Anatomy of the gluteal region
Dr Rania Gabr
Objectives
• Identify the bony landmarks of the pelvis and hip on the
articulated skeleton and bones.
• Enlist the prominent bony features of the femur.
• Identify the muscles of the gluteal region in terms of their
origin, insertion, nerve supply and actions.
• Identify the superior gluteal and inferior gluteal nerves in
relation to Piriformis muscle.
• Explain how the anatomical position affects the muscle
function.
The Gluteal Region
 It extends from the iliac crest (waist) above to
the gluteal fold below.
 Buttock: The lower part of the gluteal region
which presents a rounded bulge due to fat is
called buttock.
Gluteal fold indicates the lower border of the
gluteus maximus muscle (gluteal sulcus/crease
is a skin crease for the hip joint)
A deep midline groove, the natal (intergluteal)
cleft separates the buttocks from each other.
 Hip: It is the anterosuperior part of the gluteal
region.
Boundaries
• Superiorly: iliac crest
(at L4),
• Medially: intergluteal
cleft,
• Laterally: Greater
trochanter,
• Inferiorly: gluteal fold
• The gluteal muscles
form the prominent
majority of the gluteal
region.
• The gluteal region
contains:
– Bones
– Muscles
– Ligaments
– Vessels
– Nerves
Bones of the Gluteal
Region
• Posterior aspect
of:
– Hip bone
– Femur
&
– Hip joint
Bony Pelvis
Hip Bone
Femur
Femur
Femur
Femur
Movements at Hip Joint
Movements at Hip Joint
Ligaments of the Gluteal Region
• 2 ligaments:
– Sacrospinous, connecting sacrum
to ischial spine
– Sacrotuberous, connecting
sacrum to ischial tuberosity
• They convert the greater & lesser
sciatic notches into greater &
lesser sciatic foramina
• Their main function is to:
– Stabilize the sacrum
– Prevent its posterior rotation at
the sacroiliac joint
Muscles of the Gluteal Region
•
•
•
•
•
•
•
•
•
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fascia lata
Piriformis
Superior Gemellus
Inferior Gemellus
Obturator internus
Quadratus femoris
Gluteus Maximus
• Largest muscle in the body
• Forms the prominence of
buttock
• Origin:
– Outer surface of ilium
behind the posterior gluteal
line
– Lumbar fascia
– Posterior surface of sacrum
& coccyx
– Sacrotuberous ligament
• Insertion:
– Most of the muscle (3/4th)
inserted into the iliotibial
tract
– Deeper fibers inserted to
the gluteal tuberosity
ilium
S
C
Gluteus maximus (Chief extensor)
 Most powerful & the bulkiest muscle of
the body.(Anti-gravity muscle)
 Nerve supply
Inferior gluteal nerve (L5, S1, S2)
 Actions:
 Chief extensor of thigh at hip. Helps in
rising from sitting, bending or squatting
positions and in climbing upstairs &
cycling.
 Supports the extended knee through
iliotibial tract
 Lateral rotator of thigh.
Gluteus Medius
• Origin: outer surface of ilium
between the middle and
posterior gluteal lines
• Insertion: Lateral surface of
greater trochanter
• Nerve supply: Superior gluteal
nerve (L4,5, S1)
• Action:
– Powerful abductor of thigh
at hip joint.
– Medially rotates the thigh
– Most important action is to
prevent the opposite side
of the pelvis tilting
downwards as in walking &
running
– Steady pelvis in walking
Gluteus Minimus
Origin:
outer surface of ilium
 Insertion:
Anterior surface of greater
trochanter
 Nerve supply:
Superior gluteal nerve
(L4,5, S1)
 Action:
Abducts & medially rotates
the thigh

Tensor Fascia Lata
• Origin:
Outer edge of iliac crest
• Insertion:
Into the iliotibial tract
• Nerve supply:
Superior gluteal nerve (L4,5,
S1)
• Action:
Maintains the knee in
extended position
Piriformis
• Origin:
Anterior surface of S2,3,4
vertebrae
• Insertion:
Upper border of greater
trochanter
• Nerve supply:
Anterior rami of S1,2
• Action:
– Lateral rotator of thigh
– Assists in stabilizing hip
joint especially in
abduction
Obturator Internus
• Origin:
Inner surface of obturator
membrane and adjacent
bone
• Insertion:
Upper border of greater
trochanter along with
gemelli
• Nerve supply:
nerve to obturator internus
(L4,S1)
• Action:
Lateral rotator of thigh
Piriformis forms an
important landmark in the
region
Superior & Inferior Gemelli
• Origin:
– Superior from ischial spine
– Inferior from ischial
tuberosity
• Insertion:
Upper border of greater trochanter
• Nerve supply:
– Superior from nerve to
obturator internus (L4, S1)
– Inferior from nerve to
quadratus femoris (L4, S1)
• Action:
Lateral rotators of thigh
Quadratus Femoris
• Origin:
Lateral border of ischial
tuberosity
• Insertion:
Quadrate tubercle of femur
• Nerve supply:
nerve to quadratus femoris
(L4,S1)
• Action:
Lateral rotator of thigh
Greater and Lesser Sciatic Foramen
Structures passing through greater sciatic foramen
1. Piriformis Muscle
2. Above Piriformis:
 Superior gluteal nerve
 Superior gluteal vessels
3.








Below Piriformis:
Inferior gluteal nerve
Inferior gluteal vessels
Sciatic nerve
Post. Cutaneous nerve of thigh
Nerve to quadratus femoris
Nerve to obturator internus
Pudendal nerve
Internal Pudendal vessels
Structures passing through lesser sciatic
foramen
 Nerve to obturator
internus
 Pudendal nerve
 Internal Pudendal
vessels
 Tendon of obturator
internus
The first three structures
after coming out of the
pelvis through greater
sciatic foramen, reenter the pelvis by
passing through the
lesser sciatic foramen.
Site for
Intramuscular
Injection
Trendelenburg Test

Observe patient from
behind, ask him/her to
stand on one foot and then
the other
 Negative test: Pelvis
‘tilts up’ on
contralateral side
 Positive test:
Pelvis ‘sags’ on
contralateral side
Positive Trendelenburg test, might be in
1-Fracture neck of femur
2-Dislocation of hip joint
3-Nonfunctioning gluteus medius and
minimus due to:
A- Neurological damage (L4 – 5
disc herniation)
B- Any disease affecting muscles
(myopathy)