- Anatomy:
- origin: posterior gluteal line of the ilium, tendon of sacrospinalis,
- dorsal surface of sacrum, coccyx and sacrotuberous ligament;
- insertion: gluteal tuberosity of femur and iliotibial tract of fascia lata
- it inserts partly into the
iliotibial band and partly into the gluteal tuberosity of the femur;
- also inserting into the band, but further anteriorly is the tensor fascia lata;
- together, the gluteus maximus, the fascia lata (which covers the
gluteus medius), and the tensor
fascia latae form a continuous fibromuscular sheath, the outer layer of the hip musculature;
- action:
- extends thigh at the hip, assists in laterally rotating the thigh;
- upper and middle third section of the muscle are abductors and the lower 1/3 is
inactive as an abductor or adductor in the standing position;
- reversed origin insertion action:
- when leg is fixed as in standing the gluteus maximus is an extensor of the pelvis on the thigh;
- nerve supply:
inferior gluteal,
S1 >
L4,
L5,
S2; (see
innervation of the lower extremity)
- Posterolateral Approach to the Hip:
- internal rotation of the hip may be facilitated by transversely sectioning several cm of the insertion of the
gluteus maximus tendon on the femur;
- do this w/ hip maximally internally rotated, & place tip of hemostat under tendinious structure to
lift it away from underlying vessels.
- section only the amount of the tendon necessary to allows sufficient internal rotation to dislocate the hip;
- when performing this, the surgeon will often encounter bleeding from
cruciate anastomosis vessels;
- Gait:
- gluteus maximus
contracts at
heel-strike, slowing forward motion of trunk by arresting flexion of the hip and initiating extension;
- when gluteus maximus is weak, trunk lurches backward (maximus lurch) at heel-strike on weakened side to interrupt
forward motion of trunk;
- during normal walking, hip extension is primarily a function of hamstrings rather than gluteus maximus;
Contracture of the hip secondary to fibrosis of the gluteus maximus muscle. Gluteal fibrosis.
Gluteal compartment and crush syndromes. Report of three cases and review of the literature.
