Monday, September 14, 2009

Superficial Anatomy of Buttock

Activity 1: Bones
1.1
Ilium, ischium, pubis
1.1.1
Ischium
1.1.1.1
Posterior division of anterior rami.

1.2


1.2.1.1
Bone marrow harvesting
1.2.2.1
Tensor of fascia latae, sartorius
1.2.3.1
A contusion (bruise) on the pelvis caused by a direct blow to an iliac crest. It usually causes bleeding into the hip abductor muscles, which move legs sideways, away from the midline of the body. This bleeding into muscle tissue creates swelling and makes leg movement painful. The injury usually last from one to six weeks, depending on the damage.

1.2.7.1
Superior gemelli
1.2.8.1
Sacrotuberous ligament, sacrospinous ligament and ischial spine. The sacrotuberous ligament extends across the sciatic notch converting the notch into a foramen that is further subdivided by the sacrospinous ligament and ischial spine into the greater and lesser sciatic foramen.
1.2.9.1
It is the site where the body’s weight rests on.
1.2.9.2
Inferior part of buttock when thigh is flexed.
1.2.9.3
The sciatic nerve extends from a point midway between the greater trochanter and the ischial tuberosity down the middle of the posterior aspect of the thigh. Hamstrings, biceps femoris and semitendinosus which attach proximally to the ischial tuberosity may avulse.

1.2.12.1
Inguinal ligament and indirect muscle attachments.
1.2.12.2
Provides the landmark for palpation of femoral pulse. By placing the tip of the little finger (of the right hand when dealing with the right side) on the ASIS and the tip of the thumb on the pubic tubercle, the femoral pulse can be palpated with the midpalm just inferior to the midpoint of the inguinal ligament by pressing firmly.

1.3.1
Obturator nerve and obturator artery.
1.3.2
Inferior epigastric artery.
1.3.2.1
Could be involved in strangulated femoral hernia. Surgeons placing staples during endoscopic repair of both inguinal and femoral hernias must be careful.

Activity 2: Muscles & Fascia



2.1.1
Proximal: ASIS, anterior part of iliac crest
Distal : Iliotibial trac, which attaches to lateral condyle of tibia.
2.1.2
Gluteus maximus.
2.1.3
Superior gluteal nerve( L5,S1)

2.2.1
Trochanteric bursa , the ischial bursa and gluteofemoral bursa.

2.2.2
Separate the gluteus maximus from adjacent structures, reduce friction and permit free movement.

2.2.3
A type of friction bursitis resulting from excessive friction between the ischial bursa and ischial tuberosities.

2.2.3.1
Recurrent mcirotrauma resulting from repeated stress eg : cycling, rowing or other activities involving hip extension while seated.


2.3.1
Superior gluteal nerve
2.3.2
Abduct and medially rotate thigh: keep pelvis level when ipsilateral limb is weight-bearing and advance opposite side during swing phase.

Activity 3: Vessels
3.1
Superior and inferior gluteal arteries.
3.2
Internal iliac artery which is a branch of the common iliac artery
3.2.1


Activity 4: Nerves
4.1 Inferior gluteal nerve
4.1.1
Compression and ischemia in sedentary individuals.
4.1.2
Difficulty in rising from seated position and climbing stairs.

4.2
Injections into the buttock are safe only in the superolateral quadrant of the buttock or superior to a line extending from the PSIS to the superior border of the greater trochanter (approximating the superior border of the gluteus maximus). IM injections can also be given safely into the anterolateral part of the thigh, where the needle enters the tensor fasciae latae as it extends distally from the iliac crest and ASIS. The index finger is placed on the ASIS, and the fingers are spread posteriorly along the iliac crest until the tubercle of the crest is felt by the middle finger . An IM injection can be made safely in the triangular area between the fingers (just anterior to the proximal joint of the middle finger) because it is superior to the sciatic nerve.

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