Gluteal Region, Thigh, and Popliteal Region Anatomy Notes

Gluteal Region and Lower Limb Surface Anatomy

  • Key anatomical landmarks:
    • Iliac crest
    • Anterior superior iliac spine
    • Inguinal ligament
    • Pubic tubercle
    • Lateral femoral epicondyle
    • Medial femoral epicondyle
    • Patella
    • Tibial tuberosity
    • Anterior border of tibia
    • Medial malleolus
    • Lateral malleolus

Gluteal Region

  • Surface features:
    • Intergluteal cleft
    • Gluteal fold
    • Gluteal sulcus

Hip Joint

  • Degrees of freedom: 3

Hip Motion

  • Possible Movements:
    • Flexion
    • Extension
    • Abduction
    • Adduction
    • External/Lateral Rotation
    • Internal/Medial Rotation
  • Center of rotation (fulcrum): Head of femur
  • Lever: Head, neck, and greater trochanter of femur

Muscles of the Gluteal Region

  • Muscles (Superior View):
    • Tensor fasciae latae
    • Gluteus minimus
    • Gluteus medius (anterior fibers)
    • Piriformis
    • Superior and inferior gemelli
    • Obturator internus
    • Obturator externus
    • Quadratus femoris
    • Gluteus maximus
    • Iliac
    • Pubic symphysis
    • Pubic Ramus
    • Anterior superior iliac spine
    • Posterior superior iliac spine
  • Muscle Actions:
    • Medial rotation (internal)
    • Lateral rotation (external)

Gluteal Muscles

  • Gluteus Maximus
    • Most superficial muscle
    • Innervation: Inferior gluteal nerve
    • Actions:
      • Extend the hip
      • Lateral rotation of hip
    • Power extensor
    • Distal attachments:
      • Gluteal tuberosity
    • May indirectly affect the knee joint; potential source of knee pathology.
  • Gluteal Bursae:
    • Trochanteric
    • Ischial
    • Gluteofemoral

Gluteal Muscles

  • Gluteus Medius
    • Innervation: Superior gluteal nerve
    • Actions:
      • Abduct and medially rotate hip
      • Stabilize pelvis in mid-stance phase of gait
  • Gluteus Minimus
    • Innervation: Superior gluteal nerve
    • Actions:
      • Abduct hip
      • Medially rotate hip
      • Stabilize pelvis during midstance phase of gait

Gluteal Muscles

  • Tensor Fascia Lata (TFL)
    • Innervation: Superior gluteal nerve
    • Action:
      • Flex, abduct, and internally rotate the hip
    • Completely distally attaches to IT band

Iliotibial (IT) Tract

  • Attachment: Gerdy's tubercle on tibia

Deep Gluteal Muscles

  • Piriformis
    • Innervation: Nerve to piriformis
    • Actions:
      • Laterally rotate extended hip
      • Abduct flexed hip
  • Quadratus Femoris
    • Innervation: Nerve to quadratus femoris
    • Actions: Laterally rotate hip

Deep Gluteal Muscles

  • Obturator Internus
    • Innervation: Nerve to obturator internus
    • Action: External (lateral) rotation of the hip.
  • Superior Gemellus
    • Innervation: Nerve to obturator internus
    • Action: Lateral rotation of the hip
  • Inferior Gemellus
    • Innervation: Nerve to quadratus femoris
    • Action: Lateral rotation of the hip
    • Twins

Sciatic Nerve and Gluteal Region Nerves and Vessels Summary

  • Sciatic Nerve
    • Largest nerve, rope-like structure
    • Relationship to Piriformis: In some people, the sciatic nerve pierces the piriformis muscle.
  • Gluteus Maximus
  • Inferior gluteal artery, vein, and nerve
  • Posterior femoral cutaneous nerve
  • Pudendal nerve, perineal branches
  • Obturator internus
  • Sacrotuberous ligament
  • Ischial tuberosity
  • Posterior femoral cutaneous nerve, perineal branches
  • Adductor magnus
  • Gracilis
  • Gluteus medius
  • Superior gluteal artery, vein, and nerve
  • Piriformis
  • Gemellus superior and inferior
  • Obturator internus
  • Sciatic nerve (with artery)
  • Quadratus femoris
  • Adductor magnus

Posterior Thigh Muscles: Hamstrings

  • Semitendinosus
    • Attachments:
      • Ischial tuberosity
      • Medial surface of superior part of tibia
    • Innervation: Tibial division of sciatic nerve
    • Actions:
      • Extend hip, flex knee, and medially rotate flexed knee
  • Semimembranosus
    • Attachments:
      • Ischial tuberosity
      • Medial condyle of tibia, oblique popliteal ligament
    • Innervation: Tibial division of sciatic nerve
    • Actions: Same as semitendinosus
  • Biceps Femoris
    • Long head
      • Attachments:
        • Ischial tuberosity
        • Lateral surface of head of fibula
      • Innervation: Tibial division of sciatic nerve
      • Actions: Extend hip, flex knee, laterally rotate flexed knee
    • Short head
      • Attachments:
        • Linea aspera and lateral supracondylar line of femur
        • Lateral side of head of fibula
      • Innervation: Fibular division of sciatic nerve
      • Actions: Same as long head

Hip Joint

  • Type: Ball and socket synovial joint
  • Components:
    • Pelvis - Acetabulum
      • Acetabular Notch
    • Head of the Femur

Hip Joint Ligaments

  • Anterior Ligaments
    • Pubofemoral ligament
    • Iliofemoral ligament ("Y" ligament)
      • Attachments on pelvis and intertrochanteric line
  • Posterior Ligament
    • Ischiofemoral ligament

Hip Joint - Acetabulum

  • Acetabular labrum
    • Transverse acetabular labrum
  • Synovial membrane
  • Ligament of the head of the femur (ligamentum teres)
  • Lunate surface
  • Osteoarthritis of the Hip Replacement
    • Events such as severe trauma or dislocation at a young age can lead to surgery due to blood supply being impacted
    • Very invasive surgery

Arteries of the Thigh

  • From Abdominal aorta
    • External iliac artery
      • Superficial circumflex iliac artery
      • Inferior epigastric artery
      • External pudendal artery
      • Femoral artery
        • Superficial epigastric artery
        • Deep artery of thigh
          • Lateral circumflex femoral artery
            • Lateral circumflex femoral artery (transverse branch)
          • Medial circumflex femoral artery
          • Perforating arteries
    • Internal iliac artery
      • Obturator artery
      • Inferior gluteal artery
      • Cruciate anastomosis
  • Popliteal artery
  • Adductor hiatus
    • Femoral artery becomes popliteal artery

Blood Supply to the Hip Joint

  • Superior retinacular arteries
  • Posterior retinacular arteries
  • Inferior retinacular arteries
  • Femoral artery
  • Medial circumflex artery
  • Eateral circumflex artery
  • Deep femoral artery
  • Branch of the obturator artery
  • Lateral femoral circumflex artery
  • Medial femoral circumflex artery

Popliteal Region & Fossa

  • Boundaries
    • Biceps femoris (laterally)
    • Semimembranosus (medially)
    • Heads of the gastrocnemius (inferiorly)
    • Skin and Fascia (roof)
    • Floor: popliteal surface of femur, oblique popliteal ligament, popliteal fascia

Popliteal Fossa Neurovasculature

  • Tibial Nerve
    • Medial sural cutaneous nerve
  • Common Fibular Nerve
    • Sural communicating nerve
  • Sural nerve
    • Formed by medial sural cutaneous nerve and sural communicating branch
    • Supplies lower lateral leg and ankle
  • Posterior cutaneous nerve of the thigh
    • Supplies skin of popliteal region
  • Blood Vessels
    • Popliteal Artery
    • Popliteal Vein
      • Continuation of the femoral artery and vein after it passes through the adductor hiatus.

Popliteal Fossa/Knee Joint

  • Genicular anastomosis
  • Descending branch of lateral circumflex femoral artery
  • Femoral artery
  • Adductor hiatus
  • Descending genicular artery
  • Popliteal artery
  • Superior medial genicular artery
  • Sural arteries
  • Superior lateral genicular artery
  • Middle genicular artery
  • Superior lateral genicular artery
  • Inferior lateral genicular artery
  • Inferior medial genicular artery
  • Anterior tibial artery
  • Fibular artery
  • Posterior tibial artery
  • Saphenous branch
  • Superior medial genicular artery
  • Inferior lateral genicular artery-
  • Popliteal artery
  • Circumflex fibular artery-
  • Recurrent branch of anterior tibial-
  • Interosseous membrane
  • Inferior medial genicular artery
  • Posterior tibial artery
  • Anterior tibial artery