The Gluteal Region is an anatomical area above the thigh region contains arteries, veins, and muscles. The muscle of the gluteal region is studied under the chapter of the lower limb therefore the gluteal region is considered as a part of the Lower Limb.
The Region is largely made up of Gluteal Muscles and the thick layer of superficial fascia.
The Gluteal Region is also known as the Buttock region.
Superiorly: By Iliac Crest
Inferiorly: By Fold of the buttock
Bones of the Gluteal Region:
The ileum, Ischium, and Pubis combine to form the hip bone. The ileum, Ischium and Pubis meets one another at a place known as Acetabulum. The Ileum, Ishium and Pubis combines to make a strong supporting bone, therefore,they can bear the weight of the body at sitting position.
The femur is believed as the largest and strongest bone in the present in the human body. It articulates with the hip bone at Acetabulum to form the hip joint.
On the other hand, it articulates below with tibia and Patella to form the knee joint.
Fracture of neck of the femur is common and causes avascular necrosis of the head of the femur, resulting in severe Excruciating pain in the hip and gluteal region and makes the person unable to walk.
Hip Joint :
Hip Joint is a type of Ball and socket synovial joint it is the articulation between the hemispherical head of the femur and the cup-shaped acetabulum of the hip bone.
Hyaline cartilage covers the articulating surface.
Ligaments of the hip joint:
The hip joint ligaments are divided into two groups the extracapsular which includes the
iliofemoral, pubofemoral and ischiofemoral ligaments and intracapsular the ligament of head of the femur.
Flexion – iliopsoas, rectus femoris, pectineus, sartorius
Extension – Gluteus maximus, Semimembraneous, hamstring portion of bicep femoris However other portion of bicep femoris has no role in it.
Abduction – Tensor Fascia latae, gluteus medius, gluteus minimus, piriformis
Adduction – It involves the adductors magus, longus and brevis, pectineus and gracilis
Lateral Rotation – gluteus maximus, piriformis, assisted by the obturators, Gemelli and quadratus femoris, biceps femoris However the hamstring portion has no role in lateral rotation
Medial Rotation – tensor fascia latae, anterior fibers of gluteus medius and minimus however other have no role in medial rotation.
Circumduction – It is the combination of all movements together, therefore, all muscles have a role in this movement
Anastomosis around Hip Joint:
It provides the major blood supply to the head of the femur because theses arteries pass along the femoral neck beneath the capsule.
Arteries involved in trochanteric anastomosis are:
- Superior gluteal artery
- Medial Femoral circumflex artery
- Inferior gluteal Artery
- Lateral Femoral circumflex artery
The cruciate anastomosis is found at the level of the lesser trochanter of the femur, with trochanteric Anastomosis therefore it provides a connection between internal iliac and femoral arteries.
Arteries involved in Cruciate Anastomosis:
- Inferior gluteal Artery
- Medial femoral Circumflex artery
- Lateral femoral circumflex artery
- 1st perforating artery ( a branch of profunda femoral artery)
Femoral Neck fractures interfere with or completely interrupt the blood supply from the root of the femoral neck to the head. So as a result Avascular necrosis of the femoral head occurs.
The Superior and Inferior Gluteal arteries are the branches of Internal Iliac Artery but most of the blood supply to the femoral head are arising from Medial femoral Circumflex artery.
Ligaments present on Gluteal Region other than hip Joint:
Sacrotuberous ligament: It connects the back of the sacrum with the Ischial Tuberosity, As a result, it strengthens the iliosacral Joint.
Sacrospinous Ligament: It connects the back of the sacrum with Spine of Ischium In conclusion it hold the iliosacral joint
The Functions of these ligaments is to stabilize the sacrum, As a result it prevents it from rotation at the sacroiliac joint by the weight of vertebral column.
Foramina present in Gluteal Region:
Greater Sciatic Foramena:
The greater Sciatic foramen is formed by greater sciatic notch of the hip bone and sacrotuberous, sacrospinous ligaments. The greater sciatic foramen provides an exit from pelvic into the gluteal region therefore it as an important role in the connecting gluteal region with other parts of body.
Structure exits from the foramen include:
- Sciatic Nerve
- Posterior Cutaneous Nerve of the thigh
- Superior and Inferior gluteal Nerves
- Nerves to Obturator Internus and Quadratus Femoris
- Pudendal Nerve
- Superior and Inferior Gluteal Arteries & Veins
- Internal Pudendal Artery and Vein
Lesser Sciatic Foramen:
The lesser sciatic foramen is formed by the lesser sciatic notch of the hip bone and sacrotuberous and sacrospinous ligaments similarly it provides entrance into perinum.
The Lesser Sciatic foramen provides an entrance into perineum from the gluteal region.
- Structure passes through foramen includes
- Tendon of Obturator Internus Muscle
- Nerve to Obturator Internus
- Pudendal Nerve
- Internal Pudendal artery and Vein
Muscles of Gluteal Region:
Gluteus Maximus is the largest muscle in the body and main extensor of the hip joint along with the extension, However it provides an important role in lateral rotation of the hip joint.
It also extends the knee joint and provides help in climbing up to stairs and in standing from sitting position.
Nerve supply of Gluteus maximus:
Inferior Gluteal Nerve, In other words from (L5, S1, S2) of spinal cord.
Any Injury to an inferior gluteal nerve causes weakened extension of the hip, In other words, it causes difficulty in rising from a sitting position to standing.
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Gluteus Maximus is ideal for IntraMuscular Injection, therefore, it should be focused that injection should be given on outer lateral quadrant of the buttock to avoid any injury to underlying Sciatic Nerve.
Gluteus Medius and Gluteus Minimus:
Gluteus Medius and Minimus adduct the thigh at the hip joint. These muscles help to tilts pelvis during walking to permit the opposite leg to clear ground i.e stabilizers of the pelvis during walking. Along with adduction these muscles also helps in Medial Rotation of the thigh at hip joint as well.
Nerve Supply to Gluteus Medius and Minimus:
Superior Gluteal Nerve (L5, S1)
When any injury or damage occurs to superior gluteal nerve the paralysis of Gluteus medius and minimus occurs the patient presentation will be the Waddling Gait.
Causing the Trenderburg’s Sign positive i.e Patient cannot keep pelvis on a level when he/she is standing on one leg. Also, weakness occurs in Abduction of the hip joint.