gluteal:
muscular branches & articular branches to
hip hoint
INTERNAL PUDENDAL
 Course:
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passes through GSF, below piriformis,
then crosses the tip of ischial spine &
passes through LSF
 Branches: no branches in gluteal region
Prof. Saeed Abuel Makarem
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These are collateral anastomosis between the
internal & external iliac arteries.
They are of great importance, when the
femoral artery is obstructed above the origin
of the profunda femoris artery.
Prof. Saeed Abuel Makarem
TROCHANTERIC
ANASTOMOSIS
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Site:
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in the region of
trochanteric fossa
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Importance:
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main supply for neck
& head of femur
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Constituents:
1.
Superior gluteal
2.
Inferior gluteal
3.
Medial circumflex
femoral
Prof. Saeed Abuel Makarem
CRUCIATE
ANASTOMOSIS
Site:
at the upper border of
adductor magnus
(at level of lesser
trochanter, UPPER
ART OF THE BACK
OF THE THIGH)
Constituents:
Inferior gluteal
MCF
LCF
1st perforating
Prof. Saeed Abuel Makarem
BOUNDARIES
 Greater sciatic notch,
 sacrotuberous &
 sacrospinous ligament & ischial
spine
STRUCTURES PASSING THROUGH IT
 Piriformis
 2 structures above piriformis:
superior gluteal nerve & vessels
 8 structures below piriformis:
inferior gluteal nerve & vessels,
sciatic nerve,
posterior cutaneous nerve of
thigh,
nerve to quadratus femoris,
nerve to obturator internus,
internal pudendal vessels,
pudendal nerve
Prof. Saeed Abuel Makarem
BOUNDARIES
 Body of ischium,
sacrotuberous ligament
&
 sacrospinous ligament
& ischial spine
STRUCTURES PASSING
THROUGH IT:
Tendon of obturator
internus, nerve to
obturator internus,
internal pudendal
vessels, pudendal nerve
Prof. Saeed Abuel Makarem
Prof. Saeed Abuel Makarem