STRUCTURE OF THE PELVIC WALL - Marshall University Anatomy...STRUCTURE OF THE PELVIC WALL • Bones of the Pelvis – Sacrum – Coccyx – Innominate bone ... Pelvic

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  • STRUCTURE OF THE PELVIC WALL

    Bones of the Pelvis Sacrum

    Coccyx

    Innominate bone Ilium, ischium, & pubis

    Joints & ligaments

    Divisions of the Pelvis True & false pelvis

    Pelvic Inlet Measurements for Obstetrics

    Sexually Dimorphic Pelvis Distinction between the female & male pelvis

    Walls of the True Pelvis

    Pelvic Diaphragm

    Endopelvic Fascia

    Lumbosacral Plexus

  • Netters Atlas of Human Anatomy 6th ed., Plate 243

    Pelvis

    Thoracic vertebrae

    Lumbar vertebrae

    Pelvis

    Sacrum

    Coccyx

  • Sacrum-anterior view

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 2.14A

    Sacral

    promontory

    Ala

    S1

    S2

    S3

    S4

    S5

    Coccyx

    Anterior sacral

    foramen

  • Sacrum-posterior view

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 2.14B

    Posterior sacral

    foramen

    Median sacral

    crest

    Sacral canal

    Sacral hiatusCoccyx

  • (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 4.200

    Sacral hiatus

    Sacral

    promontory

    Conus medullarisCauda equina

    S1

    S2

    L5

    Dural sac

    Sacrum-epidural anesthesia injection into sacral canal

  • Coccyx

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 2.14

    S1

    S2

    S3

    S4

    S5

    Coccyx Coccyx

    cornuacoccygeal transverse

    process

  • Innominate (hip) bone

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 26.3A

    Ilium

    Pubis

    Ischium

  • AnteriorPosteriorLateral view of innominate (hip) bone

    Ilium

    Pubis

    Ischium

    Acetabulum (hip socket)

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.3A (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.3B

  • Anterior PosteriorMedial view of innominate (hip) bone

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.2B

    Ilium

    Pubic Tubercle

    Ischial Spine

    Iliac crest

    Iliac fossa

    Anterior Superior

    Iliac Spine (ASIS)

    Greater Sciatic Notch

    Lesser Sciatic Notch

    Ischial Tubercle

    Ischial Ramus

    Anterior Inferior

    Iliac Spine (AIIS)

    Netters Atlas of Human Anatomy 6th ed., Plate 473

    Auricular Surface

  • Pubis

    Obturator foramen

    Pubic symphysis

    Inferior ramus

    Superior ramus

    Body

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.5A

    Pubic arch

  • Pelvic BrimAbove=false pelvis

    Below=true pelvis

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.1

    Lateral mass of sacrum

    Arcuate line of

    ilium

    Pecten pubis

    Pubic crest Pubic tubercle

  • Orientation of Pelvis

    Grays Anatomy for Students, 3rd ed., Fig. 5.26

  • Sacroiliac Joint

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 26.3A

    Sacroiliac joint

  • Sacroiliac Ligaments

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.10A, B

    Posterior Sacroiliac

    ligaments

    Interosseous Sacroiliac

    ligamentsAnterior Sacroiliac

    ligaments

  • Sacroiliac Ligaments

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.11A, B

    Posterior Sacroiliac

    ligaments

    Interosseous Sacroiliac

    ligaments

    Anterior Sacroiliac

    ligaments

    Anterior Sacroiliac

    ligaments

  • Sacroischial Ligaments

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.10A, B

    Sacrospinous

    ligament

    Sacrotuberous

    ligament

    Sacrotuberous

    ligament

    Sacrospinous

    ligament

    Greater sciatic

    foramen

    Lesser sciatic

    foramen

  • Sacroischial Ligaments

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.11A, B

    Sacrospinous

    ligament

    Sacrotuberous

    ligament

    Sacrotuberous

    ligament

    Sacrospinous

    ligament

    Greater sciatic

    foramen

    Lesser sciatic

    foramen

  • Function of sacrotuberous and sacrospinous ligaments:Resistance to rotational forces

    Essential Clinical Anatomy 4th ed., Fig. 3.5C

  • (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.8

    Pubic symphysis

    Sacral promontory

    Pelvic Measurements

    Manual measurement

    of diagonal conjugate

  • Inferior view of pelvis:

    Transverse diameter

    Transverse

    diameter

    Ischial

    tuberosity

    Pubic

    symphysis

    Sacrotuberous

    ligament

  • (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.7

    Pelvic inlet and outlet: sex differences

    Female Male

  • Sex differences of pelvis

    MaleFemale

    Pelvic inlet

    Pelvic outlet

    Pelvic cavity

    Pubic arches

  • Obturator foramen

    and membrane

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Figs. 16.10A, 16.11A

    Sacrotuberous

    ligament

    Sacrospinous

    ligament

    Greater sciatic

    foramen

    Lesser sciatic

    foramen

  • Obturator internus m.Sagittal section through pelvis

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 26.13

    Obturator internus m.

    Sacrotuberous

    ligament

    Sacrospinous

    ligament

    Lesser sciatic

    foramen

    Greater sciatic

    foramen

    Medial attachment: Inner surface of obturator membrane

    Lateral attachment: Medial surface of greater trochanter

    Innervation: Nerve to obturator internus (L5-S2)

    Action: Laterally rotate extended thigh

    Abduct flexed thigh

    Piriformis m.

  • Obturator internus m.Posterior view

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 26.20

    Obturator internus m.Quadratus femoris m.

    Piriformis m.

    Gemellus superior and

    inferior mm.

    Sacrotuberous

    ligament

  • Piriformis m.

    Ischial spine

    Coccygeus m.

    Greater sciatic

    foramen

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 26.13A

    Piriformis m.Posterior wall of true pelvis

    Medial attachment: Pelvic surface of sacrum

    Lateral attachment: Greater trochanter

    Innervation: Nerve to Piriformis (S1-S2)

    Action: Laterally rotate thigh

    Abduct thigh

  • Piriformis m.Posterior view

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 26.20

    Obturator internus m.Quadratus femoris m.

    Piriformis m.

    Gemellus superior and

    inferior mm.

    Sacrotuberous

    ligament

  • Pelvic diaphragm:

    coronal section

    Pelvic

    diaphragm

    Perineum

    Main pelvic

    cavity

    Rectum

    Pelvic inlet

    Anal canal

  • Pelvic diaphragm, inferior view

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.13B

    Piriformis m.

    2. Coccygeus m.

    Obturator

    internus m.

    1. Levator ani mm.

    Ischial spine

    Ischial tuberosity

    Coccygeus:

    Medial attachment: Inferior end of sacrum

    Lateral attachment: Ischial spine

    Innervation: Nerve to coccygeus S3-S4

    Action: Support pelvic viscera, flex coccyx

  • Pelvic diaphragm, inferior viewSubdivisions of Levator ani

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.13BCoccygeus m.

    2. Pubococcygeus m.

    1. Puborectalis m.

    3. Iliococcygeus m.

    Medial attachment: Tendinous arch

    Lateral attachment: Coccyx, anococcygeal body

    Innervation: Nerve to levator ani (S3-S4)

    Action: Support pelvic viscera, resist changes in abdominal viscera

  • Pelvic diaphragm, sagittal section

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.13C

    Piriformis m.

    Coccygeus m.

    Levator ani m.

    Obturator internus m.

    (obturator fascia)

    Tendinous arch of

    levator aniIschial spine

  • Pelvic diaphragm, midline structures

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.13B

    Coccyx

    Perineal body (raphe)

    Anococcygeal body

    (raphe)

    Urogenital hiatus

    Anorectal

    hiatus

  • Pelvic diaphragm, superior view

    Tendinous arch of

    levator ani

    Obturator internus m.

    (obturator fascia)

    Piriformis m.

    Coccygeus m.

    1. Puborectalis m.

    2. Pubococcygeus m.

    3. Iliococcygeus m.

    (Gilroy et al.) Atlas of Anatomy 2nd ed., Fig. 16.13A

    Anococcygeal body

    (raphe)

  • Lumbosacral Plexus

    Netters Atlas of Human Anatomy 6th ed., Plate 484

    L2

    L3

    L4

    L5

    S1S2S3

    Lumbar Plexus: T12-L5

    Sacral Plexus: L4-S4

    Green=Anterior Division

    Yellow=Posterior Division

  • Sacral plexus on posterior pelvic wall

    Lumbosacral trunk

    Superior gluteal n.

    Sciatic n.S5

    S4

    L4

    L5

    S1

    S2

    S3

    Pudendal n.

    Piriformis m.

    Coccygeus m.

    Levator ani

    Grays Anatomy for Students, 3rd ed., Fig. 5.61

  • Netters Atlas of Human Anatomy 6th ed., Plate 486

    Sacral plexus in situ

    Obturator n.

    Psoas

    major m.

    L4

    L5

    S1

    S2

    S3

    Superior gluteal a. and n.

    Inferior gluteal a.

    Pudendal n.

    Internal pudendal a.

    Nerve to levator ani

  • Sacral plexus-Posterior Division

    Netters Atlas of Human Anatomy 6th ed., Plate 486

    S5

    S4

    L4

    L5

    S1

    S2

    S3

    CoCommon fibular n. L4-S2

    Superior gluteal n. L4-S1

    Inferior gluteal n. L5-S2

    Nerve to Piriformis S1-S2

    Posterior femoral cutaneous n. S1-S3

    Lumbosacral trunk

    Sciatic n.

  • Sacral plexus-Anterior Division

    Netters Atlas of Human Anat