Lecture 3: Gluteal Region Flashcards

1
Q

What are the Superior and Inferior Boundaries of the Gluteal Region?

A

Superior: Iliac Crests

Inferior: Gluteal Sulcus (groove beneath gluteal fold)

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2
Q

What Nerve Roots supply the Superior Cluneal Nerve?

A

Dorsal Rami of L1-L3

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3
Q

What nerve roots supply the Middle Cluneal Nerve?

A

Dorsal Rami of S1-S3

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4
Q

What Nerve Roots supply the Inferior Cluneal Nerve?

A

Ventral Rami of S1-S3

Posterior Femoral Cutaneous Nerve

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5
Q

What would happen if the superior or medial cluneal nerves are impinged?

A

Nerve impingement in Lumbar Spine

-Can result in pain over distribution of cluneal nerves

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6
Q

In the gluteal region, when does the superficial gluteal structures drain into the deeper gluteal structures?

A

The external iliac nodes (superficial) drain into common iliac nodes (deep).

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7
Q

What ligament is on top of the greater sciatic foramen?

A

Sacrotuberous Ligament

Posterior Sacrum to Ischial Tuberosity

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8
Q

What structures exit the Greater Sciatic Foramen?

A

Nerves:

  • Sciatic Nerve
  • Superior Gluteal Nerve
  • Inferior Gluteal Nerve
  • Pudendal Nerve
  • Posterior Femoral Cutaneous N.
  • Nerve to Quadratus Femoris
  • Nerve to Obturator Internes

Vessels

  • Superior Gluteal Artery and Vein
  • Inferior Gluteal Artery and Vein
  • Internal Pudendal Artery and Vein

Piriformis Muscle

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9
Q
  1. Greater Sciatic Foramen is a gateway to the _____.
  2. Lesser Sciatic Foramen is a gateway to the _____.
  3. What divides the Greater Sciatic Notch from the Lesser Sciatic Notch?
A
  • Greater Sciatic Foramen is a gateway to the* pelvis.
  • Lesser Sciatic Foramen is a gateway to the* perineum.

The Sacrospinous Ligament

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10
Q

What structures enter the Lesser Sciatic Foramen?

A
  • Tendon of Obturator Internus Muscle
  • Pudendal Nerve
  • Internal Pudendal Artery and Vein
  • Nerve to Obturator Internus
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11
Q

What structures go through both Greater and Lesser Sciatic Foramen?

A
  • Pudendal Nerve
  • Internal Pudendal Artery and Vein
  • Nerve to Obturator Internus

Basically PIN Structures

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12
Q

Gluteus Maximus Muscle

What are its attachments?

A

Origin: Posterior gluteal line

Insertion: Lateral Condyle of Tibia via Iliotibial Tract; Gluteal Tuberosity

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13
Q

Gluteus Maximus Muscle

What is its action?

A
  1. Extension of Thigh
  2. Lateral Rotation of Hip
  3. Helps rise from seated position
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14
Q

Gluteus Maximus Muscle

What is its innervation and blood supply?

A

Innervation: Inferior Gluteal Nerve (L5-S2)

Blood Supply: Superficial Branch of Superior Gluteal Artery and Inferior Gluteal Artery

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15
Q

Gluteus Medius Muscle

What are its attachments?

A

Origin: External Surface of Ilium between Anterior and Posterior Gluteal Lines

Insertion: Lateral Surface of Greater Trochanter of Femur

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16
Q

Gluteus Medius Muscle

What is its action?

A
  1. Abducts thigh
  2. Medially rotate thigh
  3. Keeps hip level when ipsilateral limb is weight-bearing and advancing the opposite limb during the swing phase
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17
Q

Gluteus Medius Muscle

What is its innervation and blood supply?

A

Innervation: Superior Gluteal Nerve (L5, S1)

Blood Supply: Deep Branch of Superior Gluteal Artery

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18
Q

Gluteus Minimus Muscle

What are its attachments?

A

Origin: External Surface of Ilium between Anterior and Inferior Gluteal Lines

Insertion: Anterior Surface of Greater Trochanter of Femur

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19
Q

Gluteus Minimus Muscle

What is its action?

A
  1. Abduction of Hip
  2. Medial Rotation of Hip
  3. Keeps hip level when ipsilateral limb is weight-bearing and advancing the opposite limb during the swing phase
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20
Q

Gluteus Minimus Muscle

What is its innervation and blood supply?

A

Innervation: Superior Gluteal Nerve (L5, S1)

Blood Supply: Deep Branch of Superior Gluteal Artery

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21
Q

Tensor Fascia Lata​ Muscle

What are its attachments?

A

Origin: ASIS

Insertion: IT Tract and Lateral Condyle of Tibia

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22
Q

Tensor Fascia Lata Muscle

What is its action?

A
  1. Abducts Hip
  2. Medial Rotation of Hip
  3. Keeps hip level when ipsilateral limb is weight-bearing and advancing the opposite limb during the swing phase
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23
Q

Tensor Fascia Lata Muscle

What is its innervation and blood supply?

A

Innervation: Superior Gluteal Nerve (L5, S1)

Blood Supply: Lateral Circumflex Artery and Deep Branch of Superior Gluteal Artery

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24
Q

What muscles abduct and medially rotate thigh?

A
  1. Gluteus Medius Muscle
  2. Gluteus Minimus Muscle
  3. Tensor Fascia Lata Muscle
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25
Q

What nerve roots supply the Superior Gluteal Nerve?

A

L4-S1

26
Q

What nerve roots supply the Inferior Gluteal Nerve?

A

L5-S2

27
Q

What vessel gives rise to both the Superior and Inferior Gluteal Artery?

A

Internal Iliac Artery

28
Q

What muscles are supplied by the Superior Gluteal Artery, and by what branch for each?

A

Superficial Branch:

  • Gluteus Maximus

Deep Branch:

  • Gluteus Medius
  • Gluteus Minimus
  • Tensor Fascia Lata
29
Q

What muscles are supplied by the Inferior Gluteal Artery?

A

Gluteus Maximus

Small Lateral Rotators

Superior Hamstrings

30
Q

What muscles laterally rotate and extend the thigh?

A
  1. Piriformis Muscle
  2. Obturator Internus Muscle
  3. Superior Gemelli Muscle
  4. Inferior Gemelli Muscle
  5. Quadratus Femoris
31
Q

Piriformis Muscle

What is its attachments?

A

Origin: Anterior Surface of Sacrum and Sacrotuberous Ligament

Insertion: Superior Border of Greater Trochanter of Femur

Goes through Greater Sciatic Foramen

32
Q

Piriformis Muscle

What is its action?

A
  1. External Rotation of Thigh
  2. Abduction of Flexed thigh
  3. Stabilize Femoral Head in Acetabulum
33
Q

Piriformis Muscle

What is its innervation and blood supply?

A

Innervation: Nerve to Piriformis (Branches of anterior rami of S1, S2)

Blood Supply: Superior and Inferior Gluteal Arteries

34
Q

Obturator Internus Muscle

What is its attachments?

A

Origin: Pelvic Surface of Obturator Membrane

Insertion: Medial Surface of Greater Trochanter of Femur

35
Q

Obturator Internus Muscle

What is its action?

A
  1. Laterally Rotation of Extended Thigh
  2. Abducts flexed thigh
  3. Steady femoral head in acetabulum
36
Q

Obturator Internus Muscle

What is its innervation and blood supply?

A

Innervation: Nerve to Obturator Internus (L5,S1)

Blood Supply: Inferior Gluteal Artery

37
Q

Superior Gemelli Muscle

What is its attachments?

A

Origin: Ischial Spine

Insertion: Medial Surface of Greater Trochanter of Femur

38
Q

Superior Gemelli Muscle

What is its action?

A
  1. Lateral Rotation of Extended Thigh
  2. Abduct Flexed Thigh
39
Q

Superior Gemelli Muscle

What is its innervation and blood supply?

A

Innervation: Nerve to Obturator Internus

Blood Supply: Inferior Gluteal Artery

40
Q

Inferior Gemelli Muscle

What is its attachments?

A

Origin: Ischial Tuberosity

Insertion: Medial Surface of Greater Trochanter of Femur

41
Q

Inferior Gemelli Muscle

What is its action?

A
  1. Lateral Rotation of Extended Thigh
  2. Abduct Flexed Thigh
42
Q

Inferior Gemelli Muscle

What is its innervation and blood supply?

A

Innervation: Nerve to Quadratus Femoris (L5, S1)

Blood Supply: Inferior Gluteal Artery

43
Q

Quadratus Femoris Muscle

What is its attachments?

A

Origin: Lateral Border of Ischial Tuberosity

Insertion: Quadrate Tubercle on Femur

44
Q

Quadratus Femoris Muscle

What is its action?

A

Lateral Rotation of Thigh

45
Q

Quadratus Femoris Muscle

What is its innervation and blood supply?

A

Innervation: Nerve to Quadratus Femoris (L5,S1)

Blood Supply: Medial Circumflex Artery and Inferior Gluteal Artery

46
Q

What is piriformis syndrome?

A

Pathology of piriformis muscle can innervate sciatic nerve

47
Q

What ligament do the PIN structures run underneath?

A

Sacrotuberous Ligament

48
Q

What are the PIN structures?

A
  1. Pudendal Nerve
  2. Internal Pudendal Artery
  3. Nerve to Obturator Internus
49
Q

What arteries participate in the Cruciate Anastomosis?

A

Collateral Blood Supply to Femoral Head

  • Inferior Gluteal Artery
  • Transverse Branch of Medial Circumflex Femoral Artery
  • Terminal Part of the Transverse Branch of Lateral Circumflex Femoral Artery
  • First Perforating Brach of Deep Femoral Artery
50
Q

What structure can be damaged in some people when the Ligament of the Head of the Femur is damaged?

A

A Branch of the Obturator Nerve

51
Q

What is the most common direction for dislocation of the Femur?

A

Posterior Dislocations

52
Q

How does the lower extremity present when the femur (head or neck) is posteriorly dislocated?

A

Shortened and internally rotated

53
Q

What nerves are part of the lumbosacral plexus?

A
  • Cluneal Nerves
  • Superior and Inferior Gluteal Nerves
  • Sciatic Nerves
  • Nerve to Quadratus Femoris
  • Posterior Cutaneous Nerve of Thigh
  • Pudendal Nerve
  • Nerve to Obturator Internus
54
Q

What happens in a Gluteal Crush injury?

A

Arteries which supply the Sciatic Nerve become compressed, leading to Sciatic Nerve Damage

55
Q

The nerve that innervates the Obturator Internus also innervates what other muscle?

A

The Superior Gemellus

56
Q

The nerve that innervates the Quadratus Femoris also innervates what other muscle?

A

The Inferior Gemellus

57
Q

What three muscles are supplied by the Superior Gluteal Nerve?

A

Gluteus Medius

Gluteus Minimus

Tensor Fascia Lata

58
Q

What is the Trendelenburg Sign (Duchenne’s Limp)?

A

Lesion of Superior Gluteal Nerve that leads to weakness of Gluteus Medius and Minimus muscles

  • Pelvis drops on opposite side of injury
  • Foot cannot go into swing phase
59
Q

What nerve supplies the largest cutaneous segment in the body?

A

The Posterior Femoral Cutaneous Nerve

60
Q

What line in the gluteal region must you be sure to be superior to when performing a gluteal injection?

A

The line between the PSIS and the Superior Border of the Greater Trochanter of the Femur

61
Q

Which quadrant of the gluteal region should you perform injections?

A

Superolateral Quadrant