Gluteal Region

The gluteal region is located posterior to the pelvic girdle and extends distally into the upper leg Leg The lower leg, or just "leg" in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg as the posterior thigh Thigh The thigh is the region of the lower limb found between the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into 3 fascial compartments. Thigh. The gluteal region consists of the gluteal muscles and several clinically important arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries, veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins, and nerves. The muscles of the gluteal region help to move the hip joint Hip joint The hip joint is a ball-and-socket joint formed by the head of the femur and the acetabulum of the pelvis. The hip joint is the most stable joint in the body and is supported by a very strong capsule and several ligaments, allowing the joint to sustain forces that can be multiple times the total body weight. Hip Joint during walking, running, standing, and sitting and are specialized for bearing weight and maintaining the horizontal balance of the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. 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 Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries (branches of the internal iliac artery) 
  • Superior and inferior gluteal veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins (drain into the internal iliac vein)

Foramina:  

  • Greater and lesser sciatic foramina of the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. 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

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 Hip joint The hip joint is a ball-and-socket joint formed by the head of the femur and the acetabulum of the pelvis. The hip joint is the most stable joint in the body and is supported by a very strong capsule and several ligaments, allowing the joint to sustain forces that can be multiple times the total body weight. Hip Joint

  • Superficial gluteal muscles: 
    • Extension of the hip
    • Abduction of the hip
    • Stabilizing and maintaining balance of the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis during the gait cycle
  • Deep gluteal muscles:
    • External rotation of the extended hip
    • Abduction of the flexed hip 

Superficial gluteal muscles

Muscle Origin Insertion Nerve supply Function
Gluteus maximus Ilium posterior to the posterior gluteal line, posterior sacrum and coccyx, and sacrotuberous ligament Iliotibial tract (75%) and gluteal tuberosity (25%) Inferior gluteal nerve (S1, S2)
  • Extends the hip
  • Assists lateral rotation
Gluteus medius External ilium between the anterior and posterior gluteal lines Greater trochanter of the femur Superior gluteal nerve (L4, L5, S1)
  • Abducts and medially rotates the hip
  • Keeps the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis level when the opposite limb is off the ground (swing phase)
Gluteus minimus External ilium between the anterior and inferior gluteal lines Greater trochanter of the femur
Tensor fasciae latae Anterior superior iliac spine Iliotibial tract to the lateral condyle of the tibia
  • Flexes the hip
  • Stabilizes the knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint

Deep gluteal muscles

Muscle Origin Insertion Nerve supply Function
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 Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. 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 foramen Lesser 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 
Sciatic foramina

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 Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries

Two branches drain from the internal iliac arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. 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 Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin over the sacrum and hip joint Hip joint The hip joint is a ball-and-socket joint formed by the head of the femur and the acetabulum of the pelvis. The hip joint is the most stable joint in the body and is supported by a very strong capsule and several ligaments, allowing the joint to sustain forces that can be multiple times the total body weight. 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 Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin of the gluteal and thigh Thigh The thigh is the region of the lower limb found between the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into 3 fascial compartments. Thigh regions

Gluteal veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins

  • The veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins of the gluteal regions accompany the gluteal arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries and are named accordingly: superior and inferior gluteal veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins.
  • Drain into the internal iliac vein
Gluteal vessels

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.
Nerve Origin Muscles supplied
Sciatic Anterior and posterior divisions of the nerve roots L4-S3
  • Muscles of the posterior compartment of the leg Leg The lower leg, or just "leg" in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg
  • Muscles of the sole of the foot
  • Muscles in the anterior and lateral compartments of the leg Leg The lower leg, or just "leg" in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. 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 Thigh The thigh is the region of the lower limb found between the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into 3 fascial compartments. 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
Gluteal nerves

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 Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis during the gait cycle. Weakness of the hip abductors causes a drop of the contralateral pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. 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 Thigh The thigh is the region of the lower limb found between the hip and the knee joint. There is a single bone in the thigh called the femur, which is surrounded by large muscles grouped into 3 fascial compartments. 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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