00:01
Now let's have a look
at the neurovasculature
of the gluteal region
and how it leads then
into the posterior thigh.
00:08
So before we look
at this region,
and again, here we're looking
at the postural lateral aspects
of the right gluteal region.
00:15
There are some important
pathways we need to be sure of.
00:19
So to do that, we need to
start adding in some ligaments
to these bony structures.
00:23
To convert, what are these
little notches and grooves
into actual foramina
because this means then
structures can pass through
these holes that have been
created, these foramens.
00:35
So here we have the
sacrospinous ligament
and the sacrotuberous ligament.
00:40
The sacrospinous ligament
is coming away from
the ischial spine
and it's passing
towards the sacrum,
so sacrospinous ligament
from the sacrum to
the ischial spine.
00:52
The sacrotuberous ligament
is passing from the
ischial tuberosity,
to the sacrum,
the sacrum to the
ischial tuberosity.
01:00
We have these two ligaments,
sacrospinous, sacrotuberous
and these create two
holes or foramena.
01:07
The greater sciatic foramen
and the lesser sciatic foramen,
and these holes are important
because they allow
muscles to pass through,
and they also allow nerves and
blood vessels to pass through.
01:19
So let's start adding
in the structures.
01:21
First of all, passing out of
the greater sciatic foramen,
we have the piriformis muscle
sitting above it now,
we have the
suprapiriform foramen.
01:31
Sitting beneath it, we have
the infrapiriform foramen.
01:35
So now we've got some pathways
where structures can
pass out of the pelvis
into the gluteal region.
01:42
If we then look at the
lesser sciatic foramen,
we see coming out of the
lesser sciatic foramen
is obturator internus.
01:49
So it leaves the
inside of the pelvis
and then goes towards the femur
by passing through the
lesser sciatic foramen.
01:57
So here we can now see obturator,
internus, and piriformis.
02:01
We can start adding in
some additional muscles.
02:03
So here we can now
see superior gemellus,
inferior gemellus, struggling,
running either side
of obturator internus,
and then we have
Quadratus Femoris,
sitting most inferiorly.
02:15
If we were then add on some
of the gluteal muscles,
so now adding them on
more superficially,
we have gluteus minimus.
02:23
So now we can see all
of these muscles in situ
in their correct position.
02:27
We have gluteus minimus,
we have gluteus medius, overlying
this muscle as well remember,
then we've got piriformis,
superior gemellus,
obturatorinternus,
inferior gemellus and
quadratus femorris.
02:39
What you can't see is would have
obturator externus here as well.
02:43
Now if we add in the
suprapiriform foramen
sitting above piriformis,
we can see how the superior
gluteal nerve artery and vein
can leave the pelvis and pass
to gluteus minimus muscle.
02:55
We can then add in the
infrapiriform foramen
and we can see how the inferior
gluteal nerve artery and vein
can enter into
this space as well.
03:03
Also leaving out the
greater sciatic foramen
deep to piriformis before
it then descends anterior
to superior inferior gemellus,
obturator internus,
quadratus femoris
is the sciatic nerve we
can see running down here.
03:17
We also have the posterior
femoral cutaneous nerve.
03:20
What we can then add
into this position
is the lesser sciatic foramen.
03:24
We haven't spoken much about
the lesser sciatic foramen,
apart from how
obturator internus
leaves the pelvis
through this route
to go and attach to the femur.
03:33
But what we can also add in now
is how the pudendal nerve
and the internal
pudendal artery and vein,
they leave the pelvis
but they need to enter a region
which is now superficial
to the pelvic floor.
03:46
We cover this in the
abdominopelvic lectures.
03:49
But it's important to
recognize in this space,
you may be able to see
the pudendal nerve,
internal pudendal
artery and vein.
03:56
As they leave the pelvis,
they very briefly enter
the gluteal region
by leaving the pelvis through
the greater sciatic foramen.
04:04
They then curve over the
sacrospinous ligament
to enter the perineum
which is a structure
superficial to the pelvis.
04:14
So now they're sitting
underneath the pelvic floor.
04:17
And they do this by
passing into the perineum
via the lesser sciatic foramen.
04:23
It's a complicated arrangement.
04:25
And if you can find yourself
a plastic over your pelvis,
you can start building
up these structures
by using various
gloves or pipe cleaners
to mirror where these
nerves and blood vessels
and muscles would be located.
The lecture Neurovasculature of the Gluteal Region by James Pickering, PhD is from the course Anatomy of the Gluteal Region.
What passes through the greater sciatic foramen? Select all that apply.
Which structures pass through the lesser sciatic foramen? Select all that apply.
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