Gluteal Region Anatomy and Significance

Last Updated on July 1, 2025

The gluteal region is the anatomical area located posterior to the pelvic girdle, marking the proximal end of the femur. In lay terms, it corresponds to the region of the buttocks. There are two gluteal regions — left and right — separated by the intergluteal cleft.

Functionally, this region plays a vital role in hip movement and lower limb control, as its muscles act primarily on the hip joint, contributing to extension, abduction, rotation, and pelvic stabilization during gait.

Cutaneous Nerves, Vessels and Lymphatics

Cutaneous Nerve Supply

The skin of the gluteal region receives sensory innervation from multiple nerves, primarily derived from lumbar and sacral spinal nerves:

• Upper anterior region:
  Supplied by lateral cutaneous branches of the subcostal and iliohypogastric nerves.
• Upper posterior region:
  Supplied by posterior rami of L1–L3 and S1–S3 spinal nerves.
• Lower anterior region:
  Supplied by branches of the posterior division of the lateral cutaneous nerve of the thigh.
• Lower posterior region:
  Supplied by branches of the posterior cutaneous nerve of the thigh (S1–S3) and the perforating cutaneous nerve.

Cutaneous Blood Supply

The skin and subcutaneous tissue receive blood supply from perforating branches of the:

• Superior gluteal artery
• Inferior gluteal artery

Lymphatic Drainage

• Superficial lymphatics from the gluteal skin drain into the lateral group of the superficial inguinal lymph nodes.
• Deeper lymphatics, not covered here, follow gluteal vessels toward the internal iliac nodes.

Deep Fascia

Beneath the skin and subcutaneous tissue lies the deep fascia, which varies in thickness across the gluteal region and plays an important role in muscle compartmentalization and force transmission.

At the margins of the gluteus maximus, the deep fascia splits to enclose the muscle, providing a sheath that aids in its movement and structural support.

Over the gluteus medius (i.e., anterior and superior to the gluteus maximus),
the fascia is thick, dense, opaque, and pearly white. This strong layer contributes to the origin of some thigh muscles and blends with the fascia lata.

Over the gluteus maximus, the fascia becomes thin, translucent, and more loosely attached.

Muscles of the Gluteal Region: Overview and Classification

The muscles of the gluteal region are primarily responsible for the movement of the femur at the hip joint. They also play a vital role in stabilizing the pelvis during locomotion.

These muscles are divided into two functional groups:

Superficial Group (Abductors and Extensors)

This group consists of larger, more superficial muscles that primarily extend and abduct the femur:

• Gluteus maximus
• Gluteus medius
• Gluteus minimus
• Tensor fasciae latae

Deep Group (Lateral Rotators of the Hip)

These are smaller muscles, located deep to the gluteus maximus and medius, that function mainly to laterally rotate the femur and stabilize the hip joint:

• Obturator externus
• Piriformis
• Obturator internus
• Superior gemellus
• Inferior gemellus
• Quadratus femoris

Superficial Muscles of Gluteal Region

Gluteus Maximus

The gluteus maximus is the largest, most superficial muscle of the gluteal region and forms the bulk and contour of the buttock. It plays a crucial role in extending and laterally rotating the hip, especially during forceful movements.

Origin

The muscle originates from

• Outer slope of the dorsal segment of the iliac crest.
• Posterior gluteal line.
• Posterior part of the gluteal surface of the ilium behind the posterior gluteal line.
• Aponeurosis of erector spinae.
• Dorsal surface of the lower part of the sacrum.
• Side of the coccyx.
• Sacrotuberous ligament.
• Fascia covering the gluteus maximus.

Insertion

It slopes across the buttock at a 45-degree angle, then inserts into the iliotibial tract and the gluteal tuberosity of the femur. The deep fibers of the lower part of the muscle are inserted into the gluteal tuberosity. And the greater part of the muscle is inserted into the iliotibial tract.

Nerve Supply

Inferior gluteal nerve (L5, S1, S2).

Action

• Extension of the hip joint, especially during activities like rising from a seated position, running, or climbing stairs
• Lateral rotation of the thigh
• Supports the extended knee via tension on the iliotibial tract

Gluteus Medius

The gluteus medius is a fan-shaped muscle located deep to the gluteus maximus and superficial to the gluteus minimus. It covers much of the lateral surface of the pelvis and is essential for pelvic stability during gait.

Origin

The gluteal surface of the ilium, between the anterior and posterior gluteal lines.

Insertion

Into the greater trochanter of the femur, on the oblique ridge on the lateral surface. The ridge runs downwards and forwards.

Nerve Supply

Superior gluteal nerve (L5,S1)

Actions

Gluteus medius abducts and medially rotates the lower limb. During locomotion, it secures the pelvis, preventing pelvic drop of the opposite limb.

Posterior fibres of the gluteus medius are also thought to produce a small amount of lateral rotation.

Gluteus Minimus

The gluteus minimus is the deepest and smallest of the superficial gluteal muscles. It is covered by the gluteus medius . It is similar in shape and function to the gluteus medius.

Origin

From the gluteal surface of the ilium between the anterior and inferior gluteal lines.

Insertion

It inserts into the greater trochanter of the femur, on a ridge on the lateral part of the anterior surface.

Nerve Supply

Superior gluteal nerve (L5,S1)

Actions

Abducts and medially rotates the lower limb. During locomotion, it secures the pelvis, preventing pelvic drop of the opposite limb.

Tensor Fascia Lata (TFL)

The tensor fasciae latae is a small superficial muscle that lies towards the anterior edge of the iliac crest. It lies between the gluteal region and the front of the thigh. It acts primarily in hip stabilization, abduction, and medial rotation of the thigh.

Origin

• Anterior 5 cm of the outer lip of the iliac crest up to the tubercle.
• Anterior superior iliac spine and the notch below it.

Insertion

Iliotibial tract, which itself attaches to the lateral condyle of the tibia.

Nerve Supply

Superior gluteal nerve (L4,5)

Actions

• It assists the gluteus medius and minimus in abduction and medial rotation of the lower limb.
• Helps stabilize the pelvis and the knee joint via tension on the iliotibial tract
• Contributes to flexion of the hip in early stance phase of gait

The Deep Muscles of the Gluteal Region

These muscles lie beneath the gluteus minimus and function primarily as lateral rotators of the hip. They also contribute to hip joint stability by maintaining femoral head congruency within the acetabulum.

Piriformis

The piriformis is the most superior of the deep muscles. It lies, below and parallel to the posterior border of the gluteus medius.It runs obliquely from the sacrum to the greater trochanter, forming a muscular landmark in the greater sciatic foramen.

Origin

It arises within the pelvis from.

• Pelvic surface of the middle three sacral segments
• Upper margin of the greater sciatic notch
• Surrounding sacroiliac joint capsule
• Adjacent part of the sacrotuberous ligament

Insertion

Apex of the greater trochanter of the femur.

Nerve Supply

Nerve to piriformis  [Ventral rami of S1,2].

Actions

Lateral rotation and abduction.

Note: Clinical note: The piriformis is a key anatomic landmark. Structures exiting the pelvis are described in relation to it (e.g., sciatic nerve emerges below, superior gluteal nerve emerges above).

Obturator Internus

The obturator internus forms the lateral walls of the pelvic cavity. It is a fan-shaped, flattened belly lies in the pelvis, and the tendon in the gluteal region. Some authors consider the obturator internus and the gemelli muscles as one muscle – the triceps coxae.

Origin

• The pelvic surface of the obturator membrane.
• Surrounding bony margins of the obturator foramen
• Pelvic or inner surface of the body of the ischium, ischial tuberosity, ischiopubic rami, and ilium below the pelvic brim.

Insertion

The tendon of the obturator internus leaves the pelvis through the lesser sciatic foramen and runs laterally to be inserted into the medial surface of the greater trochanter of the femur.

Nerve Supply

Nerve to the obturator internus (L5, S1)

Actions

Lateral rotation and abduction.

Note: The muscle belly lies in the pelvis, while its tendon exits through the lesser sciatic foramen, making it an important anatomical conduit between pelvic and gluteal spaces.

Superior and Inferior Gemelli

The gemelli muscles are two small, vertically oriented muscles that flank the tendon of the obturator internus, often functioning together as part of a composite unit called the triceps coxae.

Origin

• Superior gemellus muscle originates from the ischial spine
• Inferior gemellus from the ischial tuberosity.

Insertion

Both insert along with the tendon of the obturator internus onto the medial surface of the greater trochanter of the femur

Nerve Supply

• Superior gemellus – Nerve to obturator internus (L5, S1)
• Inferior gemellus – Nerve to quadratus femoris (L5, S1)

Actions

• Lateral rotation of the extended thigh
• Abduction of the flexed thigh
• Reinforce posterior hip joint stability

Note: Though small, the gemelli muscles act synergistically with the obturator internus and other deep rotators to stabilize the hip during dynamic movements.

Quadratus Femoris

The quadratus femoris is a flat, rectangular muscle located inferior to the gemelli. It lies between the inferior gemellus and the adductor magnus. It acts as a strong lateral rotator and adductor of the thigh and plays an important role in posterior hip joint stabilization.

Origin

Upper part of the outer border of ischial tuberosity, just anterior to the origin of the hamstring muscles

Insertion

• Quadrate tubercle and the area below it on the intertrochanteric crest.
• Also inserts on the adjacent inferior portion of the intertrochanteric area

Nerve Supply

Nerve to quadratus femoris (L5,S1)

Actions

• Lateral rotation of the thigh
• Assists in adduction of the thigh when the hip is flexed
• Contributes to stabilizing the femoral head in the acetabulum

Obturator externus

The obturator externus is a flat, triangular muscle located on the anteroinferior aspect of the pelvis, deep to the pectineus and adductor longus. Though not always grouped with the other deep gluteal muscles, it plays a similar role in lateral rotation and hip stabilization.

Origin

It arises from

• Outer surface of the obturator membrane.
• Outer surface of the bony margins obturator foramen

Insertion

The muscle ends in a tendon which runs upwards and laterally behind the neck of the femur to insert into the trochanteric fossa on the medial surface of the greater trochanter.

Nerve Supply

Posterior division of the obturator nerve. [L3,4]

Structures Deep to the Gluteus Maximus

The gluteus maximus, being the largest and most superficial muscle of the gluteal region, covers a complex network of muscles, nerves, vessels, bones, and connective tissues that lie beneath it. Understanding this layered anatomy is essential for interpreting clinical signs, planning surgical approaches, and avoiding complications during procedures like intramuscular injections.

Muscles Under Gluteus Maximus

Gluteus medius & Gluteus minimus

Immediately beneath the gluteus maximus lie the gluteus medius and gluteus minimus, forming the upper muscular layer of the deep gluteal region. These muscles occupy the superolateral portion of the field and contribute to abduction and medial rotation of the hip.

Short Lateral Rotators of Hip

Deeper and more medially positioned are the short lateral rotators of the hip, including the piriformis, obturator internus, superior and inferior gemelli, and quadratus femoris. These muscles create a muscular shelf that stabilizes the hip joint and guide the femoral head within the acetabulum.

Origin of Four Hamstrings

Along the inferior medial border of the gluteus maximus, the origin of the hamstring muscles (from the ischial tuberosity) begins, contributing to the posterior thigh musculature. The reflected head of rectus femoris and the upper fibers of adductor magnus are also in proximity, reflecting the anatomical transition toward the posterior compartment of the thigh.

Vessels of the Gluteal Region

The vascular anatomy deep to the gluteus maximus is primarily derived from branches of the internal iliac artery, which supply the gluteal musculature, skin, joints, and adjacent regions. These vessels also participate in important anastomotic networks that safeguard blood supply to the femoral head, hip joint, and posterior thigh.

Superior Gluteal Artery

The superior gluteal artery is a branch of the posterior division of the internal iliac artery. It exits the pelvis through the greater sciatic foramen, passing above the piriformis muscle, accompanied by the superior gluteal nerve.

Within the gluteal region, it divides into two primary branches:

• The superficial branch passes posteriorly to supply the gluteus maximus, contributing muscular and cutaneous twigs.
• The deep branch courses laterally between the gluteus medius and minimus, and itself subdivides:
  • The superior division runs along the anterior gluteal line and continues toward the anterior superior iliac spine, where it anastomoses with the ascending branch of the lateral circumflex femoral artery and branches from the deep circumflex iliac artery.
  • The inferior division follows the inferior gluteal line, eventually contributing to the trochanteric anastomosis, which ensures robust perfusion of the femoral head.

This dual branching architecture ensures both deep muscular and superficial coverage, making the superior gluteal artery one of the key arterial supplies of the upper gluteal region.

Inferior Gluteal Artery

The inferior gluteal artery, a branch of the anterior division of the internal iliac artery, exits the pelvis below the piriformis, traveling alongside the inferior gluteal nerve. It courses deep to the gluteus maximus and lies adjacent to the sciatic nerve during its passage.

It supplies several important structures:

• Muscular to the gluteus maximus, as well as to the short external rotators (e.g., piriformis, obturator internus, gemelli, and quadratus femoris).
• Cutaneous branches supply the inferior gluteal skin and the posterior thigh.
• Articular branches contribute to the hip joint capsule.
• It also gives off:
  • A branch to the sciatic nerve, providing a nutrient supply.
  • A coccygeal branch that nourishes the skin and subcutaneous tissues over the coccyx.
  • A contributing branch to the cruciate anastomosis, enhancing collateral circulation in the upper thigh.

This artery plays a key role in deep muscular perfusion and posterior hip vascularization.

Internal Pudendal Artery

Although primarily a perineal artery, the internal pudendal artery briefly transits the gluteal region. It is a branch of the anterior division of the internal iliac artery and exits the pelvis via the greater sciatic foramen, positioned medial to the nerve to obturator internus and lateral to the pudendal nerve.

Its gluteal course is short. It crosses the ischial spine and re-enters the pelvis through the lesser sciatic foramen, ultimately reaching the ischiorectal fossa.

During this brief passage, it remains largely subfascial but is an important landmark during procedures such as pudendal nerve blocks or pelvic floor surgeries.

Anastomotic Networks

The gluteal region hosts two major arterial anastomotic systems that serve critical functional and surgical importance:

Trochanteric Anastomosis

Located near the greater trochanter, it ensures blood flow to the femoral head. Its contributing vessels include

• Superior gluteal artery
• Inferior gluteal artery
• Ascending branches of both the lateral and medial circumflex femoral arteries

Cruciate Anastomosis

Found near the lesser trochanter, this network facilitates collateral flow between the internal iliac and profunda femoris systems. It involves:

• Inferior gluteal artery
• First perforating branch of the profunda femoris artery
• Transverse branches of the medial and lateral circumflex femoral arteries

Together, these networks safeguard perfusion during arterial compromise or hip procedures and represent essential collateral systems of the lower limb.

Nerves of the Gluteal Region

Several important nerves course deep to the gluteus maximus, most of which exit the pelvis via the greater sciatic foramen, either above or below the piriformis muscle. These nerves are not only responsible for motor innervation of the gluteal and posterior thigh muscles but also supply extensive cutaneous territories and structures of the perineum.

Superior Gluteal Nerve (L4,5,S1)

Emerging above the piriformis, the superior gluteal nerve is a branch of the sacral plexus (L4–S1). It accompanies the superior gluteal artery and passes between the gluteus medius and minimus, supplying both these muscles as well as the tensor fasciae latae.

Because it does not innervate the gluteus maximus, it lies entirely within the deep gluteal plane and is often involved in Trendelenburg-type gait abnormalities when injured.

Inferior gluteal Nerve (L5,S1,2)

It passes inferior to the piriformis. The inferior gluteal nerve arises from L5–S2 and runs alongside the inferior gluteal artery. It enters the deep surface of the gluteus maximus, supplying it exclusively

Injury to this nerve, though rare in isolation, can weaken hip extension and disrupt rising from a seated position or climbing stairs.

Sciatic nerve (L4,L5,S1,S2,S3)

The largest nerve in the body, the sciatic nerve, originates from L4–S3 and exits the pelvis below (posterior)the piriformis, typically as a single trunk. It courses deep to the gluteus maximus but superficial to the short lateral rotators, notably the obturator internus and quadratus femoris.

It descends midway between the greater trochanter and ischial tuberosity, a clinically significant landmark due to its vulnerability during intramuscular injections. The nerve then continues into the posterior thigh, eventually bifurcating into the tibial and common fibular nerves.

Posterior Cutaneous Nerve of the Thigh (S1, S2, S3)

This purely sensory nerve (S1–S3) emerges inferior to the piriformis and descends posterior or medial to the sciatic nerve, lying just deep to the fascia lata.

It provides cutaneous innervation to the posterior thigh, inferior gluteal region, and perineum via its gluteal and perineal branches.

Despite its size and proximity to the sciatic nerve, it is often overlooked but clinically relevant in posterior thigh pain syndromes.

Nerve to Quadratus Femoris (L4,L5, S1)

This nerve arises from the L4–S1 roots and passes deep to both the sciatic nerve and the obturator internus as it courses inferiorly. It supplies the quadratus femoris and inferior gemellus, and sends a branch to the hip joint. Its deep position makes it less vulnerable to iatrogenic injury.

Nerve to Obturator Internus ( L5–S2)

Emerging from L5–S2, this nerve crosses the ischial spine lateral to the pudendal nerve and enters the lesser sciatic foramen to reach the obturator internus. It innervates the obturator internus and superior gemellus.

Due to its close relationship with the pudendal neurovascular bundle, its injury may coincide with perineal dysfunctions.

Pudendal Nerve (S2–S4)

Though not a gluteal nerve per se, the pudendal nerve (S2–S4) briefly transits the gluteal region. It exits the pelvis via the greater sciatic foramen, crosses the ischial spine, and enters the ischiorectal fossa through the lesser sciatic foramen.

Alongside the internal pudendal vessels and nerve to obturator internus, it is a major supplier of the perineum, including external genitalia and anal sphincters.

Perforating Cutaneous Nerve (S2,S3)

A less prominent sensory branch from S2–S3, this nerve pierces the sacrotuberous ligament near its lower part and curves around the inferomedial margin of gluteus maximus to supply the skin of the inferomedial gluteal region.

A table of neurovascular structures in the gluteal region is given below for quick reference.

Skeletal and Ligamentous Elements

Bones and Joints

The posterior surfaces of the ilium, ischium, greater trochanter, sacrum, and coccyx form the deep skeletal foundation beneath the gluteus maximus. The hip joint and sacroiliac joint lie in this region, both stabilized by thick surrounding musculature and ligaments.

Ligaments

The sacrospinous and sacrotuberous ligaments play a crucial anatomical role by converting the sciatic notches into the greater and lesser sciatic foramina, through which most of the nerves and vessels pass. These ligaments also serve as surgical and radiologic landmarks.
The ischiofemoral ligament is a capsular ligament found on the posterior aspect of the hip joint. It restricts the internal rotation of hip.

Bursae

Several bursae are interposed between the gluteus maximus and the underlying structures to reduce friction:

• Trochanteric bursa: Located between the gluteus maximus and the greater trochanter.
• Ischial bursa: Lies between the gluteus maximus and the ischial tuberosity, often involved in ischial bursitis.
• The gluteofemoral bursa may be present between the gluteus maximus muscle and the vastus lateralis, especially in individuals with frequent lower limb activity.

Clinical Significance of the Gluteal Region

Intramuscular Injections

Intramuscular injections are commonly administered in the gluteal region due to the bulk of muscle mass and good vascular supply. The safest site is the anterosuperior quadrant of the gluteal region, typically targeting the gluteus medius and minimus. This avoids injury to the sciatic nerve, which runs in the posteroinferior quadrant.

Incorrect placement may lead to sciatic nerve injury, hematoma, or the formation of abscesses.

Weakness  of Gluteus Maximus

Paralysis of the gluteal muscle weakens the extension of the hip. The patient is not able to stand up from a sitting posture without support. Such patients, while trying to stand up, rise gradually, supporting their hands first on the legs and then on the thighs. This climbing on oneself is a frequently seen feature in muscular dystrophies.

Weakness of Gluteus medius and minimus

These muscles are the primary abductors and pelvic stabilizers during gait. Weakness causes Trendelenburg gait, where the pelvis drops on the contralateral (unsupported) side.

To compensate, patients sway their torsos toward the affected side during the stance phase. Bilateral involvement may cause a waddling gait, seen in neuromuscular conditions like poliomyelitis or muscular dystrophies.

Piriformis Syndrome

Piriformis syndrome is a neuromuscular condition where the sciatic nerve is compressed or irritated by the piriformis muscle. This may be due to hypertrophy, anatomical variations, or overuse.

Symptoms include buttock pain, radicular pain down the leg (sciatica), and tenderness over the piriformis. It mimics discogenic sciatica but lacks spinal findings. MRI and nerve conduction studies help differentiate.

Management includes stretching, physical therapy, NSAIDs, and occasionally steroid injections or surgery.

Sciatic Nerve Injury in Trauma or Surgery

The sciatic nerve is vulnerable during posterior hip dislocations, pelvic fractures, or improperly placed surgical retractors. It may also be inadvertently injured during hip replacement or intramuscular injections.

Injury can result in foot drop, weakness of knee flexion, and sensory loss over the posterior thigh, leg, and foot (depending on the division affected).

Gluteal Abscess and Infections

The gluteal region is a common site for deep soft tissue infections, especially in immunocompromised individuals. Gluteal abscesses may arise from infected injections, pilonidal sinuses, or hematogenous spread.

Because of the dense muscle and fascia, pus may track into deeper spaces such as the ischiorectal or presacral spaces. Prompt imaging and surgical drainage are essential to prevent systemic spread.

References

• Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Clinically Oriented Anatomy (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
• Standring, S. (2016). Gray’s Anatomy (41st ed.). Edinburgh: Elsevier Churchill Livingstone.
• Collinge CA, Ziran NM, Coons DA. Relationship Between the Superior Gluteal Vessels and Nerve at the Greater Sciatic Notch. Orthopedics. 2015 Oct;38(10):e929-33. [PubMed]
  

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