Gluteal region & Thigh

• Gluteal region


  Transitional region between the trunk and the free lower limbs, includes the buttocks posteriorly and the hip region laterally

  
• Femoral region (thigh)


  Lies between the gluteal/abdominal/perineal regions proximally and the knee region distally, includes most of the femur

  
• Knee region


  Includes the prominences of the distal femur, proximal tibia and head of fibula, the posterior region includes the popliteal fossa

  
• Leg region


  Includes most of the tibia and fibula, connects the knee and foot

  
• Talocrural region (ankle)


  Includes the medial and lateral prominences that flank the ankle

  
• Foot


  Distal part of the lower limb containing tarsus, metatarsus and phalanges

  
• The medial rotation and permanent pronation of the lower limb explain how the knee extends anteriorly and flexes posteriorly, the foot becomes oriented with the great toe on the medial side whereas the thumb is on the lateral side, and the "barber pole" pattern of cutaneous innervation of the lower limb

  
• Femur


  Longest and heaviest bone in the body, articulates proximally with the acetabulum of the os coxae and distally with the patella and tibia, transmits body weight from the os coxae to the tibia when standing

  
• Angle of inclination


  Angle made between the bent proximal femur so that the head and neck projects superomedially to the shaft

  
• Angle of torsion


  When viewed superiorly, the transverse axis of the femur and the axis of the head lie at an angle

  
• Features of the Femur

  • Femoral head
  • Fovea for ligament of head (fovea capitis)
  • Femoral neck
  • Greater trochanter
  • Intertrochanteric line
  • Trochanteric fossa
  • Lesser trochanter
  • Intertrochanteric crest
  • Gluteal tuberosity
  • Pectineal line
  • Femoral shaft
  • Linea aspera
  • Medial and lateral lips of the linea aspera
  • Medial supracondylar line
  • Lateral supracondylar line
  • Popliteal surface
  • Lateral condyle
  • Lateral epicondyle
  • Medial condyle
  • Medial epicondyle
  • Adductor tubercle
  • Intercondylar fossa
  • Patellar surface

  
• Gluteal region


  Prominent area posterior to the pelvis, inferior to the level of the iliac crests, extending laterally to the posterior margin of the greater trochanter, divided into the buttocks and hips

  
• Hip region


  Overlies the greater trochanter laterally, extends to the ASIS anteriorly

  
• Intergluteal cleft


  Groove that separates the buttocks from each other
• Gluteal fold


  Demarcates the inferior boundary of the buttocks and superior boundary of the thigh

  
• Muscles of the Gluteal Region

  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
  • Piriformis
  • Obturator internus
  • Superior gemelli
  • Inferior gemelli
  • Quadratus femoris

  
• Gluteal bursae


  Trochanteric bursa, ischial bursa, gluteofemoral bursa, bursa of obturator internus

  
• Fascia lata


  Deep fascia of the thigh, attaches superiorly to the inguinal ligament, iliac crest, sacrum and coccyx, and inferiorly to the exposed parts of bones around the knee and deep fascia of the leg, encloses the large thigh muscles

  
• Iliopubic tract


  Thickened and strengthened lateral portion of fascia lata, shared aponeurosis of the tensor fasciae latae and gluteus maximus, extends from the iliac tubercle to the anterolateral tubercle of the tibia

  
• Compartments of the thigh

  Anterior, medial and posterior compartments, walls formed by fascia lata and 3 fascial intermuscular septa

  
• Muscles of the Posterior Thigh Region

  • Semitendinosus
  • Semimembranosus
  • Biceps femoris

  
• Hamstring muscles


  Semitendinosus, semimembranosus and long head of biceps femoris, have proximal attachment to the ischial tuberosity and distal attachment to the bones of the leg, produce extension at the hip joint and flexion at the knee joint, innervated by the tibial division of the sciatic nerve

  
• Nerves of gluteal and posterior thigh regions

  • Superior clunial
  • Middle clunial
  • Inferior clunial
  • Sciatic
  • Posterior cutaneous n. of thigh
  • Superior gluteal

  
• Sacral plexus


  1. Ant. rami of L4-S3

  2. Enters gluteal region via greater sciatic foramen

  3. Inferior to piriformis and deep to gluteus maximus

  4. Descends in posterior thigh deep to biceps femoris

  5. Bifurcates into tibial and common fibular nerves at apex of popliteal fossa

  
• Sciatic nerve


  • Supplies all muscles of posterior compartment of thigh

  
• Sacral plexus


  1. Ant. rami of S1-S3

  2. Enters gluteal region via greater sciatic foramen

  3. Inferior to piriformis and deep to gluteus maximus

  4. Emerges from inferior border of gluteus maximus

  5. Descends in posterior thigh deep to fascia lata

  6. Supplies skin of posterior thigh and popliteal fossa

  7. Supplies skin of lateral perineum and upper medial thigh via perineal br.

  
• Sacral plexus


  1. Ant. rami of L4-S1

  2. Enters gluteal region via greater sciatic foramen superior to piriformis

  3. Courses laterally between gluteus medius and minimus as far as tensor fasciae latae

  
• Superior gluteal nerve


  • Supplies gluteus medius, gluteus minimus, tensor fasciae latae

  
• Sacral plexus


  1. Ant. rami of L5-S2

  2. Enters gluteal region via greater sciatic foramen inferior to piriformis and deep to gluteus maximus

  3. Supplies gluteus maximus

  
• Sacral plexus


  1. Ant. rami of L4-S1

  2. Enters gluteal region via greater sciatic foramen inferior to piriformis anterior to sciatic nerve

  3. Supplies inferior gemellus, quadratus femoris, hip joint

  
• Sacral plexus


  1. Ant. rami of S2-S4

  2. Exits pelvis via greater sciatic foramen inferior to piriformis

  3. Descends posterior to sacrospinous ligament

  4. Enters perineum through lesser sciatic foramen

  
• Pudendal nerve


  • Principal nerve of perineum

  
• n. to obturator internus


  • Supplies superior gemellus, obturator internus
• Superior gluteal artery


  1. Enters gluteal region through greater sciatic foramen superior to piriformis

  2. Divides into superficial and deep branches

  3. Anastomoses with inferior gluteal and medial circumflex femoral aa.

  
• Superior gluteal artery


  • Supplies gluteus maximus, gluteus medius, gluteus minimus, tensor fasciae latae

  
• Inferior gluteal artery


  1. Enters gluteal region through greater sciatic foramen inferior to piriformis

  2. Descends on medial side of sciatic nerve

  3. Anastomoses with superior gluteal artery

  4. Participates in cruciate anastomosis of thigh

  
• Inferior gluteal artery


  • Supplies gluteus maximus, obturator internus, quadratus femoris, superior parts of hamstrings

  
• Internal pudendal artery


  1. Enters gluteal region through greater sciatic foramen

  2. Descends posterior to ischial spine

  3. Enters perineum through lesser sciatic foramen

  
• Internal pudendal artery


  • Supplies external genitalia, perineal muscles

  
• Perforating arteries


  1. Enter posterior compartment by perforating aponeurotic portion of adductor magnus attachment and medial intermuscular septum

  2. After providing muscular branches to hamstrings, continues to anterior compartment by piercing lateral intermuscular septum