Superior Gluteal Nerve

Description

Arising from the posterior divisions of the L4 to S1 ventral rami within the sacral plexus, the superior gluteal nerve is traced along the posterolateral wall of the lesser pelvis, deep to the piriformis and adjacent to the anterior sacral foramina. It exits the pelvis through the greater sciatic foramen superior to piriformis, separating it from the larger sciatic nerve that passes inferior to the muscle. Lateral to the ischial spine and posterior to the acetabulum, the nerve courses between gluteus medius and gluteus minimus on the lateral ilium, sending branches toward tensor fasciae latae. Orientation matters. Clinically, this nerve is the one you worry about when the “safe” upper outer quadrant is ignored. Injury during a posterolateral approach to the hip, pelvic fracture patterns involving the greater sciatic notch, or iatrogenic trauma from poorly placed intramuscular gluteal injections can denervate the hip abductors, producing a Trendelenburg gait and pelvic drop on the contralateral side. This view also helps clarify why piriformis is a key landmark, because the superior gluteal neurovascular bundle exits above it while the sciatic nerve typically exits below. Orthopaedic trainees can use this plate to map surgical planes in total hip arthroplasty and to rehearse where retractors threaten the superior gluteal nerve near the greater sciatic foramen. Anatomy and neuroanatomy courses will find it useful for teaching the sacral plexus, the relationship of the sciatic and gluteal nerves to the lesser pelvis, and nerve pathways relative to the sacrum, ilium, and proximal femur. Anatomical accuracy verified by SciePro's Medical Advisory Board.