The gluteus maximus has its origin between (and around) the iliac crest and the coccyx, from where one part radiates into the iliotibial tract and the other stretches down to the gluteal tuberosity under the greater trochanter. The gluteus maximus is primarily an extensor and lateral rotator of the hip joint, and it comes into action when climbing stairs or rising from a sitting to a standing posture. Furthermore, the part inserted into the fascia latae abducts and the part inserted into the gluteal tuberosity adducts the hip. The two deep glutei muscles, the gluteus medius and minimus, originate on the lateral side of the pelvis. The medius muscle is shaped like a cap. Its anterior fibers act as a medial rotator and flexor; the posterior fibers as a lateral rotator and extensor; and the entire muscle abducts the hip. The minimus has similar functions and both muscles are inserted onto the greater trochanter. The ventral hip muscles function as lateral rotators and play an important role in the control of the bodys balance. Because they are stronger than the medial rotators, in the normal position of the leg, the apex of the foot is pointing outward to achieve better support. The obturator internus originates on the pelvis on the obturator foramen and its membrane, passes through the lesser sciatic foramen, and is inserted on the trochanteric fossa of the femur.
This, in turn, increases the duodenal compression, which worsens the underlying cause, creating a cycle of worsening symptoms.Fear of eating is commonly seen among those with the chronic form of SMA syndrome. For many, symptoms are partially relieved when in the left lateral decubitus or knee-to-chest position, or in the prone (face down) position. A Hayes maneuver, which corresponds to applying pressure below the umbilicus in cephalad and dorsal direction, elevates the root of the SMA, also slightly easing the constriction. Symptoms can be aggravated when leaning to the right or taking a face up position. Causes
Retroperitoneal fat and lymphatic tissue normally serve as a cushion for the duodenum, protecting it from compression by the SMA. SMA syndrome is thus triggered by any condition involving an insubstantial cushion and narrow mesenteric angle. SMA syndrome can present in two forms: chronic/congenital or acute/induced.Patients with the chronic, congenital form of SMA syndrome predominantly have a lengthy or even lifelong history of abdominal complaints with intermittent exacerbations depending on the degree of duodenal compression. Risk factors include anatomic characteristics such as: asthenic (very thin or "lanky") body build, an unusually high insertion of the duodenum at the ligament of Treitz, a particularly low origin of the SMA, or intestinal malrotation around an axis formed by the SMA.