The gluteal region is located posterior to the pelvic girdle and connects the back to the lower limb. The gluteal region extends from the iliac crests superiorly, the greater trochanter of the femur laterally and the gluteal fold inferiorly. In the midline of the gluteal region is the intergluteal (natal) cleft, which separates the right and left buttocks (Fig. 7.1).

The bones of the gluteal region consist of the ilium, ischium, pubis and sacrum which together form the pelvis and articulate with the femur (Fig. 7.2). There are several bony features that can be palpated within this region. Laterally, the iliac crests can be palpated at the level of L4 as two horizontal bony ridges. At the most anterior aspect of the iliac crests are the anterior superior iliiac spines which can be palpated. At the most posterior aspect of the iliac crests, the posterior superior iliac spines can be easily identified by slight depressions in the skin. These are located at ver­tebral level S2, lateral to the vertebral column. On the posterior surface in the midline is the sacrum. The lateral margins of the sacrum articulate with the ilium via the paired sacroiliac joints. Although the joints themselves cannot be easily palpated, the overlying posterior sacroiliac ligaments can be felt. Inferiorly, at the level of the gluteal fold, the bony prominences formed by the ischial tuberosity are easily palpable.

The bone of the thigh is the femur. The femur articulates superiorly with the acetabulum and inferiorly with the tibia at the knee joint (Fig. 7.4). The degree of adduction of the femur (or Q angle) is more pronounced in the female than male, which is due to a wider pelvis in females. Although the shaft of the femur cannot be palpated, there are a number of bony features that are palpable. The greater trochanter lies in the upper lateral part of the thigh and is easily palpated. In contrast, the lesser trochanter is not palpable. At the distal end of the femoral shaft are the medial and lateral femoral condyles. The lateral and medial epicondyles can be easily identified as the bony prominences on the

femoris (L5, S1)

nerve (L4, L5, S1)

Laterally rotates femur at hip joint

Abducts femur at hip joint; holds pelvis secure over stance leg and prevents pelvic drop on the opposite swing side during walking; medially rotates thigh

femoris, vastus medialis, vastus lateralis and vastus inter­medius muscles (Table 7.2). All but the vastus intermedius muscle, which lies deep to the rectus femoris muscle, can be palpated. In the midline, when contracted, the rectus femoris muscle appears raised along the length of the anterior thigh. On the medial side is the vastus medialis muscle. This muscle forms a particular bulge at its distal insertion point when contracted (Fig. 7.6). On the lateral side of the thigh is the vastus lateralis, which forms a less obvious bulge on the lateral side of the knee when contracted.

Lying superficial to the quadriceps muscles is the sartorius muscle (Table 7.2). This narrow straplike muscle passes from lateral to medial across the anterior surface of the thigh. The sartorius muscle can be palpated along its length when the knee is extended, the hip joint flexed and laterally rotated. The upper part of sartorius forms the lateral bound­ary of the femoral triangle. Lying deep to the sartorius muscle are the saphenous branch of the femoral nerve, the femoral artery and the femoral vein. These neurovascular structures pass through the adductor canal toward the medial side of the distal thigh. The saphenous nerve carries on into the leg to supply the skin on the medial side of the proximal part of the foot and ankle.