Gluteal Region

The gluteal region is located posterior to the pelvic girdle and extends distally into the upper leg as the posterior thigh. The gluteal region consists of the gluteal muscles and several clinically important arteries, veins, and nerves. The muscles of the gluteal region help to move the hip joint during walking, running, standing, and sitting and are specialized for bearing weight and maintaining the horizontal balance of the pelvis.

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Components and Boundaries of the Gluteal Region

Components

The gluteal region is the area posterior to the pelvic girdle between the iliac crest and the gluteal fold. The region comprises the following:

Muscle groups: 

  • Superficial gluteal muscles: 
    • Gluteus maximus
    • Gluteus medius
    • Gluteus minimus
    • Tensor fasciae latae
  • Deep gluteal muscles:
    • Piriformis
    • Superior and inferior gemelli
    • Obturator internus
    • Quadratus femoris

Nerves: 

  • Sciatic
  • Superior and inferior gluteal
  • Posterior femoral cutaneous
  • Pudendal

Vessels: 

  • Superior and inferior gluteal arteries (branches of the internal iliac artery) 
  • Superior and inferior gluteal veins (drain into the internal iliac vein)

Foramina:  

  • Greater and lesser sciatic foramina of the pelvis (formed by the sacrospinous and sacrotuberous ligaments)

Boundaries

  • Superior: iliac crest
  • Medial: intergluteal cleft 
  • Lateral: a line from the anterior superior iliac spine to the greater trochanter
  • Inferior: inferior gluteal cleft

Boundaries of the gluteal region

Image by BioDigital, edited by Lecturio.

Gluteal Muscles

The gluteal muscles can be divided into 2 groups that are responsible for the main movements of the hip joint: 

  • Superficial gluteal muscles: 
    • Extension of the hip
    • Abduction of the hip
    • Stabilizing and maintaining balance of the pelvis during the gait cycle
  • Deep gluteal muscles:
    • External rotation of the extended hip
    • Abduction of the flexed hip 

Superficial gluteal muscles

MuscleOriginInsertionNerve supplyFunction
Gluteus maximusIlium posterior to the posterior gluteal line, posterior sacrum and coccyx, and sacrotuberous ligamentIliotibial tract (75%) and gluteal tuberosity (25%)Inferior gluteal nerve (S1, S2)
  • Extends the hip
  • Assists lateral rotation
Gluteus mediusExternal ilium between the anterior and posterior gluteal linesGreater trochanter of the femurSuperior gluteal nerve (L4, L5, S1)
  • Abducts and medially rotates the hip
  • Keeps the pelvis level when the opposite limb is off the ground (swing phase)
Gluteus minimusExternal ilium between the anterior and inferior gluteal linesGreater trochanter of the femur
Tensor fasciae lataeAnterior superior iliac spineIliotibial tract to the lateral condyle of the tibia
  • Flexes the hip
  • Stabilizes the knee joint

Deep gluteal muscles

MuscleOriginInsertionNerve supplyFunction
Piriformis
  • Anterior surface of the sacrum
Greater trochanter (superior surface) Anterior rami of S1
  • Lateral rotation of the extended hip
  • Abduction of the flexed hip
Gemelli
  • Superior: ischial spine
  • Inferior: ischial tuberosity
Greater trochanter (medial surface)
Obturator internus
  • Pelvic surface of the ilium, ischium, and obturator membrane
Greater trochanter (medial surface)
Quadratus femoris
  • Ischial tuberosity
Intertrochanteric crest N to the quadratus femoris (L5, S1)
  • Lateral rotation 
  • Holds the head of the femur within the acetabulum

Sciatic Foramina

The superior and inferior foramina are formed by the following ligaments inserted into the bony pelvis:

  • Sacrospinous ligament: extends from the lateral edge of the sacrum and coccyx to the ischial spine
  • Sacrotuberous ligament: extends from the lateral edge of the sacrum and coccyx to the ischial tuberosity

The sacrospinous and sacrotuberous ligaments create the following foramina, or passageways:

Greater sciatic foramenLesser sciatic foramen
Boundaries
  • Superior: anterior sacroiliac ligament
  • Inferior: sacrospinous ligament and the ischial spine
  • Anterolateral: greater sciatic notch of the ilium
  • Posteromedial: sacrotuberous ligament
  • Superior: sacrospinous ligament and the ischial spine
  • Anterior: ischial tuberosity
  • Posterior: sacrotuberous ligament
Contents
  • Piriformis muscle
  • Suprapiriform foramen: superior gluteal vessels and nerve
  • Infrapiriform foramen:
    • Pudendal nerve
    • Internal pudendal vessels
    • Sciatic nerve
    • Inferior gluteal vessels and nerve
    • Nerves to the obturator internus and quadratus femoris muscles
    • Posterior femoral cutaneous nerve
  • Pudendal nerve
  • Internal pudendal vessels
  • Tendon and nerve of the obturator internus muscle 

The greater and lesser sciatic foramina are created by the spaces between the sacrospinous and sacrotuberous ligaments.

Image by BioDigital, edited by Lecturio.

Gluteal Vessels

Gluteal arteries

Two branches drain from the internal iliac arteries:

  • Superior gluteal artery: 
    • The largest branch of the internal iliac
    • Goes through the greater sciatic foramen and the suprapiriform foramen
    • Supplies the gluteus medius, minimus, tensor fasciae latae, and piriformis muscles in the gluteal region
    • Also supplies the skin over the sacrum and hip joint
  • Inferior gluteal artery: 
    • Goes through the greater sciatic foramen and the infrapiriform foramen
    • Supplies the gluteus maximus, obturator internus, and quadratus femoris muscles in the gluteal region
    • Also supplies the sciatic nerve, pelvic floor, and skin of the gluteal and thigh regions

Gluteal veins

  • The veins of the gluteal regions accompany the gluteal arteries and are named accordingly: superior and inferior gluteal veins.
  • Drain into the internal iliac vein

The gluteal vessels emerging through the suprapiriform foramen and infrapiriform foramina

Image by BioDigital, edited by Lecturio.

Gluteal Nerves

  • Several important nerves originating from the sacral plexus either traverse or have branches that innervate the gluteal region.
  • The sciatic nerve, the largest branch of the lumbosacral plexus and largest nerve in the body, exits just caudally to one of the deep gluteal muscles, the piriformis muscle.
NerveOriginMuscles supplied
Sciatic Anterior and posterior divisions of the nerve roots L4-S3
  • Muscles of the posterior compartment of the leg
  • Muscles of the sole of the foot
  • Muscles in the anterior and lateral compartments of the leg
  • Innervates no muscles in the gluteal region
Superior gluteal L4-S1 (Sacral plexus)
  • Gluteus medius
  • Gluteus minimus
  • Tensor fasciae latae
Inferior gluteal L5-S2 (Sacral plexus)
  • Gluteus maximus
Posterior femoral cutaneous S1-S3 (Sacral plexus)
  • Skin over the lower and lateral parts of the gluteus maximus
  • Skin of the posterior and medial thigh
Pudendal S2-S4 (Pudendal plexus)
  • Muscles of the pelvic floor
  • Cutaneous perineal branches 
Sacral plexus  L4-S4 (direct branches)
  • Piriformis  
  • Obturator internus and externus
  • Superior and inferior gemelli  
  • Quadratus femoris

The deep layer of the gluteal region, featuring the nerves of the gluteal region

Image by BioDigital, edited by Lecturio.

Clinical Relevance

The following are clinically relevant to the gluteal region:

  • Intramuscular injections: The superolateral region of the gluteal region is relatively free of nerves and vessels and is often used for intramuscular injections.
  • Trendelenburg gait: abnormal gait secondary to the weakness of the hip abductors, primarily the gluteus medius and gluteus minimus muscles, which are essential to maintaining the balance of the pelvis during the gait cycle. Weakness of the hip abductors causes a drop of the contralateral pelvis while walking, or a Trendelenburg gait. 
  • Piriformis syndrome: Also called deep gluteal syndrome or wallet neuritis, piriformis syndrome is characterized by a combination of symptoms involving the hip, buttock, and upper thigh. Described as peripheral neuritis of the sciatic nerve and may be related to irritation of the same at the level of the piriformis muscle. May be caused by trauma, hematoma, excessive sitting, and anatomic variations of the muscle and nerve. 
  • Superior gluteal nerve palsy: occurs secondary to a peripheral injury of the superior gluteal nerve leading to motor loss, specifically involving the gluteus medius and minimus. Superior gluteal nerve palsy manifests as a Trendelenburg gait. The most common cause is an iatrogenic injury during hip surgery and intramuscular injection. 
  • Lesions of the inferior gluteal nerve: most commonly occur through iatrogenic injuries (e.g., surgery), trauma, hernias, or pelvic tumors. May lead to a functional deficiency of the gluteus maximus muscle, causing a “gluteus maximus lurch.” Patients present with difficulties walking up stairs or standing up from a chair.

References

  1. Drake, R.L., Vogl, A.W., & Mitchell, A.W.M. (2014). Gray’s Anatomy for Students (3rd ed.). Churchill Livingstone.

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