Gluteal Region and Hip Joint

• Innominate: Medial view

  
• Innominate: Lateral view

  
• Greater and Lesser Sciatic Foramina

  
• Femur

  •Angle of inclination

  •Angle of anteversion (torsion)

  
• Femur

  
• Muscles of Gluteal Region

  Lateral Rotators of Hip

  •Gluteus Maximus (extensor)

  •Piriformis

  •Obturator internus

  •Gemelli

  •Quadratus femoris

  Medial Rotators  and  Abductors of Hip

  •Gluteus Medius

  •Gluteus Minimus

  Support

  •Tensor fasciae latae
• Gluteus Maximus

  Sacrum, sacrotuberous ligament and ilium behind posterior gluteal line   

  • Iliotibial tract (3/4) and gluteal tuberosity of femur (1/4)

  •Extends hip; assists lateral rotation

  •Inferior gluteal nerve–(L5, S1, 2)

  
• Tensor Fasciae Latae

  Anterior iliac crest and Anterior superior iliac spine

  • Iliotibial tract

  •Tenses fasciae latae and iliotibial tract; Supports femur on tibia during standing

  •Superior Gluteal nerve–(L4, 5, S1)

  
• Tensor Fasciae Latae

  
• Gluteus Medius

  Ilium between posterior and anterior gluteal lines

  • Greater trochanter of femur (lateral surface)

  •Abducts and medially rotates hip

  •Superior gluteal nerve–(L4, 5, S1)

  
• Gluteus Minimus

  Ilium between anterior and inferior gluteal lines

  ->Greater trochanter of femur(anterior surface)

  •Abducts and medially rotates hip

  •Superior gluteal nerve–(L4, 5, S1)

  
• Piriformis

  Anterior Sacrum and Sacrotuberous ligament

  • Greater Trochanter of femur (superior border)

  –Passes through greater sciatic foramen

  •Laterally rotates hip 

  •Anterior rami of S1, 2

  
• Obturator internus

  Pelvic surface of Obturator membrane and surrounding bones

  • Medial side of greater trochanter (Trochanteric Fossa)

  –Passes through lesser sciatic foramen

  •Laterally rotates hip

  •Nerve to obturator internus  (L5, S1)

  
• Gemelli

  •Superior: Ischial spine

  •Inferior: Ischial tuberosity

  • Blend with tendon of Obturator internus

  •Laterally rotate hip

  •Superior: Nerve to obturator internus

  •Inferior: Nerve to quadratus femoris

  
• Obturator internus inside pelvis

  
• Quadratus femoris

  Ischial tuberosity        

  • Quadrate tubercle on intertrochanteric crest of femur

  •Laterally rotates hip

  •Nerve to quadratus femoris (L5, S1)

  
• Obturator externus

  Outer surface of obturator membrane

  • Trochanteric fossa

  •Laterally rotates hip

  •Obturator nerve–L3, 4

  
• Obturator externus

  
• Sciatic nerve

  •L4, 5, S1, 2, 3

  •Tibial leaves below piriformis

  •Common Peroneal may leave below, above or through piriformis

  
• Gluteal Vessels and Nerves

  •Superior gluteal vessels and nerves

  •Inferior gluteal vessels and nerves

  •Relative to Piriformis

  
• Gluteal Vessels and Nerves

  
• Posterior cutaneous nerve of thigh

  •Lies on posterior aspect of sciatic nerve

  –(S1, 2, 3)

  •Inferior Clunial nerves to skin of inferior half of buttock

  
• Cutaneous Nerves – Gluteal and Posterior Thigh

  
• Hip Joint

  •Articular surfaces

  •Capsule attachments

  •Ligaments

  •Arterial supply

  
• Articular Surfaces

  
• Capsule attachments

  
• Iliofemoral ligament

  •AIIS → Intertrochanteric line

  •Upper and lower bands

  Limits:

  •Extension

  •Lateral rotation

  •Adduction (upper)

  •Abduction (lower)

  
• Iliofemoral Ligament

  
• Pubofemoral ligament

  •Iliopubic eminence    

  → Lower part of intertrochanteric line

  Limits:

  •Extension

  •Lateral rotation

  •Abduction

  
• Ischiofemoral ligament

  •Posterior aspect of acetabulum → Greater trochanter

  Limits:

  •Extension

  •Medial rotation

  •Adduction

  
• Blood Supply to the Hip Joint