BUTTOCKS AND THIGH

PIRIFORMIS
o

A. Skin of the Buttocks

Only muscle that passes through the great sciatic foramen

rami of the spinal nerves

o

Primary function:
o

Support the weight of the body

Provide a stable foundation in standing, walking, and running

CUTANEOUS NERVES are derived from the posterior and anterior

Upper medial quadrant

Supplied by the posterior rami of the upper three

lumbar nerves and the upper three sacral nerves

(specialized for locomotion)

o

I. THE GLUTEAL REGION

Upper lateral quadrant

(L1) and 12th thoracic nerves (anterior rami)

Boundaries
o

Superior: ILIAC CREST (highest point of LE)

Inferior: GLUTEAL FOLD

Supplied by the lateral branches of the iliohypogastric

Lower lateral quadrant

Supplied by the branches from the lateral cutaneous

nerve of the thigh (L2 and 3, anterior rami)

Lower medial quadrant

Supplied by the branches from the posterior

cutaneous nerve of the thigh (S1-S3, anterior rami)

Skin over the coccyx

Supplied by small branches of the lower sacral and

coccygeal nerves

Lymph vessel

Drain into the lateral group of the superficial

inguinal nodes

B. Fascia of the Buttocks

1. SUPERFICIAL fascia

C. Bones of the Gluteal Region

Hip Bone

Contributes to prominence of buttock

Composed of the Ilium, Ischium and Pubis.

Impregnated with large quantities of fat

They meet one another at the ACETABULUM.

thick especially in women

Articulates with the sacrum and sacroiliac joints and form the
anterolateral walls of the Pelvis

2. DEEP fascia
o

Articulates inferiorly at the Symphysis Pubis

Continuous with FASCIA LATA (deep fascia of the thigh

that keeps muscle in place like a compression stocking)

1. ILIUM

Gluteal region: Encloses gluteus maximus

Iliac crest

Above the gluteus maximus, it continues as a single

ASIS, PSIS, AIIS, PIIS

layer that covers the outer surface of the gluteus

Iliac tubercle

medius and is attached to the iliac crest

Greater sciatic notch

Lateral surface of thigh: ILIOTIBIAL TRACT

2. ISCHIUM (L-shaped)

Body (Thick portion)

Forms a sheath for the TENSOR FASCIAE LATAE

Ramus (Thin Portion)

muscle and receives the greater part of the insertion

Ischial Spine

of the gluteus maximus

Ischial Tuberosity

Lesser Sciatic notch

ILIOTIBIAL TRACT

The superficial fascia and deep fascia forms the GREATER and
LESSER SCIATIC FORAMEN

3. PUBIS
o

Symphysis Pubis

Superior Ramus

Inferior Ramus

Pubic Crest

Pubic Tubercle

D. Muscles of the Gluteal Region

GLUTEUS MEDIUS and MINIMUS

o

Main action:

ABDUCT THIGH

a. G. maximus

Medially rotate thigh

b. G. medius

Keeps pelvis level when limb is weight-bearing

1. Superficial muscles

c. G. minimus
d. Tensor fasciae latae

Innervation: SUPERIOR gluteal nerve

Blood supply: SUPERIOR gluteal artery

2. Deep muscles
a. Piriformis

TENSOR FASCIAE LATAE

b. Obturator foramen

FLEXOR of the thigh

c. Superior and inferior gemelli

Assists the gluteus maximus in maintaining the knee

d. Quadratus femoris

TRICEPS COXAE
o

extended

Obturator internus, gemellus superior and gemellus inferior

GLUTEUS MAXIMUS
o

Main actions

THIGH EXTENSION

Lateral rotation

Extension of trunk if legs fixed

STANDING UP from sitting position

CLIMBING STAIRS

Innervation: INFERIOR gluteal nerve

Blood supply: INFERIOR gluteal artery

Innervation: SUPERIOR gluteal nerve

Blood supply: SUPERIOR gluteal artery

PIRIFORMIS
o

Serves to separate the gluteal vessels and nerves from the

inferior gluteal vessels and nerves

E. Ligaments of the Gluteal Region

o

G. Nerves of the Gluteal Region

Stabilize the sacrum and prevent its rotation at the sacroiliac

joint by the weight of the vertebral column

The nerves that enter the lower limb from the abdomen and pelvis are
TERMINAL BRANCHES of the LUMBOSACRAL PLEXUS on

1. SACROTUBEROUS ligament (Sacrum + tuberosity)

o

Connect the back of the sacrum to the ischial tuberosity

2. SACROSPINOUS ligament (Sacrum + Spine)

o

the posterior wall of the abdomen and the posterolateral walls of the
pelvis

Connect the back of the sacrum to ischial spine

inferior parts

FORMS THE GREATER AND LESSER SCIATIC FORAMINA

F. Foramina of Gluteal Region

PIRIFORMIS separates the greater sciatic foramen into superior and

o

Superior: Superior gluteal nerve

Inferior: most of the nerves

1. Superior gluteal nerve

2. Inferior gluteal nerve

1. GREATER SCIATIC foramen

o

Formed by greater sciatic notch of the hip bone and the

3. Sciatic nerve
4. Posterior cutaneous nerve of the thigh

sacrotuberous and sacrospinous ligaments

a. Gluteal branches

Provides EXIT FROM PELVIS TO GLUTEAL REGION

b. Perineal branches

PIRIFORMIS is the only muscle to pass through greater

c. Cutaneous branches

sciatic foramen)

5. Pudendal nerve
6. Nerve to quadratus femoris and inferior gemellus muscles

2. LESSER SCIATIC foramen

o

7. Nerve to obturator internus and superior gemellus muscles

Formed by lesser sciatic notch of the hip bone and

sacrotuberous and sacrospinous ligaments

Provides ENTRANCE FROM GLUTEAL REGION TO

PERINEUM

Intramuscular (IM) injection should be done in the UPPER

OUTER quadrant of the buttocks (GLUTEUS MEDIUS) to avoid
injury to the underlying SCIATIC nerve

H. Arteries of the Gluteal Region

TROCHANTERIC ANASTOMOSIS
o Provides the main blood supply to the head of the

1. SUPERIOR GLUTEAL artery

femur

o A branch from the internal iliac artery

o Passes through superior opening of greater sciatic

o Nutrient arteries pass along the femoral neck beneath

foramen ABOVE the piriformis

2. INFERIOR GLUTEAL artery

the capsule

CRUCIATE ANASTOMOSIS

o A branch of the internal iliac artery

o Situated at the level of the lesser trochanter of the femur

o Passes though inferior opening of greater sciatic foramen

o Together

BELOW the piriformis

with

o Supply pelvic organ

trochanteric anastomosis,

provides a connection between the internal iliac and

femoral arteries

3. Internal PUDENDAL artery

the

II. THE THIGH

C. Saphenous Opening

A. Surface Anatomy

ANTERIOR Thigh

a.k.a. FOSSA OVALIS

Gap in deep fascia (small opening) in front of the thigh just below the

Quadriceps

inguinal ligament situated about 1.5 in (4 cm) below and lateral to the

Quadriceps tendon

pubic tubercle

Adductors on the MEDIAL side

Femoral triangle

POSTERIOR Thigh
o

HAMSTRINGS - antagonist of Quadriceps femoris

Popliteal fossa

QUADRICEPS FEMORIS is 4x stronger than hamstrings

FALCIFORM MARGIN
The lower lateral margin of the saphenous opening, which lies
anterior to the femoral vessels

The saphenous opening is filled with loose connective tissue called

the CRIBIFORM FASCIA

B. Fascia of the Thigh

1. SUPERFICIAL Fascia (subcutaneous tissue)

D. Great Saphenous Vein

a. Fatty layer

Longest vein

b. Membranous layer

Can be located in front of medial malleolus (1 cm cut open in cut down

Both are continuation of superficial fascia of anterior abdominal wall

o

CAMPERs fascia (fatty)

SCARPAS fascia (membranous)

catheterization for IV access)

a.k.a FASCIA LATA

Continuous with fascia of buttocks

Encloses the thigh that provides a dense tubular sheath to

prevent the muscles from bulging excessively due to
contraction
Keep muscles in various compartments

Improves effectiveness of the muscles

and

connected

to

deep

veins

through

Used for venous cut downs and for CORONARY ARTERY

BYPASS GRAFT

valves

PERFORATING VEINS

2. DEEP fascia

Possesses

E. Superficial Inguinal Nodes

H. ANTERIOR Compartment of the Thigh

HORIZONTAL group
o

Lower abdominal wall

Gluteal region

Perineum

1. Muscles HIP FLEXORS and KNEE EXTENSORS

a. SARTORIUS (HF)

PENILE CANCER lymph nodes are below the inguinal ligament

TAILORs muscle

Longest muscle in the body

Most superficial muscle

Covers femoral artery

VERTICAL group
b. ILIOPSOAS (Combination of Iliacus and Psoas) (HF)

From lower limbs

Drains lower limbs

STRONGEST FLEXOR of the thigh

Inguinal lymph adenopathy

Important antigravity postural muscles

For erect posture

F. Deep Inguinal Nodes

Beneath deep fascia

Lie along medial side of femoral vein

Biggest muscle of the body

Femoral sheath contains femoral canal

Stronger than Hamstrings

Pass through the femoral canal to join the nodes along exterior iliac

Rectus femoris

vessels

V. medialis

V. lateralis

Form the
Quadriceps tendon

V. intermedius

Contains the
patella

Continue as
the
PATELLAR
LIGAMENT

c. QUADRICEPS FEMORIS (KE)

G. Fascial Compartments of the Thigh

Anterior

Medial

Innervation: FEMORAL n.

Posterior

Blood supply: FEMORAL a.

FASCIA LATA is responsible for the division of the compartments

of the thigh

2. FEMORAL ARTERY
o

Main arterial supply of the lower limb

Starts at the inguinal ligament and ends at the adductor hiatus

Enters the thigh from behind the inguinal ligament, as a

continuation of the external iliac artery

Descends almost vertically toward the adductor tubercle of

3. Superficial external pudendal artery

Small branch that runs medially to supply the skin of

the scrotum (or labium majus)

4. Deep external pudendal artery

the femur and ends at the opening in the adductor magnus

Runs medially and supplies the skin of the scrotum

(or labium majus)

muscle by entering the popliteal space (hiatus) as the popliteal

artery

5. Profunda femoris artery

BIGGEST BRANCH

Large and important branch that arises from the

lateral side of the femoral artery about 1.5 in. below
the inguinal ligament

Passes medially behind the femoral vessels and enters

the medial fascial compartment of the thigh

Ends by becoming the fourth perforating artery

At its origin, it gives off the medial and lateral

femoral circumflex arteries and during its course it

Branches of the Femoral Artery

1. Superficial circumflex iliac artery

Small branch that runs up to the region of the anterior

gives off three perforating arteries

6. Descending genicular artery

superior iliac spine

its termination

2. Superficial epigastric artery

Small branch that crosses the inguinal ligament and

runs to the region of the umbilicus

Small branch that arises from the femoral artery near

Assist in supplying the knee joint

3. FEMRORAL VEIN

6. FEMORAL SHEATH

Continuation of popliteal vein

Part of deep fascia

Leaves the thigh in the intermediate compartment of the

Funnel-shaped

femoral sheath and passes behind the

Anterior

Inguinal region to become the external iliac vein

Intermediate portion of femoral sheath

Nerve supply of anterior compartment of thigh

Largest branch of lumbar plexus (L2, 3, and 4)

NOT INCLUDED IN THE FEMORAL SHEATH

continuous

above

with

the

fascia

transversalis of abdominal wall

o

Posterior wall: continuous with the fascia iliaca

Compartments:

4. FEMORAL NERVE
o

wall:

Lateral: FEMORAL artery

Intermediate: FEMORAL vein

Medial: FEMORAL canal (contains deep inguinal

nodes)

The femoral nerve is NOT included in the femoral sheath

because it is lateral to the femoral artery

5. FEMORAL TRIANGLE
o

Boundaries:

7. FEMORAL CANAL (most medial)

Superior: INGUINAL LIGAMENT

Small medial compartment FOR LYMPH VESSELS

Lateral: SARTORIUS

Upper Opening: FEMORAL RING

Medial: ADDUCTOR LONGUS

Closes the ring: FEMORAL SEPTUM

Floor: is gutter-shaped (space for neurovascular

Contents:

bundles)

Fatty connective tissue

Roof: skin and fascia lata

Lymph vessel from deep inguinal nodes

Contents: NAVEL

NODE OF CLOQUET

Femoral nerve (N)

F. artery (A)

F. vein (V)

Empty F. canal (E)

Deep inguinal lymph nodes (L)

Superiormost deep inguinal lymph node

FEMORAL HERNIA needs surgical emergency!!! because

it will compromise the blood supply

I. MEDIAL Compartment of the Thigh

8. ADDCUTOR CANAL
o a.k.a. Subsartatorial or HUNTERs canal

Muscles ADDUCTORS

o Boundaries:

a. Gracilis

Anterior/Roof: SARTORIUS

Posterior:

ADDUCTOR

LONGUS

and

Most medial side and WEAKEST muscle

b. Pectineus

MAGNUS

c. Adductor longus

Lateral: VASTUS MEDIALIS

d. Adductor magnus
-

o Contents:

Most powerful adductor

e. Adductor brevis

Femoral artery

F. vein

Saphenous nerve

Innervation: OBTURATOR nerve

Nerve to v. medialis

Blood supply: PROFUNDA FEMORIS a. and OBTURATOR

f. Obturator externus

a.
o Note: Nerves DO NOT PASS through adductor hiatus

9. ADDUCTOR HIATUS
o Opening in the tendon of ADDUCTOR MAGNUS

PES ANSERINUS
o

o Passage of femoral artery and vein and certain nerves

o Femoral vessels then becomes popliteal vessels

Conjoined

tendon

of

the

gracilis,

sartorius

and

semitendinosus
o

Synergy in adduction, flexion and medial rotation of the thigh

J. POSTERIOR Compartment of the Thigh

Boundaries
o

POPLITEAL FOSSA

Muscles

Superomedial: Semitendinosus, Semimembranosus

Superolateral: Biceps femoris

HAMSTRING muscles

Biceps femoris (long head)

Inferior: Two heads of Gastrocnemius

Semitendinosus

Roof: Popliteal fascia (continuation of deep fascia of

Semimembranosus

Adductor Magnus

thigh and leg)

Criteria for Hamstring muscles

Contents of Popliteal fossa

o

Popliteal artery

Origin should be ischial tuberosity

Popliteal vein

Should insert into either tibia or fibula

Tibial nerve (bigger) tibia

Nerve supply should be from tibial portion of sciatic

Common fibular nerve

nerve

CLINICAL CORRELATIONS

Biceps femoris (short head) is NOT a part of the hamstring muscles

because its nerve supply comes from the common peroneal branch of
the sciatic nerve

Origin is from LINE ASPERA

1. WADDLING GAIT
o

Caused by the paralysis of the ABDUCTORS of the thigh

Most common: injury to SUPERIOR GLUTEAL nerve

Sags on the unsupported limb

2. KNEE-JERK REFLEX

Common origin: ISCHIAL TUBEROSITY

Tapping the PATELLAR TENDON

Innervation: SCIATIC nerve

FEMORAL nerve

Blood supply: FEMORAL artery