The pelvis.

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1. Welcome 1

2. Dewan Institute Of Rehabilitation Sciences Shaheed Benazir Bhutto Dewan University 2

3. THE PELVIS Presented By: Saadiya Naeemi 3 -DPT Batch-I

4. THE PELVIS: It is the lower part of the trunk between the abdomen and the lower limb. THE BONES: Innominate Bones ( Illium , Ischium & Pubis) Sacrum. Coccyx 4

5. Fig. The Bones Of Pelvis. Innominate Bones: Forms the Lateral and Anterior wall. 2. Sacrum and Coccyx: Part of the vertebral column and forms the back wall. 5

6. Articulation : -Anteriorly: Symphysis Pubis. -Posteriorly: Sacrum at Sacroiliac Joint. 6

7. PELVIC BRIM : - Posteriorly : Sacral Promontary . Anteriorly : Symphysis Pubis. Laterally: I leopectineal Line. 7

8. Posterior: Lumbar Vertebra. Lateral: Illiac Fossa , Illiacus muscle. Anterior: Lower part of Ant. Abdominal wall. False Pelvis : (Greater Pelvis) 8

9. Clinical Importance After 3 rd month of pregnancy, helps support Gravid Uterus. False Pelvis : (Greater Pelvis) 9

10. True Pelvis : Pelvic Inlet. Pelvic Outlet. Pelvic Cavity. (Lesser Pelvis) 10

11. i ) Pelvic Inlet: - Anterior: Symphysis Pubis . Posterior: Illeopectineal Line. Lateral: Sacral Promontory. 11

12. Fig. Pelvic Inlet 12

13. ii) Pelvic Outlet: - Anterior: Pubic Arch. Posterior: Coccyx Lateral: Ischial Tuberosity . 13

14. Fig. Pelvic Outlet 14

15. ii) Pelvic Outlet: Sub-Pubic Angle: The angle beneath the pubic arch is known as the  sub-pubic angle  and is of a greater size in women. 15

16. F E M A L E P E L V I S Fig. Sub-Pubic Angle Female. 16

17. P E L V I S M A L E Fig. Sub-Pubic Angle Female. 17

18. ii) Pelvic Outlet: Notches: Three wide notches. Anteriorly, the pubic arch is in between the ischiopubic rami below the pubic symphysis . Laterally, are the two sciatic notches which are divided by Sacrotuberous Ligament & Sacrospinous Ligament. 18

19. Fig. Pelvic Outlet 19

20. iii)Pelvic Cavity: Lies between the inlet and outlet. Short, curved canal. Shallow anterior wall and a much deeper posterior wall. 20

21. Pelvic Walls: Anterior wall. Posterior wall. Lateral wall. Inferior wall (Pelvic Floor). 21

22. 1 .Anterior wall : Shallowest wall. Formed by posterior surface of: Pubic rami . Symphysis Pubis. Pubic Bones. 22

23. M A L E P E L V I C W A L L 23

24. F E M A L E P E L V I C W A L L 24

25. 2 .Posterior wall : Formed by : Sacrum. Coccyx. Piriformis Muscle. 25

26. M A L E P E L V I C W A L L 26

27. F E M A L E P E L V I C W A L L 27

28. 3 .Lateral wall : Formed by parts of hip bones. Pelvic Inlet. Obturator membrane. Sacrotuberous Ligament. Sacrospinous Ligament Obturator Internus Ligament. 28

29. M A L E P E L V I C W A L L 29

30. F E M A L E P E L V I C W A L L 30

31. 4 .Inferior wall : Supports Pelvic Viscera. Formed by Pelvic Diaphragm. In order to allow for urination and defecation, there are a few gaps in the structure. There are two ‘holes’ that have significance: The urogeninital hiatus  – An anteriorly situated gap, which allows passage of the urethra (and the vagina in females). The Ano -rectal hiatus  – A centrally positioned gap, which allows passage of the anal canal. ( Pelvic Floor) 31

32. M A L E P E L V I C W A L L 32

33. F E M A L E P E L V I C W A L L 33

34. Pelvic Diaphragm: Funnel-shaped. There are three components: Levator ani muscles (largest component). Coccygeus muscle. Fascia coverings of the muscles. 34

35. 1 .Levator Ani Muscles: It is a broad sheet of sub-muscles. It is composed of three separate paired muscles. Pubo-coccygeus muscle. Pubo-rectalis muscle. Illio-coccygeus muscle. Acting together they raise the pelvic floor and assist the abdominal muscles in forced expiration activities 35

36. a. Pubo-coccygeus : The muscle fibres of the pubococcygeus arise from the body of the  pubic bone  and the anterior aspect of the  tendinous arch . The fibres travel around the margin of the urogenital hiatus and run posteriomedially,attaching at the  coccyx  and  anococcygeal ligament . As the fibres run inferiorly and medially, some fibres divide and loop around the prostate in males ( levator prostatae ) and around the vagina in females ( pubovaginalis ). 36

37. Fig. Pubococcygeus Muscle 37

38. b. Pubo-rectalis : The puborectalis muscle is a U-shaped sling, extending from the bodies of the pubic bones, past the  urogenital hiatus , around the anal canal. Its tonic contraction bends the canal anteriorly, creating the anorectal angle (90degrees) at the  anorectal junction  (where the rectum meets the anus). The main function of this thick muscle is to maintain faecal continence – during defecation this muscle relaxes. 38

39. Fig. Puborectalis Muscle 39

40. Fig. Puborectalis Muscle 40

41. Fig. Puborectalis Muscle 41

42. c. I lleococcygeus : The iliococcygeus has thin muscle fibres. Starts anteriorly at the  ischial spines  and posterior aspect of the  tendinous arch . They attach posteriorly to the coccyx and the anococcygeal ligament. 42

43. Fig. Illeococcygeus Muscle 43

44. 2. Coccygeus : The coccygeus is the smaller part. The levator ani muscles situated anteriorly. It originates from the  ischial spines  and travels to the lateral aspect of the sacrum and coccyx, along the  sacrospinous   ligament. Supports the Pelvic Viscera and flexes the coccyx. 44

45. Fig. Coccygeus Muscle 45

46. Types Of Pelvis: 46

47. Nerve Supply Superior Hypogastric Nerve. Inferior Hypogastric Nerve. Pelvic Splanchnic Nerve. Lumbar Plexus: Lumbosacral trunk. Obturator Nerve. 47

48. Nerve Supply 5. Sacral Plexus : Sciatic Nerve. Superior & Inferior Gluteal Nerve. Nerve to Quadratus Femoris & Obturator Internus . Posterior Cutaneous Nerve of Thigh. Pudendal Nerve. Nerve to Piriformis . Pelvic Splanchnic Nerve. Profratory Cutaneous Nerve. 48

49. Arterial Supply: 49

50. Arterial Supply: 50

51. Fig. Arterial Supply. 51

52. Organs RENAL TRACT: Ureters : Originate at Renal Pelvis Path initially medial to vertebrae and at pelvic brim take infero -posterior path Oblique entry into bladder avoids urinary reflux Arterial supply via gonadal , renal, vesical, vaginal and aortic branches Autonomic innervation . 52

53. Organs 53

54. Organs 54

55. Organs 55

56. Organs 56

57. Organs 57

58. Organs 58

59. 59 Sympathetics from aortic plexus and parasympathetics from pelvic plexus . Right ovarian vein drains to IVC whilst left to left renal vein Female Viscera:

60. 60 Female Viscera:

61. 61 Scrotum: Male Viscera:

62. 62 Testes: Male Viscera:

63. 63 Fig. Scrotum and Testes. Male Viscera:

64. 64 M A L E V I S C E R A Multi-lobar (5) with posterior groove. Apex at the bottom and base at top . Smooth muscle. Contains prostatic urethra Arterial supply from inferior vesical, middle rectal and occasionally pudendal arteries. Drains to venous plexus and then to internal iliac vein. Sympathetic nerves promote ejaculation and smooth muscle contraction whilst parasympathetics promote erection.

65. 65 M A L E V I S C E R A

66. 66 M A L E V I S C E R A

67. 67 M A L E V I S C E R A

68. QUESTIONS??? 68

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