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Posterior Compartment of The Thigh and Gluteal Region Nieve MartinLearning Outcomes • muscles and describe the innervation and actions of these muscles • Identify and describe the anatomy of the ilio-tibial tract; identify the tensor fascialata muscle and describe the innervation and action of this muscle • Identify the piriformis, superior and inferior gemelli, obturator internus, obturator externus and quadratus femoris muscles and describe the innervation and actions of these muscles • Identify the biceps femoris, semitendinosus and semimembranosus muscles and describe the origin, insertion, innervation and actions of these muscles• Identify the gluteus maximus, gluteus medius and gluteus minimus muscles and describe the innervation and actions of these muscles Superior gluteal nerve (L5, S1-2) Inferior gluteal nerve (L5, S1-2) • Superior gluteal – medius and minimus • Inferior gluteal – maximus• Abducts and medially rotates thigh, keeps pelvis • Abducts and medially level when ipsilateral limb rotates thigh, keeps weight bears pelvis level when ipsilateral limb weight bears • Extends thigh, assists in lateral rotation, steadies thigh Clinical Relevance • Injury to the superior gluteal nerve causes a trendelenburg gait. • Pelvis drop on normal/unaffected side • Gluteus medius and minimus become weak. Contralateral pelvis dips downwards when that (normal) limb is raised of the ground. • Gluteus medius and minimus should contract to stabilise the pelvis on the side with the limb on the ground. Clinical Relevance • Intragluteal injections– avoid sciatic and gluteal nerves• Identify and describe the anatomy of the ilio-tibial tract; identify the tensor fascialata muscle and describe the innervation and action of this muscle Tensor fasciae latae Superior gluteal nerve (L5, S1-2) Iliotibial Tract Tensor fasciae latae • Abducts and medially rotates thigh, keeps pelvis level when ipsilateral limb weight bears Iliotibial Tract• Identify the piriformis, superior and inferior gemelli, obturator internus, obturator externus and quadratus femoris muscles and describe the innervation and actions of these muscles Piriformis Branches anterior rami S1,2 Superior Gemellus Nerve to obturator internus L5,S1 Obturator internus Branches anterior rami S1,2 Inferior Gemellus Nerve to quadratus femoris L5,S1 Quadratus femoris Obturator externus Nerve to quadratus Posterior branch femoris L5,S1 obturator nerve L3,4 Piriformis Laterally rotates, abducts thigh Superior Gemellus Laterally rotates, abducts thigh Obturator internus Laterally rotates, abducts thigh Inferior Gemellus Laterally rotates, abducts thigh Quadratus femoris Obturator externus Laterally rotates thigh Laterally rotates thigh Clinical Relevance • Piriformis syndrome • Literal pain in the butt • Spasm of piriformis annoys sciatic nerve passing from underneath this muscle • femoris angler quadratus • Persistent radiating low back pain, buttock pain, numbness, paraesthesia, difficulty walking eg. squatting, standingtivities• Identify the biceps femoris, semitendinosus and semimembranosus muscles and describe the origin, insertion, innervation and actions of these musclesBiceps femoris (long head) Semitendinosus SemimembranosusBiceps femoris Tibial nerve L5-S2 (long head), common fibular nerve L5-S2 (short head) Semitendinosus Tibial nerve L5-S2 (long head) Semimembranosus Tibial nerve L5-S2 (long head)Biceps femoris Flexes leg and laterally rotates, extends thigh Semitendinosus Flexes leg and medially rotates, extends thigh Semimembranosus Flexes leg and medially rotates, extends thigh Clinical Relevance • Hamstrings rupture • Sprinting sports (remember hamstrings extend thigh (bring backwards)) • Acute severe pain, bruising, difficulty mobilising • Severe tears (shown) require surgical reattachment of tendon1. During a clinical consultation you suspect a patient has a palsy of the superior gluteal nerve. During the gait cycle the patient demonstrates a dropping of the left pelvis (trendelenberg gait). Which nerve is affected and on what side?1. During a clinical consultation you suspect a patient has a palsy of the superior gluteal nerve. During the gait cycle the patient demonstrates a dropping of the left pelvis (trendelenberg gait). Which nerve is affected and on what side? Right superior gluteal nerve. If the patient has a dipping pelvis on the left side (when the left limb is raised from the ground), it means on the right side the gluteus medius and minimus are not contracting. They should do this to to stabilise the pelvis when the contralateral limb is lifted away from the ground.2. A GP if preparing to administer an intragluteal injection to a toddler. Where should the injection be safely administered in the buttock? a) Upper inner quadrant b) Lower inner quadrant c) Upper outer quadrant d) Lower outer quadrant2. A GP if preparing to administer an intragluteal injection to a toddler. Where should the injection be safely administered in the buttock? a) Upper inner quadrant b) Lower inner quadrant c) Upper outer quadrant d) Lower outer quadrant3. The integrity of which muscle is assessed by the Trendelenburg test? a) Piriformis b) Gluteus maximus c) Gluteus medius d) Semimembranosus e) Quadratus femoris3. The integrity of which muscle is assessed by the Trendelenburg test? a) Piriformis b) Gluteus maximus c) Gluteus medius d) Semimembranosus e) Quadratus femoris4. A 60-year-old keen hill walker experiences pain in her leg when walking uphill and climbing stairs. Which of the following muscles is responsible for hip extension? a) Gluteus medius b) Gluteus minimus c) Gluteus maximus d) Tensor fasciae latae e) Rectus femoris4. A 60-year-old keen hill walker experiences pain in her leg when walking uphill and climbing stairs. Which of the following muscles is responsible for hip extension? a) Gluteus medius b) Gluteus minimus c) Gluteus maximus d) Tensor fasciae latae e) Rectus femoris5. • A 19-year-old man is playing rugby when he suddenly notices a severe pain at the posterolateral aspect of his right thigh. Which one of the following muscle groups is most likely to have been injured? a) Biceps femoris b) Semimembranosus c) Semitendinosus d) Vastus lateralis e) Gastrocnemius5. • A 19-year-old man is playing rugby when he suddenly notices a severe pain at the posterolateral aspect of his right thigh. Which one of the following muscle groups is most likely to have been injured? a) Biceps femoris b) Semimembranosus c) Semitendinosus d) Vastus lateralis e) Gastrocnemius6. An 82-year-old man is being treated by physiotherapy in the community, following a long period of immobilisation due to depression. He is having particular difficulty abducting his hip. What muscle contributes most to this movement? a) Gluteus maximus b) Gluteus medius c) Hamstrings d) Iliopsoas Quadratus femoris6. An 82-year-old man is being treated by physiotherapy in the community, following a long period of immobilisation due to depression. He is having particular difficulty abducting his hip. What muscle contributes most to this movement? a) Gluteus maximus b) Gluteus medius c) Hamstrings d) Iliopsoas Quadratus femoris