Lab Manual - Gluteal Region, Posterior Thigh & Hip

Learning Objectives:

Upon completion of this session, the student will be able to:

  1. Describe the anatomy of the lateral femoral (hip) region, including the gluteal muscles, their nerve supply, and their actions in locomotion. (explanation)
  2. Identify the sacral plexus, its general plan, and its major branches in the hip and posterior thigh regions. (explanation)
  3. Describe the muscular anatomy of the posterior thigh, its muscles, their nerve supply, and their actions in locomotion. (explanation)
  4. Predict the functional loss and cutaneous areas affected by a given nerve injury to the hip and posterior thigh region; or conversely, given a functional and/or cutaneous loss, be able to predict which nerve or nerves are involved and the probable level of the injury. (explanation)
  5. Define the popliteal fossa and give the spatial relationships of its contents. (explanation)
  6. Recall the general plan of the collateral circulation at the hip and knee. (explanation)
  7. Identify the bony, cartilagenous, ligamentous and membranous components of the hip joint. (explanation)
  8. Correlate hip joint movements with the muscles producing these actions. (explanation)
  9. Describe the functional capabilities and limitations of the hip based on its bony structure and ligaments. (explanation)

Readings and Modules:

Procedure:

1. Review the bony landmarks. (Play movie; View images: N 353, 354, 486, 489, 503, 512, TG 6-04A, 6-04B, 3-05, 6-06, 3-07, 3-09)

Identify on the skeleton: obturator foramen and groove, the greater sciatic notch (foramen), spine of the ischium, the lesser sciatic notch (foramen), ischial tuberosity. Locate the sacroiliac articulation. The sacrotuberal and sacrospinal ligaments help to form the greater and lesser sciatic foramina. On the femur, locate the lesser and greater trochanters, gluteal tuberosity, intertrochanteric crest, trochanteric fossa of femur.

 

Bony structures of the hip

2. Define the gluteus maximus and reflect it laterally. (Play movie; View images: N 490, 491, 494, 495, 502, 503, TG 3-12, 3-13, 3-17, 3-26A, 3-26B, 3-28)

Clear the gluteal region of all superficial fascia. Define the gluteus maximus fascia and the gluteal aponeurosis covering the gluteus medius muscle. Define the gluteus maximus muscle. Reflect the muscle laterally from its origin on the sacrum and sacrotuberous ligament to expose the deeper structures. Care must be taken in removing it from the sacrotuberous ligament to not remove the ligament. Cut along its superior border to separate the gluteus maximus from the gluteal aponeurosis covering the gluteus medius. In reflecting the muscle do not injure deeper structures along its inferior border, especially the sacrotuberal ligament, the posterior femoral cutaneous and sciatic nerves. Note that most of the muscle is enclosed within the deep fascia. Now locate the tensor fasciae latae muscle. Slit open the fascia lata vertically and expose the muscle. Note that both gluteus maximus and tensor fasciae latae insert via the iliotibial tract of the fascia lata. Where does this attach? Now observe the other insertion of gluteus maximus into the gluteal tuberosity.

3. Reflect the gluteus medius and examine the superior gluteal vessels and nerve. (Play movie; View images: N 503, 512, TG 3-25A, 3-25B, 3-26, 3-27, 3-28, 6-17)

Remove the gluteus medius fascia as far anterior as the anterior superior iliac spine. Trace the muscle to its insertion. Locate the superior gluteal artery and nerve coursing deep to the gluteus medius muscle; what is their source? This plane can be used to separate the gluteus medius from the underlying gluteus minimus. Reflect the gluteus medius from its origin and define the gluteus minimus. Trace the superior gluteal artery and nerve to the muscles supplied, including the tensor fasciae latae. What is the innervation and blood supply to gluteus maximus? Now consider the insertions and actions of the gluteal muscles.

4. Define the greater and lesser sciatic foramina and the structures traversing each. (Play movie; View images: N 353, 398, 402, 411, 495, 497, 499, 502, 503, TG 3-07, 3-25A, 3-25B, 3-26, 3-27, 3-28, 6-06, 6-17, 6-30)

Locate the piriformis muscle and trace it to its insertion. Through what foramen does it exit the pelvis? Note its relation to the superior gluteal neurovascular bundle and to the inferior gluteal artery, vein and nerve and sciatic nerve.

Define the obturator internus tendon and trace to its insertion. Through what foramen does it pass? Define the superior and inferior gemellus muscles. Inferior to the inferior gemellus muscle, locate and define the quadratus femoris muscle. What major action do these muscles have in common?

Trace the sciatic nerve into the thigh, noting relations to the hip muscles. Review the posterior femoral cutaneous nerve. Identify the inferior gluteal nerve to the gluteus maximus.

Clean the sacrotuberal ligament; is there a perforating cutaneous nerve and artery associated with it? Reflect the ligament from the ischial tuberosity and identify the following as they lie on the sacrospinal ligament: pudendal nerve, the internal pudendal artery and vein, and the nerve to obturator internus and superior gemellus. Note that there is usually a web of fascia extending between the two ligaments, which must be removed to see the structures clearly. Define the sacrospinal ligament. Note how it and the sacrotuberal ligament form the greater and lesser sciatic foramina. What structures does each transmit? Review the course of the pudendal nerve and internal pudendal artery. Now observe the complete origin and course of the obturator internus muscle. Confirm its innervation.

Review completely the muscles, the nerves supplying them, and the blood supply to the region. Note how the lumbosacral trunk and sacral nerves unite to form the sacral plexus. Consider the formation of the sacral plexus and trace its major branches.

Read about the sacroiliac articulation, noting specifically the bones entering into its formation and how the ligaments support the joint: long and short posterior sacroiliac, interosseous sacroiliac, and anterior sacroiliac ligaments.

5. Dissect the hamstrings from origin to insertion (Play movie; View images: N 492, 495, 502, 540, TG 3-29, 3-57, 3-65, 3-66)

Uncover and dissect the biceps femoris, semitendinosus and semimembranosus muscles. Note the manner of attachment to the ischial tuberosity. Locate the short head of biceps femoris muscle. Note specifically the relation of biceps femoris to the sciatic nerve. Trace semitendinosus to its insertion and complete the dissection of the pes anserinus. Trace the innervation to all muscles. Do you find a branch from the tibial division of the sciatic nerve to adductor magnus; and one from the common fibular division to the short head of biceps?

Arteriogram of lower limb vessels

6. Define the popliteal fossa, clean and identify its contents. (Play movie; View images: N 493, 495, 502, 512, 517, 546, TG 3-29, 3-31A, 3-31B, 3-62, 3-70)

Define the boundaries of the popliteal fossa. Remove the popliteal fascia (part of what fascia?). Identify the muscles bounding the fossa. Clear the fat and identify the tibial nerve and its medial sural cutaneous branch; also identify the common fibular (peroneal) nerve and its lateral sural cutaneous branch. Note the relationship to the biceps femoris tendon as the nerve courses around the neck of the fibula. Now clear the popliteal vein and trace the lesser saphenous vein to its termination. Explore the popliteal artery, the adductor hiatus and the manner in which the vein and artery enter and leave the popliteal fossa. Where exactly is the popliteal fossa located in the lower extremity? Do you find lymph nodes here?

Surface features of the popliteal fossa
Popliteal artery and vein

Remove the popliteal vein and expose the popliteal artery. Identify the muscular branches to hamstrings and sural branches. Then locate the superior medial and superior lateral genicular arteries crossing the heads of origin of the gastrocnemius muscles, but lying directly on the bone. Locate a middle genicular artery entering the posterior side of the knee joint.

7.  Plastinated specimens are available for this dissection. Review joints on plastinated specimens. If you wish to perform joint dissections, you may do so on one limb only.  

The hip joint is dissected by removing the overlying muscles, opening its capsule posteriorly and medially rotating the femur. (Play movie; View images: N 486, 487A, 487B, 487C, 490, 491, 493, 492, 496, 503, 504A, 504B, 539, TG 3-04, 3-12, 3-13, 3-17, 3-21, 3-26, 3-54A, 3-54B, 3-55A, 3-55B, 3-62, 3-64)

Consider the development and fusion of the elements of the hip bone or os coxae. On the skeleton identify the acetabulum, the acetabular notch, the obturator foramen. On the femur identify the head, fovea capitis, the neck, the intertrochanteric line, and intertrochanteric crest, trochanteric fossa, the medial and lateral condyles, the intercondylar fossa, patellar surface, the medial and lateral epicondyles and the notch for the popliteal tendon.  

Carefully remove the iliopsoas, reflecting it to its insertion. Note the iliopectineal bursa beneath the muscle. Does it communicate with the hip joint? http://www.med.umich.edu/lrc/coursepages/m1/anatomy2010/html/images/answer_btn.gif Examine the insertion of psoas major and iliacus (iliopsoas). Remove the adductor muscles and expose the obturator externus. Trace its tendon beneath the neck of the femur into the trochanteric fossa. Action? Innervation? http://www.med.umich.edu/lrc/coursepages/m1/anatomy2010/html/images/answer_btn.gif Reflect this muscle to expose the obturator membrane and the distribution of the obturator artery.

Completely strip all muscles covering the hip joint and expose the iliofemoral, pubofemoral, and ischiofemoral ligaments. Look for the capsule appearing in gaps between these ligaments. Note a bursa (synovial sac) emerging from beneath the ischiofemoral ligament for the obturator externus tendon. Examine the effect of these ligaments in restricting freedom of action of the hip joint. Open the joint posteriorly and examine the zona orbicularis, the acetabular labrum, the transverse acetabular ligament, the ligamentum capitis femoris and the synovial folds of the acetabular notch. Consider blood supply to these articulations. Importance?

 

Updated: 07 Nov 2011