gluteal region extends from the iliac crest above to the gluteal fold below. the superficial fascia...
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Gluteal region Extends from the iliac crest above to the
gluteal fold below.
The superficial fascia is thick dense and
fatty, the deep fascia is thick over the
anterior border of gluteus maximus while
elsewhere is thin. It continuous below with
the fascia lata and attached to the iliac
crest above.
Gluteal region
Cutaneous nerves of the gluteal region
• 1- lateral cutaneous branches from subcostal (T12) and
iliohypogastric nerve(L1) supply the upper lateral
quadrant of the buttock.
• 2-The lower lateral quadrant is supplied by the lateral
cutaneous nerve of the thigh(L2,L3).
• 3- The lower medial quadrant supplied by the posterior
cutaneous nerve of the thigh which curve over the lower
border of gluteus maximus (inferior cluneal nerve).
• 4- The upper medial quadrant supplied by the lateral
cutaneous branches from dorsal rami L1-L3 (superior
cluneal nerves) and the lateral cutaneous branches of
the dorsal rami of S1-S3 (middle cluneal nerves)
• The perforating cutaneous nerve (S2,3) of the sacral
plexus, pierces the sacrotuberous ligament and gluteus
maximus mid way between coccyx and ischial tuberosity.
Cutaneous nerves of the gluteal region
• Sacrotuberous ligament:
• It is a strong band passes upwards from the
medial side of the ischial tuberosity to the margins
of the sacrum and coccyx and to both posterior
iliac spines. The lateral edge of the ligament forms
the posteromedial border of the greater and lesser
sciatic notches.
Sacrotuberous ligament
• Sacrospinous ligament:
• This is a thick triangular band it passes
from the the ischial spine to the margin of
coccyx and last piece of the sacrum deep
to the sacrotuberous ligament.
Sacrospinous ligament
• Sciatic foramina
• The greater sciatic foramen: bounded by the
greater sciatic notch of the hip bone the
sacrotuberous ligament and the sacrospinous
ligament, it transmit structures from the pelvis to
the gluteal region.
• The lesser sciatic foramen: bounded by
the lesser sciatic notch and the
sacrospinous and sacrotuberous
ligaments, it transmits structures between
the gluteal region and the perineum.
Structures which enter the gluteal region from the pelvis
• 1- Remain in the gluteal region these include;
the gluteal vessels and nerves and the piriformis
muscle.
• 2- Descend from the gluteal region into the back
of the thigh include; the sciatic nerve, the
posterior cutanous of the thigh and branches of
the inferior gluteal vessels.
• 3- Turn forwards through the lesser sciatic
foramen into the perineum include; the
internal pudendal vessels, pudendal nerve
and nerve to obturator internus muscle.
Muscles of the gluteal region
• The large muscles include: Gluteus maximus, medius and minimus.
• The small muscles include: piriformis, obturator internus, superior and inferior gemelli and quadratus femoris.
Large muscles of the gluteal region
Small muscles of gluteal region
Piriformis muscle• it is a land mark muscle in the gluteal region. It is
conical muscle arise in the pelvis from the pelvic
surface of the middle three pieces of the sacrum, It
passes through the greater sciatic foramen to be
inserted in the upper border of the greater trochanter
of the femur.
• Nerve supply from the first and second sacral
nerves.
Gluteal vessels
• Include • Inferior gluteal artery • Superior gluteal artery
Inferior gluteal artery:
it is a branch of the internal iliac artery emerges
from the pelvis below piriformis muscle
accompany the inferior gluteal nerve supply the
gluteus maximus and gives cutaneous branches
to the buttock and the back of the thigh, it also
give a slender companion artery to the sciatic
nerve.
Superior gluteal artery arise from the internal iliac artery accompany the
superior gluteal nerve, it enters the gluteal region
above the piriformis muscle. It divided into
• Superficial branch passes between the gluteus
medius and piriformis.
• Deep branch follow the superior gluteal nerve
supply the gluteus medius, minimus and the hip
joint.
Inferior and superior gluteal artery
Nerves of the gluteal region
• Inferior gluteal nerve (L5 S1 S2): it is a branch
from the sacral plexus enter the gluteal region
with the posterior cutanous nerve of the thigh
inferior to the piriformis m. supply gluteus
maximus m.
• Superior gluteal nerve (L4 L5 S1): it is a
branch from the sacral plexus enters the
gluteal region above the piriformis m.
divided into numbers of branches supply
the glueus medius , minimus and tensor
fasciae lata m.
Sciatic nerve (L4 L5 S1 S2 S3)• it is the thickest nerve in the body arise from the sacral
plexus, pass inferior to the piriformis m through the
greater sciatic foramen, deep to the gluteus maximus m.
in the upper part of its course it descends over:
• 1- ischial wall of the acetabulum.
• 2- Obturator internus m. and the 2 gemelli ms.
• 3- Quadratus femoris m.
• It leaves the buttock by passing deep to the long
head of the biceps femoris, it supply the
hamstring ms and gives articular branch to the
hip joint. the sciatic nerve then descends on the
posterior surface of the adductor magnus m. at
the lower third of the thigh it divided into medial
branch (tibial nerve) and lateral branch (common
peroneal nerve).
Sciatic nerve
Anastomosis between branches from the internal and external iliac arteries
• 1- between medial circumflex femoral artery
and:
• a- obturator artery.
• b- Both gluteal arteries.
• c- Lateral circumflex artery.
• d- perforating branches of the profunda artery.
• 2- Between The superior gluteal artery and
• a- lateral circumflex artery.
• b- Superficial circumflex iliac artery.
• 3- between internal pudendal artery, deep
and superficial external pudendal arteries of
the femoral artery.
The back of the thigh(the posterior compartment)
• The muscles of the back of the thigh are the
hamstring muscles which are extensors of the
hip joint and flexors of the knee joint, all arise
from the ischial tuberosity except the short head
of the biceps m. and all are inserted in the bones
of the leg.
• These muscles include: biceps femoris,
semitendinosus and semimembranosus.
All supplied by the sciatic nerve.
• Cutaneous supply of the back of the thigh is the
posterior cutanous nerve of the thigh. which is a
branch of the sacral plexus enters the thigh inferior to the
piriformis muscle through the greater sciatic foramen. it
descend through the posterior midline of the thigh giving
small branches from both sides to the skin of the back of
the thigh and the popliteal fossa, it pierce the fascia lata
and ends as a cutaneous branches over the calf.
• The blood supply of the posterior compartment are the
perforating branches from the profunda femoris artery.
Posterior cutaneous nerve of the thigh
The popliteal fossa
• It lies behind the knee, the lower 1/3 of the
femur and the upper part of the tibia. It is
diamond in shape.
• The superficial fascia of the fossa contain
little fat, while the deep fascia is thin, strong
and firmly attached to the tendons.
Boundaries• Upper lateral --------- biceps femoris m.
• Upper medial--------- semimembranosus and semitendinosus
ms.
• Lower lateral and medial--------- the 2 heads of the
gastrocnemius m.
• The anterior wall is the popliteal surface of the femur, the
posterior capsule of the knee joint and the fascia of the
popliteus m.
• The posterior wall is the deep fascia of the fossa.
The popliteal fossa
Contents of the fossa
• These include:• 1- The popliteal vessels.• 2- Branches of the sciatic nerve, the tibial
and common peroneal nerves.• 3- Popliteal lymph nodes.• 4- Posterior cutaneous nerve of the thigh.
Contents of the fossa
The popliteal vesselsThese are the direct continuation of the femoral vessels enter the fossa through the adductor hiatus. They lie anterior to the tibial nerve, the common peroneal nerve pass laterally accompany the tendons of the biceps muscle. The popliteal artery ends at the lower border of the popliteus muscle by dividing into anterior and posterior tibial arteries. it lies aganist the posterior part of the capsule of the knee joint, then it lies posterior to popliteus muscle in the upper part of the leg.
• The popliteal artery: begin at the adductor hiatus and ends at the lower border of the popliteus m. where it divided into anterior and posterior tibial arteries. The popliteal artery is anterior to the semimembranosus m. Popliteal vein, tibial nerve, the heads of the gastrocnemius and plantaris ms.
The popliteal artery
• Branches: • 1- muscular branches to the hamstring ms. And
to the muscles of the calf.• 2- Articular branches these are the lateral and
medial superior and inferior genicular and middle genicular arteries to the knee joint correspond to the genicular branches from the tibial and common peroneal nerves. they anastomosed with the branches from the lateral circumflex femoral, descending genicular arteries, and the recurrent branches of the anterior tibial artery
The popliteal vein
• formed by the union of the anterior tibial, the posterior tibial and the peroneal veins at the lower border of the popliteus muscle, it lies superficial to the artery and between it and the tibial nerve. it receive tributaries correspond to the branches of the popliteal artery and the lesser saphenous vein. it become the femoral vein at the adductor hiatus.
• Tibial nerve (L4 L5 S1 S2 S3).• It is the largest of the two terminal branches of
the sciatic nerve, it begins above the popliteal fossa descends vertically in the fossa, Lying first on the lateral side of the popliteal artery then posterior to it and finally medial to it then it pass between the two heads of the gastrocnemius muscle and under the soleus muscle. It supply the muscles of the back of the thigh and leg, the sole of the foot, the skin of the lateral and lower half of the back of the leg and sole of the foot.
Tibial nerve
• Branches in the popliteal fossa:• 1- sural nerve: it is a cutaneous branch descend in the
groove between the two heads of the gastrocnemius m. it pierce the deep fascia about the middle of the back of the leg join the peroneal communicating branch from the peroneal nerve, supply the skin of the lower posterior part of the leg and the skin of the lateral side of the dorsum of the foot. It accompany the small saphenous vein.
• 2- Muscular branches to the gastrocnemius, plantaris, soleus and popliteus ms.
• 3- Articular branches, it gives superomedial, inferomedial and middle genicular branches to the knee joint, accompanied the corresponding branches from the popliteal artery
• Common peroneal nerve (L4 L5 S1 S2)• It is smaller than tibial nerve runs follow
the tendon of biceps femoris m. along the upper lateral border of the popliteal fossa to the back of the head of the fibula, then curves forwards along the neck of the fibula deep to the peroneus longus m. here it divides into deep and superficial branches.
• Branches in the popliteal fossa:• 1- cutaneous branches, these include the
peroneal communicating branch which arise in the upper part of the popliteal fossa descend on the posterolateral side of the calf to join the sural nerve about the middle of the back of the leg, it supply the proximal 2/3 of the posterolateral part of the leg.
• Lateral cutaneous nerve of the calf arise on the lateral head of the gastrocnemius m. supply the lateral side of the leg.
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