Chapter 6 hamstrings. The extra-pelvic part of the IGA anastomoses with the SGA and with the internal pudendal, obturatory and medial circumflex femoral arteries. NERVES IN THE GLUTEAL REGION The gluteal region is innervated by many nerves that can be divided into a superficial and a deep group. The deep nerves are the most important clinically. The superficial gluteal nerves The skin of the buttock receives cutaneous nerves from several lumbar and sacral segments, called cluneal nerves. They are divided into a (1) superior, (2) middle and an (3) inferior cluneal group. The deep gluteal nerves The seven deep gluteal nerves are branches of the sacral plexus. They leave the lesser pelvis through the greater sciatic foramen caudal to the piriformis muscle, except for the superior gluteal nerve, emerging cranial to this muscle. The superior gluteal nerve The superior gluteal nerve arises from the dorsal branches of the ventral rami of L4-L5 and S1 and leaves the pelvis cranial to the piriformis muscle together with the SGA. It accompanies the deep branch of the SGA (see above) between the gluteus medius and minimus and divides into a superior branch that supplies the gluteus medius and an inferior branch that supplies the gluteus medius and minimus and the tensor fasciae latae muscles. The inferior gluteal nerve This nerve arises from the dorsal branches of the ventral rami of L5 and S1-S2 and leaves the pelvis caudal to the piriformis muscle, superficially from the sciatic nerve and laterally from the pudendal nerve and internal pudendal artery, that, together with the IGA, all issue through the same space. The sciatic nerve This largest nerve in the body, the main branch of the sacral plexus, is formed by the ventral rami of L4-L5 and S1-S3. It usually does not supply structures in the pelvis, but is a well palpable landmark in the gluteal region. It usually passes out of the pelvis to enter the gluteal region caudal to the piriformis muscle and consists of a medial tibial and a lateral common peroneal nerve. The posterior femoral cutaneous nerve This nerve, supplying a very large skin area, also gives rise to the inferior cluneal nerves. It arises from the dorsal branches of the ventral rami of S1-S2, supplying the skin of the inferior buttock, and the ventral branches of the ventral rami of S2-S3, supplying the skin of the perineum. 93
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