Gluteus Medius

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The Gluteus Medius is a muscle of the gluteal region.

Collectively with the Gluteus Minimus and Gluteus Maximus, they maybe referred to as the Glutes.

Anatomical Attachments:

• Origin: Attaches to the upper lateral surface of the ilium and from the anterior ¾ of the iliac crest, between the anterior and posterior gluteal lines and to the gluteal aponeurosis.
• Insertion: Attaches into the oblique ridge on the lateral surface of the greater trochanter.

Action: Abducts and rotates the thigh medially.

Synergist:  

• Prime Movers: Gluteus maximus, Adductor magnus (posterior part).
• Accessory Movers: Semimembranosus, Semitendinosus, Biceps femoris (long head), Piriformis.

Antagonist: Iliopsoas, Pectineus, Tensor fasciae latae, Adductor brevis, Sartorius.

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Nerve Supply: Superior Gluteal Nerve (L4, L5, S1).

Nerve Entrapment: While there is no entrapment syndrome associated with the gluteus medius, Travell and Simons note that this muscle invaginates with the piriformis. As the piriformis is directly indicated with entrapment syndromes, it is possible that the gluteus medius indirectly participates in the piriformis entrapment syndrome. Additionally, extreme hypertonicity of this muscle could apply tensile compression over the numerous sacral nerves which it overlies.

Vascular supply: Deep branch of the superior gluteal artery.

• Primary: The trigger point referral predominantly involves the sacroiliac joint, the crest of the ilium, deep into the buttock, and down the posterior aspect of the leg.
• Satellite or associated triggers: Quadratus lumborum, Piriformis, Gluteus minimus, Gluteus maximus, Tensor Fasciae Latae.

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Trigger Point Signs and Symptoms: The individual has buttock and hip pain, is unable to lie on the dysfunctional side, and has an expressed inability to sit in a slumped position or have their weight on the buttock.

Trigger Point Activating and Perpetuating Factors: Post injection soreness, trauma during sports, trauma from falls.

Differential Diagnosis: Sacroiliac joint dysfunction, Lumbar articulating dysfunction, Inflammation of the sub gluteus medius bursa, S1 nerve compression (Sciatica), Neurovascular entrapment, Trochanteric bursitis, Articular dysfunction, Degenerative disc disease, (Segmental, Subluxation, Somatic dysfunction) Lower lumbar arthrosis herniation nerve compression (L4, L5 radiculopathy), Intervertebral stenosis, Hip Dislocation, Hip fracture, Hip Pointer, Piriformis syndrome, Tensor fasciae latae syndrome, Bone cancer or Malignant neoplasm of the hip, Sacroiliac joint displacement, Coccygodynia, Reiter’s disease, Intervertebral stenosis, Ankylosing Spondylitis, Coxa plana, Pregnancy, Osteoarthritis, Reflex Sympathetic Dystrophy (Complex regional pain syndrome), Fibromyalgia, Polymyalgia rheumatica, Rheumatoid arthritis, Cauda equina syndrome, Eosinophilic fasciitis, Tetanus, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

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