Skip to main content

Gross and Endoscopic Posterior Hip Anatomy

  • Chapter
  • First Online:
Posterior Hip Disorders

Abstract

The deep gluteal space is anterior and beneath the gluteus maximus and posterior to the posterior border of the femoral neck, the linea aspera (lateral), the sacrotuberous and falciform fascia (medial), the inferior margin of the sciatic notch (superior), and the hamstring origin (inferior). Within the deep gluteal space, there are ligamentous, muscular, neurological, and vascular structures of great importance. The objective of this chapter will be to review the complex pertinent aspects of the gross and endoscopic deep gluteal space anatomy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Martin HD, Shears SA, Johnson JC, Smathers AM, Palmer IJ. The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy. 2011;27(2):172–81.

    Article  PubMed  Google Scholar 

  2. Martin HD, Palmer IJ, Hatem MA. Deep gluteal syndrome. In: Nho S, Leunig M, Kelly B, Bedi A, Larson C, editors. Hip arthroscopy and hip joint preservation surgery. New York: Springer; 2014. p. 1–17.

    Google Scholar 

  3. Bierry G, Simeone FJ, Borg-Stein JP, Clavert P, Palmer WE. Sacrotuberous ligament: relationship to normal, torn, and retracted hamstring tendons on MR images. Radiology. 2014;271(1):162–71.

    Article  PubMed  Google Scholar 

  4. Martin HD, Savage A, Braly BA, et al. The function of the hip capsular ligaments: a quantitative report. Arthroscopy. 2008;24:188–95.

    Article  PubMed  Google Scholar 

  5. Hewitt JD, Glisson RR, Guilak F, et al. The mechanical properties of the human hip capsule ligaments. J Arthroplasty. 2002;17:82–9.

    Article  PubMed  Google Scholar 

  6. Loukas M, Louis RG Jr, Hallner B, Gupta AA, White D. Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome. Surg Radiol Anat. 2006;28:163–9.

    Article  PubMed  Google Scholar 

  7. Henry AK. Exposures in the lower limb. In:Extensile exposures. Baltimore: Williams & Wilkins; 1970. p. 180–97.

    Google Scholar 

  8. Testut L, Latarjet A. Anatomía humana. 4th ed. Barcelona: Salvat Editores SA; 1990. p. 660–76.

    Google Scholar 

  9. Pfirrmann CWA, Chung CB, Theumann NH, et al. Greater trochanter of the hip. Attachment of the abductor mechanism and a complex of three bursae – MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers. Radiology. 2001;221:469–77.

    Article  CAS  PubMed  Google Scholar 

  10. Hernando MF, Cerezal L, Pérez-Carro L, Abascal F, Canga A. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiol. 2015;44(7):919–34.

    Article  PubMed  Google Scholar 

  11. Shinohara H. Gemelli and obturator internus muscles: different heads of one muscle? Anat Rec. 1995;243:145–50.

    Article  CAS  PubMed  Google Scholar 

  12. Solomon LB, Lee YC, Callary SA, Beck M, Howie DW. Anatomy of piriformis, obturator internus and obturator externus: implications for the posterior surgical approach to the hip. J Bone Joint Surg Br. 2010;92:1317–24.

    Article  CAS  PubMed  Google Scholar 

  13. Hallin RP. Sciatic pain and the piriformis muscle. Postgrad Med. 1983;74:69–72.

    Article  CAS  PubMed  Google Scholar 

  14. Chen WS. Bipartite piriformis muscle: an unusual cause of sciatic nerve entrapment. Pain. 1994;58:269–72.

    Article  CAS  PubMed  Google Scholar 

  15. Beason LE, Anson BJ. The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Rec. 1937;70:1–5.

    Google Scholar 

  16. Pecina M. Contribution to the etiological explanation of the piriformis syndrome. Acta Anat. 1979;105:181–7.

    Article  CAS  PubMed  Google Scholar 

  17. Roche JJ, Jones CD, Khan RJ, Yates PJ. The surgical anatomy of the piriformis tendon, with particular reference to total hip replacement: a cadaver study. Bone Joint J. 2013;95-B:764–9.

    Article  CAS  PubMed  Google Scholar 

  18. Van der Made AD, Wieldraaijer T, Kerkhoffs GM, Kleipool RP, Engebretsen L, Van Dijk CN, Golano P. The hamstring muscle complex. Knee Surg Sports Traumatol Arthrosc. 2015;23:2115–22.

    Article  PubMed  Google Scholar 

  19. Miller SL, Gill J, Webb GR. The proximal origin of the hamstrings and surrounding anatomy encountered during repair. A cadaveric study. J Bone Joint Surg Am. 2007;89(1):44–8.

    Article  PubMed  Google Scholar 

  20. Garrett WE Jr, Rich FR, Nikolaou PK, Vogler JB 3rd. Computed tomography of hamstring muscle strains. Med Sci Sports Exerc. 1989;21(5):506–14.

    Article  PubMed  Google Scholar 

  21. Beck M, Sledge JB, Gautier E, et al. The anatomy and function of the gluteus minimus muscle. J Bone Joint Surg Br. 2000;82:358–63.

    Article  CAS  PubMed  Google Scholar 

  22. Gottschalk F, Kourosh S, Leveau B. The functional anatomy of tensor fasciae latae and gluteus medius and minimus. J Anat. 1989;166:179–89.

    PubMed  PubMed Central  CAS  Google Scholar 

  23. Bywaters EGL. The bursae of the body. Ann Rheum Dis. 1965;24:215–8.

    Article  CAS  PubMed  Google Scholar 

  24. Duparc F, Thomine JM, Dujardin F, et al. Anatomic basis of the transgluteal approach to the hip-joint by anterior hemimyotomy of the gluteus medius. Surg Radiol Anat. 1997;19:61–7.

    Article  CAS  PubMed  Google Scholar 

  25. Standring S. Gray’s anatomy the anatomical basis of clinical practice. London: Churchill Livingstone Elsevier; 2008.

    Google Scholar 

  26. Akita K, Sakamoto H, Sato T. Arrangement and innervation of the glutei medius and minimus and the piriformis: a morphological analysis. Anat Rec. 1994;238:125–30.

    Article  CAS  PubMed  Google Scholar 

  27. Lavigne P, de Loriot Rouvray TH. The superior gluteal nerve. Anatomical study of its extrapelvic portion and surgical resolution by trans-gluteal approach. Rev Chir Orthop Reparatrice Appar Mot. 1994;80:188–95.

    PubMed  CAS  Google Scholar 

  28. Diop M, Parratte B, Tatu L, et al. Anatomical bases of superior gluteal nerve entrapment syndrome in the piriformis foramen. Surg Radiol Anat. 2002;24:155–9.

    Article  CAS  PubMed  Google Scholar 

  29. Thomine JM, Duparc F, Dujardin F, et al. Abord transglutéal de hanche par hémimyotomie antérieure du gluteus medius. Rev Chir Orthop. 1999;85:520–5.

    PubMed  CAS  Google Scholar 

  30. Apaydin N, Bozkurt M, Loukas M, et al. The course of the inferior gluteal nerve and surgical landmarks for its localization during posterior approaches to hip. Surg Radiol Anat. 2009;31:415–8.

    Article  PubMed  Google Scholar 

  31. Ling ZX, Kumar VP. The course of the inferior gluteal nerve in the posterior approach to the hip. J Bone Joint Surg Br. 2006;88:1580–3.

    Article  CAS  PubMed  Google Scholar 

  32. Smoll NR. Variations of the piriformis and sciatic nerve with clinical consequence: a review. Clin Anat. 2010;23(1):8–17.

    Article  PubMed  Google Scholar 

  33. Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat. 2014;36(3):273–80.

    Article  PubMed  Google Scholar 

  34. Güvençer M, Iyem C, Akyer P, Tetik S, Naderi S. Variations in the high division of the sciatic nerve and relationship between the sciatic nerve and the piriformis. Turk Neurosurg. 2009;19(2):139–44.

    PubMed  Google Scholar 

  35. Hollinshead WH. Anatomy for surgeons: the back and limbs. 3rd ed. Philadelphia: Harper & Row; 1982.

    Google Scholar 

  36. Sunderland S, Hughes ES. Metrical and non-metrical features of the muscular branches of the sciatic nerve and its medial and lateral popliteal divisions. J Comp Neurol. 1946;85:205–22.

    Article  CAS  PubMed  Google Scholar 

  37. Sunderland S, Ray LJ. The intraneural topography of the sciatic nerve and its popliteal divisions in man. Brain. 1948;71:242–73.

    Article  CAS  PubMed  Google Scholar 

  38. Moayeri N, Groen GJ. Differences in quantitative architecture of sciatic nerve may explain differences in potential vulnerability to nerve injury, onset time, and minimum effective anesthetic volume. Anesthesiology. 2009;111:1128–34.

    Article  PubMed  Google Scholar 

  39. Georgakis E, Soames R. Arterial supply to the sciatic nerve in the gluteal region. Clin Anat. 2008;21:62–5.

    Article  PubMed  Google Scholar 

  40. Karmanska W, Mikusek J, Karmanski A. Nutrient arteries of the human sciatic nerve. Folia Morphol (Warsz). 1993;52:209–15.

    CAS  Google Scholar 

  41. Ugrenovic SZ, Jovanovic ID, Vasovic LP, Stefanovic BD. Extraneural arterial blood vessels of human fetal sciatic nerve. Cells Tissues Organs. 2007;186:147–53.

    Article  PubMed  Google Scholar 

  42. Del Pinal F, Taylor GI. The venous drainage of nerves; anatomical study and clinical implications. Br J Plast Surg. 1990;43:511–20.

    Article  PubMed  Google Scholar 

  43. Coppieters MW, Alshami AM, Babri AS, Souvlis T, Kippers V, Hodges PW. Strain and excursion of the sciatic, tibial, and plantar nerves during a modified straight leg raising test. J Orthop Res. 2006;24:1883–9.

    Article  PubMed  Google Scholar 

  44. Franco CD. Posterior approach to the sciatic nerve in adults: is Euclidean geometry still necessary? Anesthesiology. 2003;98:723–8.

    Article  PubMed  Google Scholar 

  45. Standring S, editor. Gray’s anatomy. 39th ed. Edinburgh: Elsevier; 2005. p. 1457.

    Google Scholar 

  46. Franco CD, Choksi N, Rahman A, et al. A subgluteal approach to the sciatic nerve in adults at 10 cm from the midline. Reg Anesth Pain Med. 2006;31:215–20.

    Article  PubMed  Google Scholar 

  47. Windhofer C, Brenner E, Moriggl B, et al. Relationship between the descending branch of the inferior gluteal artery and the posterior femoral cutaneous nerve applicable to flap surgery. Surg Radiol Anat. 2002;24:253–7.

    Article  CAS  PubMed  Google Scholar 

  48. Schraffordt SE, Tjandra JJ, Eizenberg N, et al. Anatomy of the pudendal nerve and its terminal branches: a cadaver study. ANZ J Surg. 2004;74:23–6.

    Article  PubMed  Google Scholar 

  49. Mathes SJ, Nahai F. Reconstructive surgery: principles, anatomy, and technique. New York: Churchill Livingstone; 1997. p. 501–35.

    Google Scholar 

  50. Kalhor M, Beck M, Huff TW, Ganz R. Capsular and pericapsular contributions to acetabular and femoral head perfusion. J Bone Joint Surg Am. 2009;91:409–18.

    Article  PubMed  Google Scholar 

  51. Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82:679–83.

    Article  CAS  PubMed  Google Scholar 

  52. Carliouz H, Pous JG, Rey JC. Les epiphysiolyses femorales superrieures. Rev Chir Orthop Reparatice Appar Mot. 1968;54:388–481.

    Google Scholar 

  53. Perez Carro L, Golano P, Fernandez EN, Ruperez VM, Victor Diego V, Cerezal L. Normal articular anatomy. In: Kim J, editor. Hip magnetic resonance imaging. Berlin: Springer; 2014. p. 57–72.

    Chapter  Google Scholar 

  54. Voos JE, Rudzki JR, Shinkdle MK, et al. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007;23:1246.e1–5.

    Article  Google Scholar 

  55. Robertson WJ, Kelly BT. The safe zone for hip arthroscopy: a cadaveric assessment of central, peripheral, and lateral compartment portal placement. Arthroscopy. 2008;24:1019–26.

    Article  PubMed  Google Scholar 

  56. Guanche CA. Hip arthroscopy techniques: deep gluteal space access. In: Nho SJ, et al., editors. Hip arthroscopy and hip joint preservation surgery. New York: Springer; 2015. p. 351–60.

    Chapter  Google Scholar 

  57. Martin HD, Hatem MA, Champlin K, Palmer IJ. The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Tech Orthop. 2012;27:172–83.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pérez-Carro, L. et al. (2019). Gross and Endoscopic Posterior Hip Anatomy. In: Martin, H., Gómez-Hoyos, J. (eds) Posterior Hip Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-78040-5_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-78040-5_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-78038-2

  • Online ISBN: 978-3-319-78040-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics