It's probably more convenient to begin in the gluteal region with the cadaver in the prone, belly-down position. We will not only look at the gluteal muscles, but we can also expect to find several sets of vessels and nerves.

Let's begin by defining the borders of the gluteus maximus. Note its extensive attachments. Follow it laterally to its attachment to the iliotibial tract. This strip of connective tissue is only a modified part of the fascia lata or the deep fascia of the thigh.

Now reflect this massive muscle and identify its motor nerve, arterial supply and venous return, the inferior gluteal nerve , artery, and vein. All three structures emerge from the inferior side of the piriformis and attach to the underside of the gluteus maximus. The other large nerve emerging from the inferior aspect of the piriformis is the sciatic nerve. Follow this huge nerve distally into the back of the thigh.

The muscle just deep and superior to the gluteus maximus is the gluteus medius. Note the different fiber direction of the gluteus medius and the gluteus maximus. Now reflect the gluteus medius and observe the underlying gluteus minimus. Its fiber direction is very similar to that of the medius. However, you can often separate the two lesser gluteals by the superior gluteal nerve artery and vein, which lie between the gluteus minimus and the gluteus medius. Observe the lesser gluteal's attachment onto the greater trochanter of the femur.

Figure 14-2
Intrinsic muscles of the hip gluteal region.

Often the pudendal nerve can be identified as it exits the greater sciatic foramen and reenters the pelvis through the lesser sciatic foramen. This occurs just inferior to the piriformis. A busy place, don't you agree? (Figure 14-2)

Just inferior to the piriformis find the superior gemellus, tendon of the obturator internus and inferior gemellus (superior to inferior). The obturator internus runs through the lesser sciatic foramen between the sacrotuberous and sacrospinous ligaments. The two gemelli insert onto the tendon of the obturator internus. These three small muscles are often hidden by the large overlying sciatic nerve.

Slightly inferior to the inferior gemellus see if you can find the quadratus femoris muscle. This muscle runs from the ischial tuberosity to the inter-trochanteric fossa of the femur and is more or less visible depending upon whether the cadaver's lower limb is medially or laterally rotated.

Directly medial to the quadratus femoris, find the proximal attachment of the hamstring muscles, the ischial tuberosity. Now locate and palpate the superior and medial running fibers of the strong sacrotuberous ligament. The gluteus maximus was attached to this ligament however, it is now reflected.

See if you can at least feel the sacrospinous ligament by first finding the ischial spine just inferior and medial to the piriformis and then running your fingers medially. You should be able to feel this tough horizontal running ligament.

Remember, the obturator internus runs between the two sacroischial ligaments.

Now you will need to turn your cadaver over into the supine position to find the remaining structures of this exercise.

You have already found the iliotibial tract. Understand that this tract not only serves as a portion of the distal attachment of the gluteus maximus, but also for the tensor fascia lata. This muscle arises from the anterior portion of the iliac crest and is often hidden under the thick iliotibial band or tract. Identify the tensor fascia lata.