
Gluteal Region
By
Dr. Khaled Saad Mohamed
Assistant professor of Human Anatomy & Embryology
Bones & Joints of the gluteal region
• Dorsal surface of sacrum
• Coccyx
• Gluteal surface of Ilium
• Ischium (ischial tuberosity)
• Upper end of femur
• Posterior aspect of hip joint
• Sacrococcygeal & sacroiliac
joint
Gluteal Region
1-Gluteal Muscles .
2-Ligaments in Gluteal Region (2 Ligs)
3- Arteries in Gluteal Region (3 As)
4- Nerves in the Gluteal Region (7 Ns)
5- Hip Joint
Gluteal Region
(Muscles)
Muscles
Main Hip Extensor
Gluteus Maximus
Hip Abductors & medial
rotators:
➢ Gluteus Medius
➢ Gluteus Minimus
➢ Tensor Fascia Lata
Hip Lateral rotators
5 Muscles
1. Piriformis.
2. Obturator internus.
3. Quadrats femoris
4. Superior gemellus
5. Inferior gemellus.
Gluteal Region
Origin
➢ Sacrum
➢ Ilium
Insertion
Greater trochanter
Except???
Gluteus Maximus
❖Origin:
1. gluteal surface behind
posterior gluteal line.
2. back of sacrum & coccyx
3. sacrutuberous ligament
❖Insertion:
1. gluteal tuberosity (1/4).
2. Iliotibial tract (3/4)
❖Nerve supply: Inf. Gluteal nerve
❖Action:
➢ Powerful extensor of hip jointprincipally when strength is required eg.
Lifting heavy weights from floor, rising
from sitting position, running, climbing
stairs)during
normal
walking
extension -by hamstring muscles
➢ Powerful lateral rotator of thigh at
the hip joint
➢ Acts with tensor fasciae latae stabilizes pelvis on thigh
➢ Acts with tensor fasciae latae to extend
knee through iliotibial tract.
Gluteus Maximus
❖Nerve supply: Inf. Gluteal nerve
If gluteus maximus is paralyzed, patient can not
stand up from sitting position without support Why ?
Patient
rises gradually
from sitting posture
supporting their hands first on their legs, then
on their thighs to be able to rise up (They climb on
themselves).
Muscles
Main Hip Extensor
Gluteus Maximus
Hip Abductors & medial
rotators:
➢ Gluteus Medius
➢ Gluteus Minimus
➢ Tensor Fascia Lata
Tensor Fascia Lata
❖Origin:
Iliac crest behind ASIS
❖Insertion:
Iliotibial tract
❖Nerve supply: Superior Gluteal
nerve
❖Action:
➢ stabilizes pelvis on thigh
➢ extend knee through iliotibial tract.
Gluteus Medius
❖Origin:
Gluteal surface. between anterior
(middle) & posterior gluteal lines
❖Insertion:
Lateral surface of Greater
trochanter
❖Nerve supply: Superior Gluteal
nerve
❖Action:
➢ Powerful Abductor.
➢ The anterior fibers help in medial
rotation of the thigh at the hip
joint.
➢ During walking: Stabilize the
pelvis (prevent tilting of the pelvis
when the opposite limb is raised
off the ground).
➢ On standing on one limb:
Prevent tilting of pelvis towards
unsupported side
Gluteus Medius
❖Nerve supply: Superior Gluteal
nerve
Gluteus Minimus
❖Origin:
Gluteal surface. between middle
& inferior gluteal lines
❖Insertion:
Anterior surface of Greater
trochanter
❖Nerve supply: Superior Gluteal
nerve
❖Action:
➢ Powerful Abductor.
➢ The anterior fibers help in medial
rotation of the thigh at the hip
joint.
➢ During walking: Stabilize the
pelvis (prevent tilting of the pelvis
when the opposite limb is raised
off the ground).
➢ On standing on one limb:
Prevent tilting of pelvis towards
unsupported side
If gluteus medius & minimis are paralyzed, patient
can not walk normally.
➢ When the foot of the normal side is raised , the
pelvis tilts to that side.
➢ If paralysis is on one side lurching gait.
➢ If on both sides waddling (Duck)
➢ gait.
Gluteal Region 2
Hip Lateral rotators
5 Muscles
1. Piriformis.
2. Obturator internus.
3. Quadrats femoris
4. Superior gemellus
5. Inferior gemellus.
Piriformis
❖Origin:
❖Action:
By 3 digitations from pelvic surface
of middle three pieces of sacrum.
➢ Lateral rotation of the thigh at
the hip joint
❖Insertion:
Apex of Greater trochanter
Leaves the pelvis through Greater
Sciatic notch
❖Nerve supply: Ventral rami S1, S2
Piriformis
Origin: middle three pieces of
sacrum
2
3
4
Insertion: Apex of Greater trochanter
Piriformis Syndrome
Sciatica
like
pain
caused
by
compression of the sciatic nerve by the
piriformis muscle during running or sitting,
can squeeze the sciatic nerve at the site
where the nerve emerges from under the
piriformis to over the gemellus and
obturator internus muscles.
Hip Lateral rotators
Nerve Supply
➢Obturator Internus – Nerve to obturator
internus
➢ Superior Gemellus - Nerve to obturator
internus
➢ Inferior Gemellus - Nerve to quadratus
femoris
➢ Quadratus femoris -Nerve to quadratus
femoris
Obt
Superior Gemellus
Inferior Gemellus
Quad
➢ Structures passing through
Greater sciatic foramen :
Piriformis muscle.
Above piriformis :
➢ Superior gluteal nerves & vessels.
Below piriformis :
➢ Inferior gluteal nerves & vessels.
➢ Sciatic nerve.
➢ Posterior cutaneous nerve of thigh.
➢ Nerve to quadratus femoris.
➢ Nerve to obturator internus.
➢ Pudendal N.
➢ Internal pudendal vessels.
Post. cutaneous
n. of thigh
➢ Structures passing through Lesser
sciatic foramen :
➢ Tendon of obturator internus.
➢ Nerve to obturator internus.
➢ Pudendal N.
➢ Internal pudendal vessels.
Obt
Compartments of thigh
Anterior compartment
(Extensor group)(Quadriceps femoris muscle)
Femoral nerve
Deep fascia
Femur
Posterior compartment
(Flexor group)
(Hamstring muscles)
Sciatic nerve
Intermuscular septum
Medial compartment
(Adductor muscles)
Obturator nerve
Posterior Compartment Of The Thigh
Contents
➢ Hamstring muscles:
➢ Biceps femoris.
➢ Semitendinosus.
➢ Semimembranosus.
➢ Ischial part of adductor magnus.
➢ Blood supply:
Profunda femoris artery.
➢ Nerve supply:
Sciatic nerve.
Origin:
➢ The long head from the ischial tuberosity
(lower part)
➢ The short head from the linea aspera .
Biceps Femoris
Insertion:
Head of the fibula.
Nerve supply:
❑ The long head is supplied by the Tibial branch
of the sciatic nerve
❑ The short head is supplied by the common
peroneal branch of the sciatic.
Action :
❑Flexion of knee.
❑Lateral rotation of the leg (Locking of
knee joint)
❑Long head: extends hip.
Head of
the fibula
Origin:
Ischial tuberosity (lower part)
Insertion:
Upper part of the medial surface of the
shaft of the tibia (SGS).
Nerve supply:
Tibial branch of the sciatic nerve
Action :
❑ Flexion and Medial rotation of knee.
❑ extends hip.
Semitendinosus
(SGS)
Semimembranosus
Origin:
Ischial tuberosity (Upper part)
Insertion:
❑ Posterior surface of the medial condyle of the
tibia.
❑ It forms the oblique popliteal ligament, which
reinforces the back of the knee joint.
Nerve supply:
Tibial branch of the sciatic nerve
Action :
❑ Flexion and Medial rotation of the knee.
❑ extends hip.
Sciatic nerve
(L4,5 S1,2,3)
➢ The sciatic nerve, a
branch of the sacral plexus
(L4 and 5; S1, 2, and 3)
➢ Leaves the gluteal region
below piriformis.
➢ It descends in midline of the
back of the thigh.
Sciatic nerve
➢ It is overlapped posteriorly
semimembranosus muscles.
by
the
biceps
femoris
➢ It lies on the posterior aspect of the adductor magnus.
➢ In the lower third of the thigh it ends by dividing into the tibial
and common peroneal nerves.
and
Sciatic nerve ends
by dividing into the
tibial and common
peroneal
(fibular)
nerves.
Branches of Sciatic Nerve
1. Cutaneous:
To all leg & foot EXCEPT:
➢ Medial side of the leg
➢ Medial side of the foot till the
big toe
supplied by the saphenous
nerve (branch of femoral nerve).
2. Muscular:
•To Hamstrings:
(flexors of knee & extensors of the hip).
(through tibial part) to:
➢ Ischial part of Adductor Magnus.
➢ Long head of Biceps Femoris.
➢ Semitendinosus.
➢ Semimembranosus.
NB. The short head of biceps receives
its branch from the lateral popliteal
(common peroneal) nerve.
SCIATIC NERVE INJURY
Causes:
The sciatic nerve is most frequently injured by…?
1- Badly placed intramuscular injections in the
gluteal region.
To avoid this, injections should be done into the
upper outer quadrant of buttock (into gluteus
maximus or medius).
Most nerve lesions are incomplete, and in 90% of
injuries, the common peroneal nerve is mostly
affected. Why? The common peroneal nerve fibers
lie superficial in the sciatic nerve.
SCIATIC NERVE INJURY
Causes:
2-Herniation or rupture of the
intervertebral disc
3 -Posterior dislocation of the hip
joint.
SCIATIC NERVE INJURY
❑Motor Effect:
➢ Marked wasting of all muscles below the knee.
➢ Weak flexion of the knee (sartorius & gracilis are
intact).
➢ Weak extension of hip (gluteus maximus is
intact).
➢ All the muscles below the knee are paralyzed,
and the weight of the foot causes it to assume the
plantar-flexed position, or Foot Drop.
➢ High steppage gait.
High steppage gait
Sciatica
➢ Sciatica describes the condition in which patients have
pain along the sensory distribution of the sciatic nerve.
➢ The pain is experienced in the posterior aspect of the
thigh, the posterior and lateral sides of the leg, and the
lateral part of the foot.
Causes of Sciatica :
➢Prolapse of an intervertebral disc,
with pressure on one or more of the roots
of the sciatic nerve (lower lumbar and
sacral spinal nerves).
➢Pressure on the sacral plexus or
sciatic nerve by an intrpelvic tumor,
(Piriformis tumor).
➢Inflammation of the sciatic nerve or
its terminal branches.
Anterior Compartment Of The Thigh
Contents
Ilio psoas
➢ Muscles:
➢ Quadriceps femoris
➢ Sartorius
➢ Articularis Genu
➢ Ilio psoas
➢ Blood supply:
Femoral artery.
➢ Nerve supply: Femoral nerve.
Sartorius
Muscles of Front of Thigh
1. Sartorius
2. Iliopsoas
3. Quadriceps femori s
a)
b)
c)
d)
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
4. Articularis genu
Quadriceps femoris muscle
It consists of 4 parts of different origin, but
has a common tendon of insertion
These 4 parts are:
1. Rectus femoris.
2. Vastus medialis
3. Vastus intermedius.
4. Vastus lateralis
Origins of Quadriceps Femoris muscle
1- Rectus femoris: Arises by 2 heads (Hip
bone):
Straight head: From anterior inferior iliac spine.
Reflected head: From impression above acetabulum
2- Vastus Lateralis ,Medialis and intermedius
From the femur.
Insertion of Quadriceps Femoris muscle
➢ The 4 heads of quadriceps femoris fuse to
Tendon
form a common tendon ((quadriceps tendon))
which is inserted into the upper border (base) of
the patella and continued to the apex of the
patella.
Patella
➢ From the apex of the patella the ((Patellar
ligament)) extends from the apex of the patella to
be
inserted into the tibial tuberosity (final
insertion).
Patellar
ligament
Quadriceps Femoris muscle
Nerve supply: Femoral nerve
Action:
➢ The main extensor of the leg at the knee joint.
➢ Rectus femoris assists in flexion of thigh at hip joint
➢ Keeps the patella in its position by contraction of the lower fleshy
fibers of vastus medialis to prevent lateral displacement of the patella
during extension of knee
Origin:
From anterior
(A.S.I.S).
Sartorius
superior
iliac
spine
Insertion:
Upper part of the medial surface of the
shaft of the tibia (SGS).
Nerve supply: Femoral nerve
Sartorius
Action : (Tailors position)
➢ Flexion, Abduction & lateral
rotation of thigh at hip j.
➢ Flexion of knee j.
Articularis Genu
Nerve supply: Femoral nerve
Action:
Elevates the synovial membrane of
knee joint during extension of the knee to
prevent it from being trapped (crushed)
between tibial & femoral condyles
Origin:
➢ The psoas major muscle In the abdomen
from all lumbar vertebrae
➢ The iliacus muscle From Iliac fossa.
Insertion:
lesser trochanter of femur
➢ Nerve supply:
➢ The psoas major muscle lumbar Plexus
➢ The iliacus muscle Femoral nerve
IlioPsoas
IlioPsoas
Action :
➢ The main flexor of the thigh at the hip joint.
➢ Acting from below: Flex the trunk as in raising
from the recumbent position
Medial compartment
(Adductor muscles)
Medial Compartment Of The Thigh
Contents
Muscles:
➢ Gracilis (medially)
➢ Pectineus.
➢ Adductor longus.
➢ Addutor brevis.
➢ Adductor magnus.
➢ Obturator externus
Blood supply: Obturator artery.
Nerve supply: Obturator nerve.
Adductor Magnus
Gracilis
Action : Adduction
Flexion Lat rotation
Pectineus
Adductor
Brevis
Adductor
Longus
Origin
Superior pubic
ramus
Pubic body and
inferior pubic ramus
Pubic body
Insertion
Pectineal line of
the femur
Pectineal line of the
femur
linea aspera
Origin
Obturator
externus
Adductor Magnus
Gracilis
Obturator
membrane
(outer surface)
➢ Pubic part :From Lower border of
pubic arch
pubic arch
➢ Ischial part: From
Ischial tuberosity
Insertion Medial surface of ➢ Pubic part: Gluteal Upper part of the
Greater trochanter
of the femur
tuberosity and linea medial surface of
aspera.
the shaft of the
➢ Ischial
part:
tibia (SGS).
Adductor tubercle
Adductor Magnus
Pubic part
Ischial part
Origin
Pubic arch
Ischial tuberosity
Insertion
Posterior surface of
shaft of femur
Adductor tubercle
N.
supply
Obturator nerve
(posterior division)
Sciatic nerve
Action
Adduction – flexion –
lat rotation hip joint
Extension of hip
adductor
magnus
Ischial part
Pubic part
Obturator Externus
Origin: Outer surface of obturator
membrane
Insertion: trochanteric fossa on the Medial
surface of greater trochanter
Nerve supply: Obturator nerve
(posterior division)
Action: Laterally rotates thigh
Obturatot nerve
(L2,3,4)
➢ The Obturator nerve,
a branch of the Lumbar
plexus (L1,2,3 and 4)
➢ It receives fibres from the
anterior divisions of L2,
L3 and L4
➢ Divide into anterior and
posterior
divisions
at
obturator externus
Branches of Obturator nerve
Anterior division:
Posterior division :
▪Muscular: gracilis, adductors longus &
▪Muscular: Obturator externus, adductors
brevis
magnus & brevis
▪Cutaneous: middle 1/3 of medial side
▪Cutaneous: No
of thigh
▪Articular: to hip joint
▪Articular: to Knee joint
▪Vascular: to femoral artery
▪Vascular: to popliteal artery
Femoral triangle
site
boundaries
roof
floor
contents
Inguinal ligament
sartorius
adductor longus.
3
2
1
Femoral sheath
Femoral sheath
Divided into three compartments by
two fibrous septa
➢ Lateral compartment: femoral a.
➢ Middle compartment: femoral v.
➢ Medial compartment: femoral
canal
Femoral hernia
• If a loop of intestine is forced into the
femoral canal , it expands to form a swelling
in the upper part of the thigh. Such a
condition is known as a femoral hernia .
• A femoral hernia is more common in
women than in men (possibly because their
wider pelvis and femoral canal ).
Adductor canal
Adductor canal
Position: middle 1/3 of front of thigh.
Boundaries
➢ Anterior wall: Sartorius
➢ Lateral wall : vastus medialis
➢ Posteomedial wall: adductors
longus and magnus
Adductor
magnus
Adductor canal
• Contents:
1. Femoral artery.
2. Femoral vein
3. Saphenous nerve
4. Nerve to vastus medialis.
Muscles of the Leg
Compartments of the leg
Anterior compartment 2 D
(Extensor group) (Dorsiflextion)
(Deep peroneal) nerve.
Posterior compartment
(Flexor group) (Planterflextion)
Tibial nerve.
Lateral compartment
(Peroneal muscles)
(Superfacial peroneal)
nerve.
Sciatic nerve ends
by dividing into the
tibial and common
peroneal nerves.
Common peroneal nerve
divide into
Deep peroneal nerve
Superfacial peroneal nerve
Common peroneal nerve
Termination:
It curves forwards on lateral side of neck of fibula
where it terminates by dividing into:
➢ Superficial peroneal branch .
➢ Deep peroneal branch .
Lateral Compartment
Anterior Compartment
Causes:
➢ Trauma or injury to the knee
➢ Compression of the fibula head
during surgery e.g.tourniquet.
➢ Fracture neck of the fibula
Motor Effect: Foot Drop.
Anterior compartment (Extensor group)
(Dorsiflextion)
Tibialis anterior Extensor digitorum
Extensor
hallucis longus
longus
Origin
➢ Lateral surface of
tibia.
➢ Interosseous
membrane.
➢ Upper 3/4 of anterior
surface of fibula.
➢ Interosseous membrane.
➢ Middle 2/4 of
anterior surface of
fibula.
➢ Interosseous
membrane.
Insertinon ❑ Medial cuneiform
By 4 tendons into Distal phalanx of
middle
and
distal
big toe
bone (main part).
phalanges of lateral 4
❑ Base of 1st metatarsal toes
bone
Peroneus tertius
Origin
➢ Lower 1/4 of anterior
surface of fibula.
➢ Interosseous membrane.
Insertinon
❑ Base of 5th metatarsal
bone
Action
Tibialis anterior
❑Dorsi flexion of
foot at ankle joint.
Extensor digitorum
Extensor hallucis
longus
longus
❑Dorsi flexion of foot ❑Dorsi flexion of ❑Dorsi flexion of foot at
at ankle joint.
❑Inversion of foot ❑Inversion of foot at
at subtalar joints
Peroneus tertius
subtalar joints
❑Extension of lateral 4
toes
foot at ankle
joint.
❑Inversion of foot
at subtalar joints
❑Extension of big
toe
ankle joint.
❑Eversion of foot
at subtalar joints
Extensor Retinaculae
Superior Extensor Retinaculae
Structures undercover it: (from medial to lateral):
1- Tibialis anterior.
Tom
2- Extensor hallucis longus
Has
3- Anterior tibial vessels
Very
4- Anterior tibial nerve
Nice
5- Extensor digitorum longus
Dog
6- Peroneus tertius.
Pigeon
Lateral compartment (Peroneal group)
(Eversion)
Peroneus longus Peroneus brevis
Origin
From
upper
2/3
of From lower 1/3 of
lateral surface of fibula
Insertinon ❑ Medial cuneiform bone
❑ Base of 1st metatarsal bone
lateral surface of fibula
❑ Base of 5th metatarsal
bone
Peroneus longus
Action:
1- Eversion of foot at subtalar joint.
2- Planter flexion of foot at ankle
joint.
3- Maintains transverse arch of foot
Peroneus longus tendon
Peroneus brevis
Action:
1- Eversion of foot
2- Planter flexion
of foot
Lateral
compartments of leg
Peroneal muscles
1
3
(Eversion)
2
1-Peroneus longus muscle.
2-Peroneus brevis muscle.
3-Peroneus tertius.
Muscles of the Back of Leg
Superficial Group:
Deep Group:
1) Gastrocnemius
2) Soleus
3) Plantaris
1) Popliteus
2) Flexor Digitorum Longus
3) Flexor Hallucis Longus
4) Tibialis Posterior
Gastrocnemius
Origin:
Medial Head medial condyle of
the femur
Insertion:
Lateral Head lateral condyle
of the femur.
posterior surface of calcaneus
(Tendon of Achilis)
N.S: Tibial Nerve
Action:
1- Chief plantar flexor
2- Flexion of knee
3 Propelling force in walking
4 Muscle pump for venous return
Tendocalcaneous
(Tendon of Achilis)
Soleus
Origin:
2- Tendinous arch
between tibia & fibula
1- Upper part of head
of the fibula
3- Soleal line & middle 1/3 of
medial border of tibia
Insertion: Posterior surface of
calcaneus
N.S: Tibial Nerve
Action:
1 Plantar flexion
2 Steadies the leg on foot during standing
3 Propelling force in walking
4 Muscle pump for venous return
Tendocalcaneous
(Tendon of Achilis)
Plantaris
Origin:
Popliteal surface of the femur
just above the lateral condyle
Insertion:
posterior surface
of calcaneus
separately or with tendocalcaneus
N.S: Tibial Nerve
Action:
1- Plantar flexion of ankle
2- Flexion of knee
Popliteus
Origin:
Popliteal groove below
lateral epicondyle
Insertion:
Posterior surface of tibia
above the soleal line
N.S:
Tibial Nerve
Action: Unlocks The Knee Joint
by initial medial rotation of tibia at the
beginning of flexion of an extended limb
Flexor Digitorum Longus
Origin:
Posterior surface of tibia
(below soleal line)
N.S: Tibial Nerve
Action: 1- Flexion of all joints of lateral 4
toes
2- Plantar flexion of ankle joint
3 Inversion of foot at subtalar joint
4 Maintains the longitudinal arch of
foot
Insertion:
Distal phalanges of
lateral 4 toes
Flexor Hallucis Longus
Origin:
Posterior surface of the fibula
N.S: Tibial Nerve
Action:
Insertion
1- Flexion of all joints of the big toe.
2- Plantar flexion of ankle joint
3 Inversion of foot at subtalar joint
4 Maintains the longitudinal arch of foot
Distal phalanx of the
big toe.
Tibialis Posterior
Origin:
➢ Posterior surface of tibia (below soleal line)
➢ Posterior surface of the fibula
➢ Interosseous membrane
N.S: Tibial Nerve
Action: 1- Plantar flexion of ankle joint
2-Inversion of foot at subtalar joint
3-Maintains the longitudinal arch of
foot
Insertion
1- Navicular Bone
(main site)
2- All Tarsal Bones
except Talus
3- Bases of 2nd ,3rd and 4th
Metatarsal Bones
Flexor Retinaculum
Definition:
Thickened band of deep fascia at medial aspect of ankle joint.
Function:
They keep flexor tendons in contact with lower end of tibia during their
contraction.
Flexor Retinaculum
Structures undercover it: (from medial to
lateral):
1- Tibialis posterior
2- Flexor digitorum longus
3- Posterior tibial vessels
4- Tibial nerve
5- Flexor hallucis longus
Tarsal Tunnel
Syndrome
• Entrapment of tibial nerve posterior
to medial malleolus (flexor
retinaculum) .
• burning pain and paraesthesias
along plantar aspect of foot.
• pain may radiate to calf
• worse with activity (walking),
relieved by rest
Popliteal Fossa
Popliteal fossa is a diamond-shaped intermuscular space situated
at the back of the knee
It is more prominent when the knee is flexed.
Boundaries:
Laterally: Biceps femoris above and the lateral head of gastrocnemius
and plantaris below
Medially: the semimembranosus and the semitendinosus above and the
medial head of the gastrocnemius below
Medial head of
gastrocnemius
lateral head of
gastrocnemius
Popliteal Fossa
The Roof
Skin, superficial fascia, and the deep
fascia of the thigh
The Floor
➢ The popliteal surface of the femur .
➢ The oblique popliteal ligament of
the knee joint .
➢ The popliteus muscle.
Popliteal surface of
the femur
Contents
1-The popliteal vessels
2- The small saphenous vein
3-the common peroneal nerve
4-tibial nerve
5-the posterior cutaneous
nerve of the thigh
6-the genicular branch of the
obturator nerve
7- Popliteal lymph nodes