Gluteus Medius: Difference between revisions

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= Description =
The gluteus medius is one of three gluteal muscles (minimus, medius and [[Gluteus Maximus|maximus]]). It is a superficial, fan shaped and broad muscle that lies in the posterolateral aspect of the pelvis, inferior to the iliac crest.<ref name="Palastanga et al, 2002">Palastanga N, Field D, Soames R. Anatomy and Human Movement, Structure and Function. 4th ed. Edinburgh: Butterworth Heinemann; 2002.</ref> The gluteus medius has a broad origin on the external (gluteal) ilium and its tendon inserts into the lateral aspect of the greater trochanter.<ref name="Drake et al, 2010">Drake RL, Vogl AW, Mitchell, AWM. Gray's Anatomy for Students. 2nd ed. Philadelphia: Churchill Livingstone; 2010.</ref> The muscle is overlapped by the gluteus maximus and covered with a strong layer of fascia.<ref name="Palastanga et al, 2002" />
= Anatomy  =
= Anatomy  =


The gluteus medius is one of three gluteal muscles (minimus, medius and [[Gluteus Maximus|maximus]]). It is a superficial, fan shaped and broad muscle that lies in the posterolateral aspect of the pelvis, inferior to the iliac crest.<ref name="Palastanga et al, 2002">Palastanga N, Field D, Soames R. Anatomy and Human Movement, Structure and Function. 4th ed. Edinburgh: Butterworth Heinemann; 2002.</ref> The gluteus medius has a broad origin on the external (gluteal) ilium and its tendon inserts into the lateral aspect of the greater trochanter.<ref name="Drake et al, 2010">Drake RL, Vogl AW, Mitchell, AWM. Gray's Anatomy for Students. 2nd ed. Philadelphia: Churchill Livingstone; 2010.</ref> The muscle is overlapped by the gluteus maximus and covered with a strong layer of fascia.<ref name="Palastanga et al, 2002" /><br>  
=== Origin ===
 
External (gluteal) surface of ilium between anterior and posterior gluteal lines.<ref name="Palastanga et al, 2002" /> Reaches from iliac crest superiorly and as far as the sciatic notch inferiorly.<ref name="Palastanga et al, 2002" /> Superficial to gluteus maximus.<ref name="Drake et al, 2010" /><br>  
===
 
Lateral surface of greater trochanter.<ref name="Drake et al, 2010" /> A bursa seperates the tendon from the greater trochanter.<ref name="Diop et al, 2002">Diop M, Parratte B, Tatu L, Vuillier F, Faure A, Monnier G. Anatomical bases of superior gluteal nerve entrapment syndrome in the piriformis foramen. Surg Radiol Anat 2002; 24: 155-9.</ref><br>  


[[Image:Gluteus Medius.PNG|frame|right|200px|Gluteus Medius]]<br>
=== Nerve supply  ===


'''Origin:''' External (gluteal) surface of ilium between anterior and posterior gluteal lines.<ref name="Palastanga et al, 2002" /> Reaches from iliac crest superiorly and as far as the sciatic notch inferiorly.<ref name="Palastanga et al, 2002" /> Superficial to gluteus maximus.<ref name="Drake et al, 2010" /><br>  
The Superior Gluteal Nerve (SGN) supplies the gluteus medius. The SGN originates at the sacral plexus at levels L4, L5 &amp; S1.<ref name="Kenny et al, 1999">Kenny P, O’Brien CP, Synnott K, Walsh MG. Damage to the superior gluteal nerve after two different approaches to the hip. J Bone Joint Surg Br 1999; 81: 979-81.</ref> The SGN divides into several branches, supplying both the gluteus medius and minimus as it passes horizontally between them both, prior to terminating at the tensor facsia latae.<ref name="Kenny et al, 1999" /><br>  


'''Insertion:''' Lateral surface of greater trochanter.<ref name="Drake et al, 2010" /> A bursa seperates the tendon from the greater trochanter.<ref name="Diop et al, 2002">Diop M, Parratte B, Tatu L, Vuillier F, Faure A, Monnier G. Anatomical bases of superior gluteal nerve entrapment syndrome in the piriformis foramen. Surg Radiol Anat 2002; 24: 155-9.</ref><br>
=== Blood Supply  ===


'''Nerve:''' The Superior Gluteal Nerve (SGN) supplies the gluteus medius. The SGN originates at the sacral plexus at levels L4, L5 &amp; S1.<ref name="Kenny et al, 1999">Kenny P, O’Brien CP, Synnott K, Walsh MG. Damage to the superior gluteal nerve after two different approaches to the hip. J Bone Joint Surg Br 1999; 81: 979-81.</ref> The SGN divides into several branches, supplying both the gluteus medius and minimus as it passes horizontally between them both, prior to terminating at the tensor facsia latae.<ref name="Kenny et al, 1999" /><br>  
Superior gluteal artery and superior gluteal vein.<ref name="Drake et al, 2010" />  


'''Blood Supply:''' Superior gluteal artery and superior gluteal vein.<ref name="Drake et al, 2010" />
= Function  =


[[Image:Gluteal Nerve (Sacral Plexus).png|thumb|center|Superior Gluteal Nerve (Nerve Root L4, L5 & S1) - Sacral Plexus]]
The gluteus medius and minimus are strong abductors and medial rotators of the hip joint.<ref name="Drake et al, 2010" /> A contraction of the anterior fibers results in flexion and inward rotation and a contraction of the posterior fibers results in extension and external rotation.<ref name="Gowda et al, 2014">Gowda AL, Mease SJ, Donatelli R, Zelicof S. Gluteus medius strengthening and the use of the Donatelli Drop Leg Test in the athlete. Physical Therapy in Sport 2014; 15(1) 15-19.</ref> Altogether they play an important role in the stabilization of the pelvis. Abnormality of this muscle can cause Trendelenburg’s sign.<br>


[[Image:Dermatomes.PNG|thumb|center|Dermatomes (Gluteal Region: L1 & L2)]]<br>  
Tears in the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis, have recently emerged as an important cause of recalcitrant greater trochanter pain syndrome. Advances in endoscopic surgery of the hip have created opportunities to better evaluate and treat pathology in the peritrochanteric compartment.<ref>Domb BG1, Nasser RM, Botser IB.Partial-thickness tears of the gluteus medius: rationale and technique for trans-tendinous endoscopic repair.Arthroscopy. 2010 Dec;26(12):1697-705</ref>&nbsp;<ref>El-Husseiny M1, Patel S, Rayan F, Haddad F.Gluteus medius tears: an under-diagnosed pathology.Br J Hosp Med (Lond). 2011 Jan;72(1):12-6.</ref>


= Palpation =
= Assessment =


Find the centre of the iliac crest (directly above the greater trochanter of the femur) and palpate inferiorly two fingers breadth to find the bulk of the muscle.<ref name="Palastanga et al, 2002" /> To isolate in function, stand alternatively on one limb and then the other, feeling the muscle contract as you weight-bear through that limb.<ref name="Palastanga et al, 2002" /> The muscles will contract alternatively during walking, switching on during stance phase to stabilise the pelvis.
=== Palpation ===


<br>  
Find the centre of the iliac crest (directly above the greater trochanter of the femur) and palpate inferiorly two fingers breadth to find the bulk of the muscle.<ref name="Palastanga et al, 2002" /> To isolate in function, stand alternatively on one limb and then the other, feeling the muscle contract as you weight-bear through that limb.<ref name="Palastanga et al, 2002" /> The muscles will contract alternatively during walking, switching on during stance phase to stabilise the pelvis.<br>  


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= Function  =
=== Power ===
 
=== Length ===
 
= See also =
 
 


The gluteus medius and minimus are strong abductors and medial rotators of the hip joint.<ref name="Drake et al, 2010" /> A contraction of the anterior fibers results in flexion and inward rotation and a contraction of the posterior fibers results in extension and external rotation.<ref name="Gowda et al, 2014">Gowda AL, Mease SJ, Donatelli R, Zelicof S. Gluteus medius strengthening and the use of the Donatelli Drop Leg Test in the athlete. Physical Therapy in Sport 2014; 15(1) 15-19.</ref> Altogether they play an important role in the stabilization of the pelvis. Abnormality of this muscle can cause Trendelenburg’s sign.<br>


Tears in the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis, have recently emerged as an important cause of recalcitrant greater trochanter pain syndrome. Advances in endoscopic surgery of the hip have created opportunities to better evaluate and treat pathology in the peritrochanteric compartment.<ref>Domb BG1, Nasser RM, Botser IB.Partial-thickness tears of the gluteus medius: rationale and technique for trans-tendinous endoscopic repair.Arthroscopy. 2010 Dec;26(12):1697-705</ref>&nbsp;<ref>El-Husseiny M1, Patel S, Rayan F, Haddad F.Gluteus medius tears: an under-diagnosed pathology.Br J Hosp Med (Lond). 2011 Jan;72(1):12-6.</ref>


== Recent Related Research (from Pubmed)  ==
== Recent Related Research (from Pubmed)  ==

Revision as of 18:03, 19 February 2016

Original Editor - Alex Palmer,

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Description[edit | edit source]

The gluteus medius is one of three gluteal muscles (minimus, medius and maximus). It is a superficial, fan shaped and broad muscle that lies in the posterolateral aspect of the pelvis, inferior to the iliac crest.[1] The gluteus medius has a broad origin on the external (gluteal) ilium and its tendon inserts into the lateral aspect of the greater trochanter.[2] The muscle is overlapped by the gluteus maximus and covered with a strong layer of fascia.[1]

Anatomy[edit | edit source]

Origin[edit | edit source]

External (gluteal) surface of ilium between anterior and posterior gluteal lines.[1] Reaches from iliac crest superiorly and as far as the sciatic notch inferiorly.[1] Superficial to gluteus maximus.[2]

===

Lateral surface of greater trochanter.[2] A bursa seperates the tendon from the greater trochanter.[3]

Nerve supply[edit | edit source]

The Superior Gluteal Nerve (SGN) supplies the gluteus medius. The SGN originates at the sacral plexus at levels L4, L5 & S1.[4] The SGN divides into several branches, supplying both the gluteus medius and minimus as it passes horizontally between them both, prior to terminating at the tensor facsia latae.[4]

Blood Supply[edit | edit source]

Superior gluteal artery and superior gluteal vein.[2]

Function[edit | edit source]

The gluteus medius and minimus are strong abductors and medial rotators of the hip joint.[2] A contraction of the anterior fibers results in flexion and inward rotation and a contraction of the posterior fibers results in extension and external rotation.[5] Altogether they play an important role in the stabilization of the pelvis. Abnormality of this muscle can cause Trendelenburg’s sign.

Tears in the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis, have recently emerged as an important cause of recalcitrant greater trochanter pain syndrome. Advances in endoscopic surgery of the hip have created opportunities to better evaluate and treat pathology in the peritrochanteric compartment.[6] [7]

Assessment[edit | edit source]

Palpation[edit | edit source]

Find the centre of the iliac crest (directly above the greater trochanter of the femur) and palpate inferiorly two fingers breadth to find the bulk of the muscle.[1] To isolate in function, stand alternatively on one limb and then the other, feeling the muscle contract as you weight-bear through that limb.[1] The muscles will contract alternatively during walking, switching on during stance phase to stabilise the pelvis.

Power[edit | edit source]

Length[edit | edit source]

See also[edit | edit source]

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Palastanga N, Field D, Soames R. Anatomy and Human Movement, Structure and Function. 4th ed. Edinburgh: Butterworth Heinemann; 2002.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Drake RL, Vogl AW, Mitchell, AWM. Gray's Anatomy for Students. 2nd ed. Philadelphia: Churchill Livingstone; 2010.
  3. ↑ Diop M, Parratte B, Tatu L, Vuillier F, Faure A, Monnier G. Anatomical bases of superior gluteal nerve entrapment syndrome in the piriformis foramen. Surg Radiol Anat 2002; 24: 155-9.
  4. ↑ 4.0 4.1 Kenny P, O’Brien CP, Synnott K, Walsh MG. Damage to the superior gluteal nerve after two different approaches to the hip. J Bone Joint Surg Br 1999; 81: 979-81.
  5. ↑ Gowda AL, Mease SJ, Donatelli R, Zelicof S. Gluteus medius strengthening and the use of the Donatelli Drop Leg Test in the athlete. Physical Therapy in Sport 2014; 15(1) 15-19.
  6. ↑ Domb BG1, Nasser RM, Botser IB.Partial-thickness tears of the gluteus medius: rationale and technique for trans-tendinous endoscopic repair.Arthroscopy. 2010 Dec;26(12):1697-705
  7. ↑ El-Husseiny M1, Patel S, Rayan F, Haddad F.Gluteus medius tears: an under-diagnosed pathology.Br J Hosp Med (Lond). 2011 Jan;72(1):12-6.
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