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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
Netter’s 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
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)
Netter’s 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
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
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
Netter’s 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
Gray’s Anatomy for Students, 3rd ed., Fig. 5.61
Netter’s 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
Netter’s 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
Netter’s Atlas of Human Anatomy 6th ed., Plate 486
S5
S4
L4
L5
S1
S2
S3
CoTibial n. L4-S3
Nerve to quadratus femoris m.
and inferior gemellus m. L4-S1
Nerve to obturator internus m.
and superior gemellus m. L5-S2
Posterior femoral cutaneous n. S1-S3
Lumbosacral trunk
Pudendal n. S2-S4
Nerve to levator ani and coccygeus m. S3-S4
Sciatic n.