THE GLUTEAL REGION: VASCULATURE, BURSAE AND CLINICAL APPLICATION

What is the vasculature of the gluteal region?

It is supplied by:

1. The branches of the internal iliac artery which are; the inferior and superior gluteal artery

2. The branches of the femoral artery which are: the medial and lateral circumflex artery

3. The branches of the profunda femoris artery which are the first to fourth perforating arteries

Describe the internal iliac arteries

They enter through the greater sciatic foramen and supply the gluteal region. They contribute to the anastomosis of the hip.

Describe the arterial supply to the femoral head

The branches of the internal iliac artery and the branches of the femoral artery along with the obturator artery of the femoral ligament form the blood supply to the femoral head.

What is the cruciate anastomosis?

It lies level with the lesser trochanter and forms a connection between the internal iliac arteries and the femoral arteries. It is formed by:

A. The ascending branches of the inferior gluteal arteries

B. The transverse branches of the medial and lateral circumflex arteries

C. The ascending branch of the first perforating artery

Bursae

It is a fluid filled sac lined with synovial membranes with an inner layer of synovial fluid.

What are the four bursae related to the gluteal region?

The gluteofemoral bursa, the trochanteric or subgluteus bursa, the ischial bursa, the psoas or iliopectinea bursa

What are the locations of the bursa

1. The gluteofemoral bursa lies between the gluteus Maximus tendon and the vastus lateralis

2. The sub gluteal bursa lies between the gluteus Maximus tendon and the greater trochanter

3. The ischial bursa lies between the gluteus Maximus and the ischial tuberosity

4. The psoas bursa lies deep to the iliopsoas of the floor of the femoral triangle just in front of the hip joint

Intramuscular injection

Allows a large amount of medicine to be administered at once but absorbed slowly. It is done on the upper outer quadrant of the gluteal region to prevent damage to the sciatic nerve and the superior gluteal vessels.

Trendelenburg test

A test that allows to test the functionality of the abductor muscles. The patient is made to stand on one leg and is observed from behind. If the the pelvis drops contralaterally to the raised leg, then there is damage

What conditions can cause pelvic drop?

1. Fracture to the neck of the femur

2. Dislocation of the hip joint

3. Coxa vara

4. Damaged gluteus medius and minimis due to neurological damage or myopathy

Hip bursitis

It is the inflammation of the trochanteric bursa causing lateral hip pain that can radiate to the gluteal region. It is caused by repetitive movement or direct trauma.