Gluteus maximus

Haloperidol and fluphenazine decanoate should be administered by a deep, Z-track IM method. Long-acting risperidone is injected by deep IM injection in the gluteus maximus, but Z-tracking is not necessary. 

Adults The preferred IM injection site is the upper outer quadrant of the buttock (ie, gluteus maximus) or the mid-lateral thigh. 

The soluble substances, mild irritants and suspensions can be injected by this route in the large skeletal muscles (deltoid, triceps, gluteus maximus, rectus femoris etc.). These muscles are less richly supplied with sensory nerves and are more vascular, so irritant solutions can be injected. Small volumes (up to 2 ml) are injected into the deltoid muscle, and small or large volumes (up to 10 ml) are injected into the gluteal mass. 

Drugs in aqueous solution are absorbed rapidly following intramuscular (i.m.) injection, although this varies depending on factors such as the blood flow to the injection site. In humans, absorption from the deltoid or vastus lateralis muscles is faster than from the gluteus maximus. Absorption from this site is slower in females than in males. This has been attributed to sex differences in the distribution of subcutaneous fat, since fat is a relatively poorly perfused tissue. 

Inject IM. Keep into gluteus maximus or lateral aspect of thigh. 

Prepare Decanoate IM injection with 21-gauge needle do not exceed maximum volume of 3 ml per IM site inject slowly, deep IM into upper outer of gluteus maximus... 

With surface electrodes, the common way of modulating muscle force is by varying the stimulation pulse amplitude at a constant frequency and pulse-width. The stimulation amplitudes may be as low as 25 V at 200 is for the stimulation of the peroneal nerve and as high as 120 V or more at 300 J,s for activation of large muscles such as the gluteus maximus. 

Flexion of 80 to 90 degrees indicates good extensibility of the gluteus maximus muscle. More than 90 degrees of flexion indicates good extensibility of the erector spinae muscle. 

Gluteus maximus gait In gluteus maximus deficiency, the trank and pelvis are hyperextended backward over both hips to maintain the center of gravity behind the involved hip joint. 

FIG. 63-2 Facilitated positional release treatment for hypertonicity of the right gluteus maximus muscle. 

On examination, the left buttocks was lender to palpation and there were tender points at the mid-pole of the sacrum on the lateral border and one deep to the gluteus maximus, where a lense piriformis could be palpated. There was a unilateral sacral flexion (sacral shear) present on the left. No lumbar somatic dysfunctions were present. There was mild tenderness at the sciatic notch of the ischium. Deep tendon reflexes were normal and muscle strength of the ihigh was normal. There was some pain on internal rotation and adduction of the left hip. 

The gluteus maximus follows the law oj muscle detorsion. Therefore, to increase hip extension, as in ballet movement, the ilium must be rotated. Somatic dysfunction of the lumbar spine will limit lumbar regional motion, pelvic rotation, and hip extension... 

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