Hello anatomy friends this is Dr Alsup and we will be discussing the muscles and neurovasculature
in the gluteal region. So the gluteal region is posterior and superiorly placed in the
lower limb. And when looking at a superficial view which is what we have
here by far the most prominent thing the most prominent structure is going to be
the gluteus maximus, and I'm going to outline it as well so you can just see
how extensive it is. This muscle is an extremely thick and large muscle, it's a difficult muscle to
reflect just due to how thick the muscle fibers are. So basically the main thing you see here
in this more superficial view is the gluteus maximus but you can see a slight sliver of the
gluteus medius here superiorly. It's that gluteus medius muscle attaches a bit more superior than
the gluteus maximus. You can also see inferiorly this very white opaque region right here which
is the gluteus maximus's major distal attachment which is the IT band or tract.
Once you get the gluteus maximus muscle reflected you can see that there's quite a bit going on just
deep to that large muscle, so this is the gluteus maximus reflected, again just see how thick the
muscle is in terms of it's not a particularly long muscle say compared to some of the other
muscles that we're going to look at in the lower limb but its thickness is just
something that is as difficult to understand without seeing it.
When you have it reflected though you can see some of these deeper muscles. You can see the entirety
of the superficial side of the gluteus medius, which is what I am outlining right here.
And this is a this is also a thick muscle certainly smaller than the gluteus maximus as
its name would suggest but still rather thick and very fan shaped. Located inferior and medial to the
gluteus medius is the piriformis muscle the "key to the hip" hopefully you remember that learning
objective. So gluteus maximus is reflected here you can see the gluteus medius and the piriformis.
On this deepest dissection where both the gluteus maximus and medius have been removed even though
you can see a bit of the muscle belly still right here of the gluteus medius you can you only see
the gluteus minimus, you can see the tendon really well here you can see a bit of its muscle belly,
which is right here on the posterior ilium so it's right on the bone. And this is the
smallest of the gluteal muscles and you can see it distally heading towards the greater trochanter
where it will have a distal attachment.
Before I get to the neurovasculature, oh wait well actually before I even get to that I
do want to talk about and kind of re-point out this really important muscle right here
which is your piriformis. So that piriformis is this triangular shaped muscle it will come, it
will have its proximal attachment actually within the pelvis hopefully we recall that from when
we were discussing within the reproduction sequence. But so you're going to have that
piriformis attaching on the sacrum it will traverse the greater sciatic foramen and it will
also distally attach on that greater trochanter and we'll come back to this in just a moment. But
before I get to the neurovasculature i do want to note that you have some smaller lateral rotators
right here in this region so some of these are quite small like these right in here
the quadratus femoris which is right here is slightly larger.
You don't have to individually identify these but I do want to point them out since they are pretty
clear here in terms of this deep dissection, so you do have some muscles right in this region as well
and these are lateral rotators of the hip joint. Okay now it's time to talk neurovasculature and
to best understand this it is time to turn to the "key of the hip" that piriformis muscle
and this will help you understand which is which or what is what here.
Superior to the piriformis muscle is the superior gluteal neurovasculature.
All right ,so all this right here, these are all branches of the superior gluteal or
gluteal neurovasculature so you're gonna have the artery the vein and the nerves all in this region,
superior gluteal nerve will innervate the gluteus medius and minimus. Inferior to the piriformis
muscle there is considerably more neurovasculature than what occurs superior to the piriformis.
But by far the most prominent structure here is the sciatic nerve, and I'm going to erase
this and now I'm going to outline the sciatic nerve and you can really bask in all of its
glory. It is a very significant nerve in terms of size it's impressive and it makes
sense that it's so large because the sciatic nerve is the largest nerve in the body. So
this will be kind of lateral and inferior to the piriformis muscle. This cut bundle right here
is going to (not S oh no no that is would be ever so wrong no) these are going to be the inferior
gluteal neurovasculature, because it is inferior to the piriformis. So you're going to have the
artery nerve and vein of the inferior gluteal and the inferior gluteal nerve will innervate the
gluteus maximus so it makes sense that this has been cut because the gluteus maximus has been
removed in a deep dissection. But important to note inferior gluteal will be inferior
to the piriformis. There are other neurovascular structures exiting the greater sciatic foramen
inferior to the piriformis muscle such as the pudendal nerve and the internal pudendal artery
but you do not need to identify them in this location
but just note that you may see other neurovascular structures there as well. All right excellent
thank you for your time and attention here and please reach out with any questions