Pelvis Anatomy Lecture 1-Structure of the Pelvic Wall 2016.pdf

Gross anatomy

1. 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
•EndopelvicFascia
•Lumbosacral Plexus

2. Netter’s Atlas of Human Anatomy 6
th
ed., Plate 243
Pelvis
Thoracic vertebrae
Lumbar vertebrae
Pelvis
Sacrum
Coccyx

3. Sacrum-anterior view
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 2.14A
Sacral
promontory
Ala
S1
S2
S3
S4
S5
Coccyx
Anterior sacral
foramen

4. Sacrum-posterior view
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 2.14B
Posterior sacral
foramen
Median sacral
crest
Sacral canal
Sacral hiatusCoccyx

5. (Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 4.200
Sacral hiatus
Sacral
promontory
Conus medullarisCauda equina
S1
S2
L5
Dural sac
Sacrum-epidural anesthesia injection into sacral canal

6. Coccyx
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 2.14
S1
S2
S3
S4
S5
Coccyx Coccyx
cornua
coccygeal transverse
process

7. Innominate (hip) bone
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 26.3A
Ilium
Pubis
Ischium

8. AnteriorPosterior
Lateral view of innominate (hip) bone
Ilium
Pubis
Ischium
Acetabulum (hip socket)
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.3A (Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.3B

9. Anterior PosteriorMedial view of innominate (hip) bone
(Gilroy et al.) Atlas of Anatomy 2
nd
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 6
th
ed., Plate 473
Auricular Surface

10. Pubis
Obturator foramen
Pubic symphysis
Inferior ramus
Superior ramus
Body
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.5A
Pubic arch

11. Pelvic Brim
Above=false pelvis
Below=true pelvis
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.1
Lateral mass of sacrum
Arcuate line of
ilium
Pectenpubis
Pubic crestPubic tubercle

12. Orientation of Pelvis
Gray’s Anatomy for Students, 3
rd
ed., Fig. 5.26

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

14. Sacroiliac Ligaments
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.10A, B
Posterior Sacroiliac
ligaments
Interosseous Sacroiliac
ligaments
Anterior Sacroiliac
ligaments

15. Sacroiliac Ligaments
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.11A, B
Posterior Sacroiliac
ligaments
Interosseous Sacroiliac
ligaments
Anterior Sacroiliac
ligaments
Anterior Sacroiliac
ligaments

16. SacroischialLigaments
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.10A, B
Sacrospinous
ligament
Sacrotuberous
ligament
Sacrotuberous
ligament
Sacrospinous
ligament
Greater sciatic
foramen
Lesser sciatic
foramen

17. SacroischialLigaments
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.11A, B
Sacrospinous
ligament
Sacrotuberous
ligament
Sacrotuberous
ligament
Sacrospinous
ligament
Greater sciatic
foramen
Lesser sciatic
foramen

18. Function of sacrotuberousand sacrospinous ligaments:
Resistance to rotational forces
Essential Clinical Anatomy 4
th
ed., Fig. 3.5C

19. (Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.8
Pubic symphysis
Sacral promontory
Pelvic Measurements
Manual measurement
of diagonal conjugate

20. Inferior view of pelvis:
Transverse diameter
Transverse
diameter
Ischial
tuberosity
Pubic
symphysis
Sacrotuberous
ligament

21. (Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.7
Pelvic inlet and outlet: sex differences
Female Male

22. Sex differences of pelvis
Male
Female
Pelvic inlet
Pelvic outlet
Pelvic cavity
Pubic arches

23. Obturator foramen
and membrane
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Figs. 16.10A, 16.11A
Sacrotuberous
ligament
Sacrospinous
ligament
Greater sciatic
foramen
Lesser sciatic
foramen

24. Obturator internus m.
Sagittal section through pelvis
(Gilroy et al.) Atlas of Anatomy 2
nd
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.

25. Obturator internus m.
Posterior view
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 26.20
Obturator internus m.
Quadratus femorism.
Piriformis m.
Gemellussuperior and
inferior mm.
Sacrotuberous
ligament

26. Piriformis m.
Ischial spine
Coccygeusm.
Greater sciatic
foramen
(Gilroy et al.) Atlas of Anatomy 2
nd
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

27. Piriformis m.
Posterior view
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 26.20
Obturator internus m.
Quadratus femorism.
Piriformis m.
Gemellussuperior and
inferior mm.
Sacrotuberous
ligament

28. Pelvic diaphragm:
coronal section
Pelvic
diaphragm
Perineum
Main pelvic
cavity
Rectum
Pelvic inlet
Anal canal

29. Pelvic diaphragm, inferior view
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.13B
Piriformis m.
2. Coccygeusm.
Obturator
internus m.
1. Levatoranimm.
Ischial spine
Ischial tuberosity
Coccygeus:
Medial attachment: Inferior end of sacrum
Lateral attachment: Ischial spine
Innervation: Nerve to coccygeusS3-S4
Action: Support pelvic viscera, flex coccyx

30. Pelvic diaphragm, inferior view
Subdivisions of Levatorani
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.13B
Coccygeusm.
2. Pubococcygeusm.
1. Puborectalism.
3. Iliococcygeusm.
Medial attachment: Tendinous arch
Lateral attachment: Coccyx, anococcygeal body
Innervation: Nerve to levatorani(S3-S4)
Action: Support pelvic viscera, resist changes in abdominal viscera

31. Pelvic diaphragm, sagittal section
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.13C
Piriformis m.
Coccygeusm.
Levatoranim.
Obturator internus m.
(obturator fascia)
Tendinous arch of
levatorani
Ischial spine

32. Pelvic diaphragm, midline structures
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.13B
Coccyx
Perineal body (raphe)
Anococcygeal body
(raphe)
Urogenital hiatus
Anorectal
hiatus

33. Pelvic diaphragm, superior view
Tendinous arch of
levatorani
Obturator internus m.
(obturator fascia)
Piriformis m.
Coccygeusm.
1. Puborectalism.
2. Pubococcygeusm.
3. Iliococcygeusm.
(Gilroy et al.) Atlas of Anatomy 2
nd
ed., Fig. 16.13A
Anococcygeal body
(raphe)

34. Lumbosacral Plexus
Netter’s Atlas of Human Anatomy 6
th
ed., Plate 484
L2
L3
L4
L5
S1
S2
S3
Lumbar Plexus: T12-L5
Sacral Plexus: L4-S4
Green=Anterior Division
Yellow=Posterior Division

35. Sacral plexus on posterior pelvic wall
Lumbosacral trunk
Superior gluteal n.
Sciatic n.
S5
S4
L4
L5
S1
S2
S3
Pudendal n.
Piriformis m.
Coccygeusm.
Levatorani
Gray’s Anatomy for Students, 3
rd
ed., Fig. 5.61

36. Netter’s Atlas of Human Anatomy 6
th
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 levatorani

37. Sacral plexus-Posterior Division
Netter’s Atlas of Human Anatomy 6
th
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.

38. Sacral plexus-Anterior Division
Netter’s Atlas of Human Anatomy 6
th
ed., Plate 486
S5
S4
L4
L5
S1
S2
S3
CoTibialn. L4-S3
Nerve to quadratus femorism.
and inferior gemellusm. L4-S1
Nerve to obturator internus m.
and superior gemellusm. L5-S2
Posterior femoral cutaneous n. S1-S3
Lumbosacral trunk
Pudendal n. S2-S4
Nerve to levatoraniand coccygeusm. S3-S4
Sciatic n.