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ADVANCED ANATOMY 2ND. ED.

CONTENTS

Pelvis

Nerves, Blood Vessels and

Lymph
Nerves, Blood Vessels and Lymph of the Gluteal Region

Nerves of the Gluteal Region

Originating from the sacral plexus (L4 – S4), there are a number of signi -
cant nerves that either directly innervated the buttocks or pass through the
gluteal region to innervate more inferior regions such as the perineum and
thigh.

These nerves can be categorized into the super cial (clunial nerves) that
provide sensation to the skin of the gluteal region, and the seven deep
gluteal nerves (superior gluteal nerve, inferior gluteal nerve, sciatic nerve,
nerve to quadratus femoris, posterior cutaneous nerve of the thigh, nerve to
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obturator internus, and the pudendal nerve) that either directly innervate
gluteal structures or continue their course inferiorly to other regions.
Next: Clinical Conditions
Super cial Gluteal Nerves:

The Clunial Nerves

The most super cial nerves of the gluteal region are the inferior, middle
and superior clunial nerves. They provide sensation within the borders of
the iliac crest, between the posterior superior iliac spine and the iliac
tubercles.

The superior clunial nerve originates from the posterior rami L1 – L3 spinal
nerves of the lumbosacral plexus, spans inferolaterally across the iliac crest
and supplies the skin of the superior buttocks.

The middle clunial nerves originates from the posterior rami of S1 -S3 spinal
nerves of the sacral plexus, travels through the sacral formina and spreads
laterally surface to supply the skin of the sacrum and skin close to the inter-
gluteal cleft of the buttocks.

The inferior clunial nerve originates from the posterior rami of S2 – S3 spinal
nerves of the sacral plexus, exiting at the inferior border of the gluteus max-
imus muscle before travelling in a superior direction to supply the inferior
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half of the buttocks to the level of the greater trochanter.
Next: Clinical Conditions
Deep Gluteal Nerves:

The seven deep gluteal nerves all originate via the lumbosacral plexus or
sacral plexus, all exit the pelvic region through the greater sciatic foramen
and with the exception of the superior gluteal nerve, all travel through the
infrapiriform foramen (inferior to the piriformis) to innervate gluteal regions
or other inferior structures.

Superior Gluteal Nerve

The superior gluteal nerve originates from the posterior divisions of anterior
rami L4 – S1 spinal nerves of the sacral plexus. It enters the gluteal region via
the greater sciatic foramen superior to the piriformis (suprapiriform fora-
men) and travels in a lateral fashion along-side the deep branch of the supe-
rior gluteal artery between the gluteus minimus and gluteus medius mus-
cle. The superior gluteal nerve further branches into a superior branch that
supplies the gluteus medius muscle, and an inferior branch that supplies
both the gluteus medius, gluteus minimus and the tensor fasciae latae.

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Inferior Joints, Ligaments
Gluteal Nerve and Connective Tissues
Next: Clinical Conditions
The inferior gluteal nerve originates from the posterior division of anterior
rami L5 – S2 spinal nerves of the sacral plexus. It enters the gluteal region via
the greater sciatic foramen inferior to the piriformis (infrapiriform foramen).
The inferior gluteal nerve travels closely with the branches of the inferior
gluteal artery and inferior gluteal vein and super cially to the sciatic nerve
before dividing into multiple branches that course to innervate the super -
cial gluteus maximus.

Sciatic Nerve

Although the sciatic nerve does not supply any of the gluteal musculature,
because of its relationship to the piriformis and individual variability in its
course, it is an important structure implicated in the clinical condition
known as piriformis syndrome (see Pelvic Clinical Conditions).

Nerve to Quadratus Femoris

The nerve to quadratus femoris originates from the anterior division of ante-
rior rami L4 – S1 spinal nerves of the sacral plexus. Travelling through the in-
frapiriform foramen to exit the pelvis, the nerve to quadratus femoris cour-
ses deep to the sciatic nerve, before passing over the posterior aspect of the
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hip joint to innervate both the quadratus femoris muscle and inferior
gemellus. Next: Clinical Conditions
Posterior Cutaneous Nerve of the Thigh

The posterior cutaneous nerve of the thigh originates from the anterior and
posterior divisions of anterior rami S1 – S3 spinal nerves of the sacral plexus.
The posterior divisions of the anterior rami S1 and S2 innervate the skin of
the inferior half of the buttocks via the inferior clunial nerves.

Nerve to Obturator Internus

The nerve to obturator internus originates from the posterior divisions of an-
terior rami L5 – S2 spinal nerves of the sacral plexus. Recalling the unique
course of the obturator internus muscle, the nerve travels through the in-
frapiriform foramen to wrap around the ischial spine where it innervates the
superior gemellus, and then courses through the lesser sciatic foramen into
the perineum to innervate obturator internus.

The Pudendal Nerves

The pudendal nerve does not innervate any muscles in the gluteal region,
but is sometimes included with the deep gluteal nerves because of its path
through through the pelvis coursing through the infrapiriform foramen. See
below sections for further information on the pudendal nerves.

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Next: Clinical Conditions

NERVES OF THE GLUTEAL REGION
Nerve Origin Course Innervation

Posterior rami of Travel in an Supply skin of

Clunial – superior L1 – L3 spinal inferolateral superior
nerves direction across buttocks
the iliac crest
Exit via sacral Supply skin over
Posterior rami of foramina and sacrum and
Clunial – middle S1 – S3 spinal pass travel adjacent area of
nerves laterally to buttocks
gluteal region
Travels from Supply skin of
Anterior rami of inferior gluteus inferior half of
Clunial – inferior S2 – S3 spinal maximus border buttocks as far as
nerves and ascends greater
super cially to trochanter
gluteus maximus
Supplies no
Enters via gluteal muscles,
Sacral plexus L4 greater sciatic but is an
Sciatic – S3 spinal foramen inferior important nerve
nerves to piriformis and of the gluteal
deep to gluteus region due to its
maximus relationship to
piriformis
Enters via Supplies inferior
Posterior greater sciatic lower half of
cutaneous nerve Sacral plexus S1 – foramen inferior buttocks via
of thigh S3 spinal nerves to piriformis and inferior clunial
deep to gluteus nerves
maximus
Enters via
greater sciatic
foramen superior
to piriformis; Innervates
Sacral plexus L4 travels laterally gluteus medius,
Superior gluteal – S1 spinal nerves between gluteus gluteus minimus
medius and and tensor
minimus and fasciae latae
terminates its
course at tensor
fasciae lata
Enters via
greater sciatic
Inferior gluteal Sacral plexus L5 – foramen inferior Gluteus
S2 spinal nerves to piriformis and maximus
deep to inferior
gluteus maximus

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Next: Clinical Conditions

 Enters via
Nerve to greater sciatic Hip joint, inferior
quadratus Sacral plexus L4 foramen inferior gemellus, and
femoris – S1 spinal nerves to piriformis, quadratus
deep to sciatic femoris
nerve
Exits pelvis via
greater sciatic
Nerve to foramen inferior Supplies superior
obturator Sacral plexus L5 – to piriformis; gemellus and
internus S2 spinal nerves descends obturator
posterior to internus
sacrospinous
ligament

Blood Vessels of the Gluteal Region

Arteries of the Gluteal Region

The major arteries that supply the gluteal region are the superior gluteal
artery and the inferior gluteal artery. Both of these arteries bifurcate via the
internal iliac arteries.

The largest branch to bifurcate from the internal iliac artery, the superior
gluteal artery divides further after its course through the suprapiriform fora-
men into a super cial branch that supplies the gluteus maximus and an in-
ferior branch that supplies the gluteus minimus, gluteus medius and the
tensor fasciae latae.

The inferior gluteal artery also originating via the internal iliac arteries, de-
scends through the infrapiriform foramen travelling deep the gluteus max-
imus and medial to the sciatic nerve. This artery is responsible for supplying
the gluteus maximus, obturator internus, quadratus femoris, and proximal
bers of the hamstrings.

Veins of the Gluteal Region

The superior and inferior gluteal veins arise from the internal iliac veins and
parallel the course of the superior gluteal artery and inferior gluteal artery
through the suprapiriform foramen and the infrapiriform foramen to drain
blood from the gluteal region. As a safety mechanism the gluteal veins con-
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nect with femoral vein tributaries to provide an alternate path for blood re-
turn if the femoral vein becomes occluded. Next: Clinical Conditions
Posterior View of the Nerves and Arteries of the Gluteal Region

Nerve Innervation of the Pelvic Floor

The pelvic oor muscles are innervated through somatic, visceral, and cen-
tral pathways. The pudendal nerves pass through the pudendal canal. The
main nerve that innervates the pelvic oor is the pudendal nerve that arises
from the ventral branches S2-S4 of the sacral plexus. The pudendal canal is
located through the lateral wall of the ischiorectal fossa. The nerves and ves-
sels are surrounded by a fascia sheath. The pudendal nerve is derived from
the second, third, and fourth sacral spinal nerves. The nerve exits the pelvis
through to the gluteal region between piriformis and coccygeus through
the greater sciatic foramen and crossing through the sacrospinous ligament
close to the attachment spot to the ischial spine. It then divides into the dor-
sal and perineal nerve of the penis or clitoris.

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Next: Clinical Conditions

Blood Supply of the Pelvic Floor:

Arteries of the Pelvic Floor

The pelvic oor is supplied by the common iliac artery that branches from
the aorta. The common iliac artery supplies the pelvic organs and the lower
limbs. The common iliac artery then branches into the external iliac artery
and internal iliac artery which supplies the pelvic organs, pelvic walls, but-
tocks, medial thighs and perineum. The internal pudendal artery is a
branch from the internal iliac artery that leaves the pelvic cavity and sup-
plies the perineum and pelvic oor.

Veins of the Pelvic Floor

The pelvic oor is drained by the veins of the pelvic oor, including the ex-
ternal iliac vein, the internal iliac vein and the common iliac vein. These
three veins correspond with the three major pelvic artier. A condition re-
ferred to as pelvic congestion syndrome occurs when blood builds within
the veins of the pelvic region (refer to Pelvic Clinical Conditions).

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Next: Clinical Conditions

 Previous: Joints, Ligaments and Connective Tissues
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Advanced Anatomy 2nd. Ed. by PHED
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