Deep gluteal space anatomy and its relationship with deep gluteal pain syndromes

Abstract

Introduction: Increasing interest has been seen in understanding the anatomy and biomechanics involved in the Deep Gluteal Syndrome, therefore the main objective of our paper was to define the anatomy of the deep gluteal space concerning the important osseous, muscular and neurological structures. Methods: 12 cadaveric models (24 hemipelvises) were used. We proceeded with classical anatomic dissection and evaluated numerous osseous, musculotendinous and neurologic structures and their relationships. We also determined the femoral anteversion and neck-shaft angles. Results: We found that 15.4% of lower limbs examined presented variations in the sciatic nerve (SN) emergence, and this was significantly longer in men. The distance from the SN to the trochanteric region was also significantly lower in males. The average ischiofemoral distance (IFD) was 2.5 ± 1.3 cm, at the same time that the structures comprised in that space showed superior areas, such as the quadratus femoris (QF) with 5.0 ± 1.1 cm and the SN with 1.4 ± 0.3 cm widths. Besides that, we also evaluated the distance from the SN to the lesser trochanter (LT) and the ischial tuberosity (IT), in the ischiofemoral space, reaching average values of 1.1 ± 0.7 cm and 1.5 ± 0.6 cm respectively. Regarding the relationship between the proximal hamstring insertion, we verified that the LT was at an average distance of 1.6 ± 1.1 cm, that the SN was only 0.2 ± 0.3 cm lateral to it, and the PN is just 2.6 ± 1.2 cm proximal to it. Conclusions: Our study confirmed the extreme variation in the SN origin that can contribute to the Piriformis syndrome. The IFD obtained in our study showed that this distance was small for the structures contained in this space. The proximal hamstring insertion showed a significantly more extended footprint in males, which puts the pudendal nerve (PN) at higher risk of iatrogenic injury.

An anatomical approach to the Tarsal Tunnel Syndrome: What can ankle’s medial side anatomy reveal us?

“…3). (12,13) Then, the neurovascular bundle was identi ed. The vascular structures were isolated and, whenever necessary, carefully pushed apart, without cutting it off, in order better identify and dissect the nervous structures (TN, LPN, MPN, BN, MCN) without moving it from its proper position (Fig.…”

An anatomical approach to the tarsal tunnel syndrome: what can ankle's medial side anatomy reveal to us?

“…As routine in our Unit, appropriate dissection techniques were performed by using proper dissection tools in order to achieve the objectives of the study [12][13][14]. The specimens were placed in a supine position and the medial side of the distal part of the leg, ankle and foot were carefully dissected in order not to disturb the normal anatomy of the medial region of the ankle [15].…”

Deep Gluteal Pain in Orthopaedics: A Challenging Diagnosis

“…It then weaves between the sacrospinous and sacrotuberous ligaments, which may act to entrap the nerve in a lobster claw fashion, about 2 to 3 cm from the superior and medial aspects of the proximal hamstring origin on the ischial tuberosity. 9 Damage to the pudendal nerve most often results in anal and penile/clitoral pain that can radiate into the buttock or medial hamstring, is made worse by sitting, and can lead to sexual dysfunction.…”

“…The boundaries of the deep gluteal space include (1) anteriorly, the posterior acetabular column and hip joint capsule; (2) posteriorly, the gluteus maximus muscle; (3) laterally, the gluteal tuberosity, (4) medially, the sacrotuberous ligament; (5) superiorly, the inferior margin of the sciatic notch, and (6) inferiorly, the proximal origin of the hamstrings at ischial tuberosity. In addition, the sciatic nerve (7), pudendal nerve (8), superior gluteal nerve, (9) and posterior cutaneous nerve of the thigh (10) are depicted. sacrospinous and sacrotuberous ligaments, which may act to entrap the nerve in a lobster claw fashion, about 2 to 3 cm from the superior and medial aspects of the proximal hamstring origin on the ischial tuberosity.…”