Vessels and nerves of the gluteal region and posterior thigh

Definitions & Key takeaways

The gluteal region and posterior thigh contain various blood vessels and nerves that supply the muscles, bones, and skin of the region.

The main artery in the gluteal region is the internal iliac artery, which gives off branches, namely the superior gluteal artery, inferior gluteal artery, and internal pudendal artery. The veins accompany the arteries and drain blood from the tissues. Major veins in the region include the superior and inferior gluteal veins, the internal pudendal veins, and the perforating veins.

The sciatic nerve, the largest nerve in the body, runs through the posterior thigh, supplying the posterior thigh muscles, all leg and foot muscles, and the skin of most of the leg and foot. The gluteal region and posterior thigh also contain other nerves, including the pudendal nerve and the posterior femoral cutaneous nerve. The pudendal nerve supplies the perineum and external genitalia, while the posterior femoral cutaneous nerve supplies the skin on the back of the thigh and the lower part of the buttocks.

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Introduction0:00–0:26

The gluteal region and posterior thigh contains an abundance of large and small muscles, and coursing through these muscles is a vast network of nerves and vessels.
These nerves mainly originate from the lumbosacral plexus, whereas the vascular supply derives either directly or indirectly from the internal iliac arteries.
Ok, so let’s start with the nerves of the gluteal region and posterior thigh. Most nerves of the lower limb arise from the lumbosacral plexus, a network of nerves derived from the roots of lumbar and sacral spinal nerves that branch out to form the nerves of the lower limb.

Innervation0:26–1:03

However, out of all the resulting nerves, the gluteal region and posterior thigh is only supplied by the cluneal nerves, superior and inferior gluteal nerves, the sciatic and pudendal nerves, the posterior cutaneous nerve of the thigh, and nerves to quadratus femoris and to obturator internus.
Let's start off with the cluneal nerves which innervate the skin of the gluteal region. The superior cluneal nerves arise from L1-L3, and supply the skin of the superior buttock.

Cluneal nerves1:03–1:39

The middle cluneal nerve arises from S1-S3 and supplies skin over the sacrum and adjacent area of the buttocks. And finally the inferior cluneal nerve is a branch of the posterior cutaneous nerve of the thigh from S2-S3 and supplies skin over the inferior half of the buttocks as far as the greater trochanter.
Next, there’s the superior gluteal nerve which is formed by the L4, L5, and S1 nerve roots. The nerve courses laterally between the gluteus medius and minimus along the deep branch of the superior gluteal artery, and it exits the pelvis through the greater sciatic foramen above the piriformis muscle.

Gluteal nerves1:39–2:42

It then goes on to innervate the the gluteus medius, the gluteus minimus, and the tensor fasciae latae. This nerve doesn’t have any sensory function.
The inferior gluteal nerve is formed by the L5, S1, and S2 nerve roots and, much like its brother, it leaves the pelvis through the greater sciatic foramen, but inferior to the piriformis.
It is also accompanied by multiple branches of the inferior gluteal artery and vein along its trajectory. The inferior gluteal nerve ultimately divides into several branches, which provide motor innervation to the overlying gluteus maximus but no sensory supply.
Then there’s the sciatic and pudendal nerves, both of which are terminal branches of the sacral plexus,. The sciatic nerve is the largest nerve in the body and it’s formed by the roots of L4, L5, S1, S2, and S3 spinal nerves.

Sciatic nerve2:42–4:33

Interestingly, the sciatic nerve is really two nerves, the tibial nerve and the common fibular nerve, which are loosely bound together in the same connective tissue sheath.
Regardless, the roots of the aforementioned spinal nerves converge at the inferior border of the piriformis to form the sciatic nerve, which enters the gluteal region underneath the piriformis and is the most lateral structure through the greater sciatic foramen.
When it reaches the apex of the popliteal fossa, the nerve separates into the tibial and common fibular nerves, which are also considered its main branches.
Now, the sciatic nerve supplies no structures in the gluteal region but it does supply the posterior thigh muscles, all leg and foot muscles, and the skin of most of the leg and foot.
It also supplies the articular branches to all joints of the lower limb. As a side note, it is important to note that the sciatic nerve can have anatomical variations.
As said before, it typically leaves the greater sciatic foramen below the piriformis. However, in up to 12% of individuals the sciatic nerve divides before exiting the greater sciatic foramen, and its common fibular division pierces the piriformis as it leaves compared to the tibial division which still exits below the piriformis.
A very small 0.5% of individuals the common fibular division will actually leave the greater sciatic foramen above the piriformis, and the tibial division still leaving below the piriformis, And medial to the sciatic nerve, there’s the pudendal nerve which originates from the S2 to S4 nerve roots and is the most medial structure to exit the pelvis through the greater sciatic foramen.

Pudendal nerve4:33–5:25

It descends inferior to the piriformis, posterolateral to the sacrospinous ligament, and enters the perineum through the lesser sciatic foramen.
Within the pudendal canal, an anatomical structure in the pelvis through which the internal pudendal artery, internal pudendal vein, and the pudendal nerve pass, the nerve divides into the inferior rectal nerve at the posterior end of the canal, and two terminal branches - the dorsal nerve of penis or clitoris and perineal nerve.
Now, while the pudendal nerve is the main nerve of the perineum, it supplies no structures in the gluteal region or posterior thigh.
Next up, the posterior cutaneous nerve of the thigh is formed by the S1, 2 and 3 nerve roots. It lies upon the psoas muscle, from where it travels laterally into the greater sciatic foramen, through which it exits the pelvis below the piriformis muscle.

Posterior cutaneous nerve5:25–6:25

Within the gluteal region, the nerve is initially situated underneath the gluteus maximus muscle, then it descends superficial to the long head of biceps femoris in the posterior thigh, where it is deep to the fascia lata.
However, it soon pierces the fascia in the popliteal fossa, and it terminates with twigs joining the sural nerve. Now, this nerve gives off three important branches.
One of them is the inferior cluneal nerve as we said earlier. Then there’s the cutaneous branch which supplies the skin of the popliteal fossa, and finally the third branch is the perineal branch, which supplies the posterior part of the scrotum or labia majora.
And finally, the nerves to quadratus femoris and obturator internus are both branches arising from the pelvic surface of the plexus.

Nerves to quadratus femoris & obturator internus6:25–7:21

The nerve to the quadratus femoris is formed by the anterior divisions of L4, L5, and S1, and it leaves the pelvis inferior to the piriformis and deep to the sciatic nerve.
It supplies an articular branch to the hip joint and innervates the inferior gemellus and quadratus femoris muscles. On the other hand, the nerve to the obturator internus arises from the anterior divisions of the anterior rami of the L5, S1, and S2 and leaves the greater sciatic foramen inferior to the piriformis to parallel the course of the pudendal nerve.
As it passes around the base of the ischial spine, the nerve supplies the superior gemellus, and, after entering the perineum via the lesser sciatic foramen, it supplies the obturator internus muscle.
Before we move on to blood vessels, let’s try and recall the main nerves of the sacral plexuses. Ok, switching over to arteries, the gluteal region is supplied or traversed by major branches of the internal iliac artery, namely the superior gluteal artery, inferior gluteal artery, and internal pudendal artery.

Quiz7:21–7:34

Vascular supply7:34–11:22

First, the superior gluteal artery is the largest of the branches, and, from its origin, it passes posteriorly between the lumbosacral trunk and the S1 nerve.
This artery leaves the pelvis through the greater sciatic foramen, superior to the piriformis, and divides immediately into superficial and deep branches.
The superficial branch supplies the gluteus maximus and skin over the proximal attachment of this muscle. The deep branch supplies the gluteus medius, gluteus minimus, and tensor fasciae latae.
Ultimately, the superior gluteal artery goes on and anastomoses with the inferior gluteal and medial circumflex femoral arteries.
Second, the inferior gluteal artery passes posteriorly through the parietal pelvic fascia, between the S1 and S2 nerves.
It then leaves the pelvis through the greater sciatic foramen, inferior to the piriformis, only to enter the gluteal region deep to the gluteus maximus and to descend medial to the sciatic nerve.
In the gluteal region, the inferior gluteal artery supplies the gluteus maximus, obturator internus, quadratus femoris, and superior parts of the hamstrings.
It also anastomoses with its sister, the superior gluteal artery and it sometimes participates in the cruciate anastomosis of the thigh.
This fancy-named structure is the union of the inferior gluteal artery, the lateral and medial circumflex femoral arteries, and the first perforating artery of the profunda femoris artery in the upper thigh, which supplies most of the structures of the proximal posterior thigh.
And third, the internal pudendal artery lies anterior to the inferior gluteal artery. Its course parallels that of the pudendal nerve, entering the gluteal region through the greater sciatic foramen inferior to the piriformis, which it leaves immediately by crossing the ischial spine only to reach perineum through the lesser sciatic foramen.
Like the pudendal nerve, it supplies the skin, external genitalia, and muscles in the perineal region. It does not supply any structures in the gluteal region or posterior thigh.
Moving on, the gluteal region also houses the four perforating arteries of the profunda femoris artery. Three of the arteries originate in the anterior compartment of the thigh, whereas the fourth is actually the terminal branch of the profunda femoris artery itself.
Now, the perforating arteries are large vessels with an intercompartmental course. This means that from their anterior origin, they perforate the aponeurotic portion of the distal attachment of the adductor magnus to enter the posterior compartment.
Here, they typically give rise to muscular branches to the hamstrings and anastomotic branches that ascend or descend to unite with those arising from the other perforating arteries or the inferior gluteal and popliteal artery.
When it comes to the posterior compartment of the thigh, this part of the thigh has no major artery exclusive to the compartment as it receives blood from multiple sources: inferior gluteal, medial circumflex femoral, perforating arteries from the profunda femoris, and popliteal artery.
These arteries form a continuous anastomotic arterial chain that extends from the gluteal to popliteal regions. Moving on, the veins of the gluteal region and posterior thigh are mostly represented by superior and inferior gluteal veins, which are tributaries to the internal iliac veins.
These accompany the arteries with the same names through the greater sciatic foramen, superior and inferior to the piriformis respectively, and drain the buttock and upper thigh.

Venous drainage11:22–12:18

Then there’s also the internal pudendal veins, which accompany the internal pudendal arteries. The internal pudendal veins ultimately join to form a single vein that enters the internal iliac vein and they drain the external genitalia or pudendum.
And finally, there are also perforating veins which accompany the arteries of the same name to drain blood from the posterior compartment of the thigh into the profunda femoris vein.
The perforating veins, like the arteries, usually communicate inferiorly with the popliteal vein and superiorly with the inferior gluteal vein.
When it comes to lymphatic drainage, lymph from the deep tissues of the buttocks follows the gluteal vessels to the superior and inferior gluteal lymph nodes, and from them to the internal, external, and common iliac lymph nodes and from them to the lateral lumbar, or aortic, lymph nodes.

Lymphatic drainage12:18–13:07

Lymph from the superficial tissues of the gluteal region passes initially to the superficial inguinal nodes, which also receive lymph from the thigh.
From the superficial inguinal nodes, lymph passes via efferent lymph vessels to the external and common iliac nodes. Lymph continues on to the right and left lumbar lymph nodes, draining via lumbar lymphatic trunks to the cisterna chyli and thoracic duct.
Now, another test! Can you label the 14 structures that come out of the greater sciatic foramen?
Here is a hint, one of them is a muscle! ##Summary Alright, as a quick recap Cutaneous innervation of the gluteal region and posterior thigh is accounted for by the superior cluneal nerve and supplies the skin on the superior two thirds of the buttock.

Quiz13:07–13:20

Next we have the nerves coming from the sacral plexus such as the middle cluneal nerve which supplies the skin over the sacrum and adjacent areas of the buttocks There is also the inferior cluneal nerve which supplies the skin of the inferior part of the buttocks as far as the greater trochanter.

Review13:20–16:43

The superior gluteal nerve supplies the gluteus medius, minimus, and the tensor fasciae latae. The inferior gluteal nerve is formed and provides motor innervation to the overlying gluteus maximus.
The sciatic nerve supplies the posterior thigh muscles, all leg and foot muscles, and the skin of most of the leg and foot and can have anatomical variations.
And the pudendal nerve supplies the perineum. The posterior cutaneous nerve of the thigh gives off branches such as the inferior cluneal nerve which we mentioned, the cutaneous branch, which supplies the skin of the popliteal fossa; and the perineal branch, which supplies the posterior part of the scrotum or labia majora.
The nerve to the quadratus femoris innervates the inferior gemellus and quadratus femoris muscles. The nerve to the obturator internus supplies the superior gemellus and the obturator internus muscle.
The arteries of the gluteal region are all branches of the internal iliac artery, namely the superior gluteal artery, inferior gluteal artery, and internal pudendal artery.
The posterior thigh receives blood from multiple sources, including the inferior gluteal, medial circumflex femoral, perforating branches of the profunda femoris, and popliteal artery.
The veins of the gluteal region and posterior thigh are mostly represented by superior and inferior gluteal veins, the internal pudendal veins, and by perforating veins.
Finally, lymphatic vessels from the deep tissues of the buttocks follow the gluteal vessels to the superior and inferior gluteal lymph nodes, and from them to the internal, external, and common iliac lymph nodes and from them to the lateral lumbar lymph nodes.
Lymph from the superficial tissues of the gluteal region enters the superficial inguinal lymph nodes, which also receive lymph from the thigh.
2 L4 L5 and S1 and it innervates the inferior gemellus and quadratus femoris muscles the nerve to obturator internus arises from L5 S1 and S2 and its supplies of superior.
Gemellus obturator internus muscle. The arteries of the gluteal region are all branches of the internal iliac artery only the superior gluteal artery inferior gluteal artery and internal pudendal artery.
Posterior thigh receives blood from multiple sources, including the inferior gluteal medial circumflex femoral Perforating branches of the profunda femoris and popliteal artery.
The veins of the gluteal region and posterior thigh are mostly represented by Superior and inferior gluteal things the internal pudendal veins and the Perforating veins.
Finally lymphatic vessels from the deep tissues of the buttocks follow the gluteal vessels to the superior and inferior gluteal lymph nodes and from then to the internal external and common iliac lymph nodes from dumb to the lateral lumbar lymph nodes from The Superficial tissues of the gluteal region, and there's a superficial inguinal lymph nodes, which also receive lymph from the thigh.