C6: PELVIC WALL

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Term Midterm

Pelvis

Region of the trunk that lies inferior to the abdomen

Loosely used to describe the region where the trunk & lower limb meets

“basin”, more correctly used applied to the skeleton of the region- Pelvic girdle
or bony pelvis

Bowl-shaped bony structure

Main functions: (CAPS)

Contains abdominal, reproductive organs, supports the fetus

Attachments for muscles

Protects

Supports

Functions (based on book)

To transmit the weight of the body from the vertebral column to the femurs

Contains, supports, and protects the lower parts of the gastrointinal and urinary
tracts 7 the male and female internal organs of reproduction

Contains important nerves, blood vessels, & lymphatic tissues and provides
attachments for trunks & lower limb muscles

COMPOSITIONS

HIP BONES

(os coxae), articulate w/ each other anteriorly at the symphysis pubis &
posteriorly w/ the sacrum at the sacroiliac joints

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 Form the lateral & anterior walls

Actually palpating the iliac crest – bony prominence

Comprised of ilium (anterior), ischium (lateral), pubis (medial)

In children, each hip bone consist of ilium (superiorly), ischium (posteriorly &
inferiorly), and pubis (anteriorly & inferiorly)

At the, these 3 bones fuse together to form one large, irregular bone

Articulation

w/ the sacrum at the sacroiliac joints (posteriorly) & form the anterolateral walls
of the pelvis

also w/ one another anteriorly at the symphysis pubis

Triradiate cartilage

joins the three separate bones of the acetabulum

Acetabulum

deep depression on outer surface of hip one

articulates with hemispherical head of femur

Sciatic Notches

converted into greater and lesser sciatic foramina by the scarotuberous &
sacrspinous ligaments

Greater Sciatic Notch

large notch behind the acetabulum

separated from the lesser sciatic notch by the spine of ischium

Ilium

the upper flattened part of the hip bone

possesses the iliac crest

Iliac Crest

Runs bet. anterior & posterior iliac spines

ASIS, AIIS, PSIS, PIIS

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 Dimple of venus

Top of hipster underwear, landmark

Or PSIS

Articular surface

Large, on inner surface of the iium

For articulation with the sacrum

Iliopectineal Line

Runs downward & forward around the inner surface of the ilium

Serves to divide the false from true pelvis

Ischium

inferior & posterior part of the hip bone and possesses an ischial spine 7 ischial
tuberosity

Ischial tuberosity

Protuberance

Ischial spine

Inferior/under

Pubis

Anterior part of the hip bone & has a body and superior & inferior pubic rami

Body of pubis

Bears the pubic crest & pubic tubercle

Articulates w/ pubic bone of the opposite side of the symphysis pubis

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 Pubis tubercle

Near the symphysis pubis

Obturator foramen

Lower part of the hip bone

A large opening bounded by the parts of ischium & pubis

Hole, covered by obturator membrane

Symhysis pubis

A cartilaginous joint bet. two pubic bones on anterior surface

Pubic arch

Triangle, or called subpubic angle

Arch formed by the infereior rami of pubic bones

SACRUM

Formed of 5 rudimentary vertebrae fused together to form a single wedge-

shaped bone w/ an anterior, concavity

5-1 (5 vertebrae fused into 1)

Anterior and posterior surfaces of the sacrum possess 4 pairs of anterior &
posterior sacral foramina

Articulations

Superiorly: 5 lumbar vertebra

th

Inferiorly: coccyx

Laterally: sacroiliac joint – Formed by the articulation of two iliac bones

Lumbosacral angle

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 An angle formed by the 5 lumbar vertebra, tilted forward

LANDMARKS

Sacral Promontory

Formed when anterior & upper margins of first sacral bulge forward

Posterior margin of the pelvic inlet

Important obstetric landmark used when measuring size of the pelvis

Top most

Sacral canal

Formed by the sacral foramina together

Contains anterior & posterior roots of lumbar, sacral, & coccygeal nerves

Spinal nerves; filum terminale; & fibrous fatty material

Also contains the lower border of second sacral vertebra

Vertebral foramina

Filum terminale

Very end of spinal cord

Helps anchor the spinal cord in place

Sacral Ala

At the lateral edg, tip

Transverse Ridges

Lines

Cervical spinous process

Posterior & prominent

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 Sacral Foramina

Holes, where sacral nerves exits from the spinal nerves of the spinal cord

Sacral hiatus

At the end of sacral canal

Formed when laminae of the 5 sacral vertebra & sometimes those of the 4,
fail to meet in the middle
Clinical importance: where the blue tip of needle ends when applying gen.
anesthesia; patients assume fetal position

Epidural anesthesia

Can still push (labor) but cannot feel pain

Disensitize anesthesia

Both motor & sensor

Piriformis Muscle

Arises from the front of the sacrum & leaves the pelvis to enter the gluteaal
region by passing laterally through the freater scitic foramen

COCCYX

Consists of 4 vertebrae fused together to form a small triangular bone, which

articulates at its base w/ lower end of sacrum

(4-1)

Coccygeal vertebrae

Concicts of bodies only, but the first vertebral possesses rudimentary

transverse process & cornua

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 Cornua

Spinous process of coccyx, horns

The remains of the pedicles & superior articular processes

Projects upward to articulate w/ the sacral cornua

Pelvic Brim

Landmark to divide the true pelvis from false pelvis

Entire thing, circle

Formed by the sacral promontory (anterior & upper margin of the first sacral
vertebra) behind

Laterally iliopectineal lines (lines that run downward & forward around the
surface of the ilium)

Forms two pelvis; true and false pelvis

BOUNDED BY (TOP VIEW)

Posteriorly: Sacral promontory (anterior & upper margin of SI)

Anteriorly: Symphysis pubis

Laterally: Iliopectineal Line

False Pelvis True Pelvis

Above pelvic brim w/ only little Has greater clinical importance

clinical importance
Bounds lower part of the abdominal
Contains the pelvic cavity below the cavity, above the brim
brim
(in females) forms the bony canal
Serves its relevance during 3rd through which child passes during
trimester of pregnancy birth

Compresses the stomach upwards / (both sexes) has inlet, outlet, &
above the pelvis to accommodate cavity
the growing fetus

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 Helps guide the fetus into true
pelvis

Flares out its upper end &

considered as part of the abdominal
cavity
Pelvic Outlet

Below the pelvic brim, where baby

Pelvic Inlet
Exactly at the pelvic brim
Bounded by sacral promontory
(posteriorly), symphysis pubis
(anteriorly), iliopectineal(laterally)
comes out
Bounded by coccyx (posteriorly),
pubic arch (anteriorly), ischial
tuberosities (laterally)
outlet – is a diamond-shaped w/
ischiopubic rami and symphysis
pubis forming the boundaries
(anteriorly and sacrotuberous
ligaments & coccyx (posteriorly

Pelvic Cavity

Short curved canal w/ a shallow anterior wall & a much deeper posterior wall

Lies between inlet & outlets

3 notches

Pubic arch, greater sciatic foramina & lesser sciatic foramina

Greater Sciatic Foramina Lesser Sciatic Foramina

Structures that pass through: Structures that enter and exit:

Piriformis muscle Tendon of obturator internus

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 Nerve to quadrates femoris Pudendal nerve

Nerve to obturator membrane Internal pudendal vessels

Pudendal nerve Nerve to obturator internus

Posterior cutaneous nerve of

thigh

Superior gluteal nerve

Superior gluteal vessel

Inferior gluteal nerve

Inferior gluteal vessel

Interbal pudendal vessels

LIGAMENTS

Sacrospinous Ligament

From sacrum to spinous process of ilium

Strong triangle shaped, attached by its base to the lateral part of the sacrum &
coccyx, and by its apex to the spine of ischium

Sacrotuberous Ligament

From sacrum to ischial tuberosity

Strong & extends lateral part of the sacrum and coccyx & posterior iliac spine to
the ischial tuberosity

both ligaments prevent the lower end of the sacrum & coccyx from being rotated
upward at the sacroiliac joint by weight of the body

also convert the greater & lesser sciatic notches into greater and lesser sciatic
foraminas

Pelvic walls

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 Formed when bones & ligaments that are prtly lined w/ muscles covered with
fascia and parietal peritoneum

Anterior, posterior, lateral walls, & inferior wall of floor

Anterior pelvic wall

Shallowest wall

Formed by bodies of ubic bones, pubic rami, & symphysis pubis

Posterior pelvic wall

Extensive

Formed by sacrum & coccyx and by piriformis muscles & their covering of
parietal pelvic fascia

Lateral pelvic wall

Formed by the part of hip bone below the pelvic inlet, obturator membrane,
sacrotuberous & sacrospinous ligaments, and obturator internus muscle &
its covering fascia

Obturator Internus Muscle

Arises from the pelvic surface of the obturator foramen & membrane

Muscle fibers converge to a tendon which leaves the pelvis through the
lesser sciatic foramen & inserts into greater trochanter of femur

Nerve to obturator internus (sacral plexus)

External rotation

Inferior wall of floor

Formed by the obturator membrane, obturator caal, symphysis pubis, sacral

promontory, urethra, vagina, anal/rectal canal (last)

Levator ani muscles

puborectalis, pubococcygeus, and iliococcygeus

A wide thin sheet forming te larger, more anterior part of the pelvic
diaphragm

Has a linear origin from the base of the muscle that would control sphincter
function

Muscle in perineum

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 4th sacral & pudendal nerve

(Action) levatores ani muscles of the two sides form an efficient muscular
sling that supports and

maintains the pelvic viscera in position

rise in intrapelvic pressure during the straining and expulsive efforts of the
abdominal muscles (as occurs in coughing)

Anterior fibers: The levator prostatae or sphincter vaginae form a sling

around the prostate or vagina and are inserted into a mass of fibrous tissue,
called the perineal body, in front of the anal canal. The levator prostatae
support the prostate and stabilize the perineal body. The sphincter vaginae
constrict the vagina and stabilize the perineal body.

Intermediate fibers: The puborectalis forms a sling around the junction of

the rectum and anal canal. The pubococcygeus passes posteriorly to be
inserted into a small fibrous mass, called the anococcygeal body, between
the tip of the coccyx and the anal canal

Posterior fibers: The iliococcygeus is inserted into the anococcygeal body

and the coccyx

Coccygeus muscle

Triangular muscle

Forms the smaller, more posterior portion of pelvic diaphragm

Helps the levator ani muscles to support the pelvic viscera & sphincter

4 & 5 sacral nerve

Flex coccyx

paresthesia – condition characterized by a burning sensation or numbness

in the UE (mostly & LE

Epistomology – an incision through area bet. vaginal opening & anus;

vagina is incised – 10 cm dilation; if pudendal nerve gets incised – problems
w/ bladder and bowel control

Acetabular notch – slowly disappears as you grow old

Obturator membrane

Fills in most of the obturator foramen

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 A fibrous sheet that almost completely closes the obturator foramen, leaving a
small gap, for passage of the obturator nerve and vessels as they leave the
pelvis to enter the thigh

Obturator Canal

Small gap

Passage of the obturator nerves & vessels

Pelvic diaphragm

Formed by the paired levator ani & coccygeus muscles and their covering
fasciae

Incomplete anteriorly to allow passage of the urethra (males) and urethra &
vagina (females)

Tendinous arch

Formed bya thickening of the fascia covering the obturator internus & spine of
ischium

Sacroiliac Joints

Strong synovial joints and are formed bet articular surfaces of the sacrum and
iliac bones

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