Gluteal Region

Sciatic Foramen

Greater Sciatic Foramen

Lesser Sciatic Foramen

greater Sciatic Foramen borders

Superior: Anterior Sacroiliac Ligament

Posteromedial: Sacrotuberous ligament

Anterolateral: Greater sciatic notch of the ilium

Inferior: sacrospinous ligament

Greater Sciatic Foramen contents

Structures entering or leaving including piriformis

Content Above Piriformis

Superior gluteal artery and vein 

Superior Gluteal Nerve

Content Below Piriformis

Sciatic Nerve

Pudendal Nerve

Inferior Gluteal artery

Inferior Gluteal Nerve

Nerve to obturator internus

Nerve to quadratus femoris

Lesser Sciatic Foramen Borders

Superior: Sacrospinous Ligament

Anterior: Ischial Spine

Posterior: Sacrotuberous Ligament

Lesser Sciatic Foramen Content

Internal pudendal artery and vein

Pudendal nerve

Muscles of Gluteal Region

Superficial Group: Gluteus maximus, gluteus medius,gluteus minimus, tensor fasciae lotae

Deep Group: Piriformis, obturator internus, superior gemellus, inferior gemellus, quadratus femoris

Gluteus maximus (Superficial)

O- Posterior Ilium to poterior gluteal line

Ins- Iliotibial tract, gluteal tuberosity of the femur

Inn- Inferior gluteal nerve

A- Extension of Hip, Lateral rotation of hip

Gluteus Medius (Superficial)

O- External surface of ilium

Ins-  Lateral surface of greater trochanter of femur

Inn- Superior Gluteal nerve

A- Together: Hip Abduction, maintenance of pelvis level when unilateral stands.

Middle portion: Abduction

Anterior: Hip Flexion, internal rotation

External : Hip extension, external rotation

Gluteus Minimus (Superficial)

O- External border of ilium

Ins- Anterior surface of greater trochanter of femur

Inn- Superior gluteal nerve

A- Hip Abduction, maintenance of pelvis level on unilateral stance, medial rotation of hip

Tensor Fasciae Latae (Superficial)

O- Anterior superior iliac spine

Insertion- Iliotibial tract

Inn- Superior Gluteal Nerve

A- Hip flexion, hip abduction, medial rotation of hip

Piriformis ( Deep)

Passes through greater sciatic foramen, used as landmark

O- - anterior surface of 2nd–4th sacral segments; superior margin of

greater sciatic notch and sacrotuberous ligament

Ins- superior border of greater trochanter of femur

Inn- branches of anterior rami of S1, S2

A- Lateral rotation of extended hip joint , ABDuction of hip joint when hip is flexed to approximately 90 degrees

Obturator Internus (Deep)

Tendon passes through lesser sciatic foramen. Tendon is sandwiched by the superior gemellus and inferior gemellus muscle bellies. Makes a 90 angle between origin and insertion

O- pelvic surface of ilium and ischium; obturator membrane

Ins- medial surface of greater trochanter of femur

Inn- nerve to obturator internus

A- Lateral rotation of extended hip joint

ABDuction of hip joint when hip is flexed to approximately 90 degrees

Superior Gemellus ( Deep)

O- ischial spine

Ins- medial surface of greater trochanter of femur

Inn- nerve to obturator internus

A- Lateral rotation of extended hip joint ABDuction of hip joint when hip is flexed to approximately 90 degrees

Inferior Gemellus (Deep)

O- ischial tuberosity

Ins- medial surface of greater trochanter of femur

Inn- nerve to quadratus femoris

A- Lateral rotation of extended hip joint ABDuction of hip joint when hip is flexed to approximately 90 degrees

Quadratus Femoris (Deep)

O-lateral border of ischial tuberosity

Ins- quadrate tubercle on intertrochanteric crest of femur and area inferior to it

Inn- nerve to quadratus femoris

A- lateral rotation of the hip

Arteries in the gluteal region

Main arteries are branches from the internal iliac artery

Superior gluteal artery

1. Exits the pelvis via the greater sciatic foramen above the piriformis muscle.

2. Supplies gluteus maximus gluteus medius, gluteus minimus, and tensor fasciae

latae.

3. Also participates in the arterial anastomosis for the hip joint

Inferior Gluteal Artery

1. Exits the pelvis through the greater sciatic foramen below the piriformis.

2. Supplies gluteus maximus, obturator internus, quadratus femoris, and superior

parts of hamstring muscles.

Internal Pudendal Artery

1. Exits through the greater sciatic foramen (below piriformis), but then re-enters

the pelvis via the lesser sciatic foramen

2. Mainly supplies the perineum.

Superior Gluteal Nerve

1. Comes from the sacral plexus

2. Leaves the greater sciatic foramen superior to piriformis and then runs

between gluteus medius and gluteus minimus

3. Innervates gluteus medius, gluteus minimus, and tensor fasciae latae

Inferior Gluteal Nerve

1. Comes from sacral plexus

2. Leaves the greater sciatic foramen inferior to piriformis and then runs deep to

the gluteus maximus

3. Innervates gluteus maximus

Sciatic Nerve

1. Comes from sacral plexus

2. Is a combination of 2 major lower extremity nerves, tibial nerve and common

fibular (peroneal) nerve

3. Leaves the greater sciatic foramen inferior to piriformis and then runs deep to

the gluteus maximus down posterior thigh

4. Sometimes common fibular nerve portion splits off early and goes through the

piriformis muscle instead of going below it.

5. Does not innervate any muscles in the gluteal region

Pudendal Nerve

1. Comes from sacral plexus

2. Enters gluteal region through greater sciatic foramen inferior to piriformis;

descends posterior to sacrospinous ligament; enters perineum through lesser

sciatic foramen

3. Does not supply any structures in the gluteal region

Nerve to Obturator Internus

1. Comes from sacral plexus

2. Enters gluteal region through greater sciatic foramen inferior to piriformis;

descends posterior to ischial spine; enters lesser sciatic foramen; passes to

obturator internus

3. Innervates superior gemellus and obturator internus

Nerve to Quadratus Femoris

1. Comes from sacral plexus

2. Leaves pelvis through greater sciatic foramen deep to sciatic nerve

3. Innervates inferior gemellus and quadratus femoris as well as providing some

of the sensory innervation to the hip joint

Bursa

A. Like the shoulder the gluteal has bursa, located in areas of friction

B. Trochanteric bursa - between the greater trochanter and gluteus maximus tendon

C. Ischial bursa - between inferior border of gluteus maximus and ischial tuberosity

D. Gluteofemoral bursa - between iliotibial tract and superior proximal attachment of the

vastus lateralis