FT2: w5/6 notes Flashcards
parts of hip bone & position relative to the remainder of the bone
Pubis
Anteromedially
Ilium
Superolaterally
Ischium
Posteroinferiorly
Pelvis vs pelvic girdle
Pelvis
* 2 hip bones (ilium, pubis & ischium)
* Sacrum
* Coccyx
Pelvic girdle
* Hip bone only (ilium, pubis & ischium)
Pelvic inlet
location
boundaries
From false pelvis to true pelvis
Boundaries
Posteriorly - sacral promontory
Laterally - arcuate line of ilium
Anteriorly - superior ramus of pubis & pubic symphysis
Male pelvis vs female pelvis
overall shape
Overall shape
MALE
Taller in height
Narrower
Narrower pelvic outlet & inlet
FEMALE
Shallower in height
Broader
Wider pelvic outlet & inlet
* To allow for childbirth
Male pelvis vs female pelvis
subpubic angles
MALE
Smaller subpubic angle (<90°)
FEMALE
Larger subpubic angle (>90°)
Pelvic outlet
-location
-boundaries
from true pelvis to exterior
Boundaries
Posteriorly - tip of the coccyx
Posterolaterally - inferior margin of the sacrotuberous ligament (running b/n coccyx & ischial tuberosity)
Laterally - ischial tuberosities
Anteriorly - ischiopubic ramus & pubic symphysis
True (lesser) pelvis
-location
-boundaries
-contents
Location
True (lesser) pelvis - between the pelvic inlet & outlet
Boundaries
Posteriorly - sacrum & coccyx
Laterally - ischium
Anteriorly - superior pubic & ischiopubic rami
Contents
Reproductive, urinary & lower GIT organs + nerves & vessels
False (greater) pelvis
-location
-boundaries
-contents
False (greater) pelvis - superior to the pelvic inlet
Boundaries
Posteriorly - lumbar vertebra (anterosuperior aspect of S1 vertebra)
Laterally - ilium
Anteriorly - abdominal muscles
Contents
GIT organs + nerves & vessels
Openings of the pelvis
Under inguinal ligament
Obturator foramen & canal
Foramen - canal + membrane
Canal - space above membrane
Greater sciatic foramen
Lesser sciatic foramen
Under inguinal ligament
Position of opening in relation to pelvis
Boundaries
Regions/spaces that communicate via opening
Anterior (opening deep to the inguinal ligament)
Boundaries
Inguinal lig
Superior pubic ramus
Anterior ilium
External - anterior thigh
Internal - false pelvis (because it’s above the pelvic inlet)
Obturator foramen
Foramen - canal + membrane
Obturator canal
Canal - space above membrane
Obturator foramen & canal
Position of opening in relation to pelvis
Boundaries
Regions/spaces that communicate via opening
Vessels
Nerves
Muscles
Position of opening in relation to pelvis
Medial
Boundaries
Obturator membrane
Obturator foramen
Regions/spaces that communicate via opening
External - medial thigh
Internal - true pelvis (because it’s below the pelvic inlet)
Vessels
Obturator & lymphatics
Nerves
Obturator
greater sciatic foramen
Position of opening in relation to pelvis
Boundaries
Regions/spaces that communicate via opening
Vessels
Nerves
Muscles
Position of opening in relation to pelvis
Posterior
Boundaries
In an anatomical position:
Superior - greater sciatic notch
Anterior - Ischial spine
Posterior - Sacrotuberous lig
Inferior - Sacrospinous lig
Regions/spaces that communicate via opening
External - gluteal region (post thigh)
Internal - true pelvis (because it’s above the pelvic floor)
Vessels
Gluteal & lymphatics
Nerves
Spinal nerves derived from the sacral plexus
* Sciatic nerve
* Sup/inf gluteal
* N. obturator internus
* N. quadratus femoris
Muscles
Piriformis
* Powerful lateral rotator of the hip joint
Lesser sciatic foramen
Position of opening in relation to pelvis
Boundaries
Regions/spaces that communicate via opening
Vessels
Nerves
Muscles
Position of opening in relation to pelvis
Posterior
Boundaries
In an anatomical position:
Anterior - Lesser sciatic notch
Lateral - Ischial spine
Inferoposteiorly - ST lig
Superior - SS lig
Regions/spaces that communicate via opening
External - gluteal region
Internal - perineum (because it’s below the pelvic floor)
Nerves
-
Muscles
Obturator internus
* Powerful lateral rotator of the hip joint
Joints of the pelvis
Pubic symphysis
Sacroiliac joint
Pubic symphysis
Definition
Articulating surfaces
Histological classification
Function
Movements possible
Definition
Pubic symphysis - joins right & left pubic bones, made of a fibrocartilage disc
* Forms boundary of the true pelvis - contributes to the anterior boundary
Articulating surfaces
* Articulation between superior rami of left & right pubic bones
Attaches to the thin layer of hyaline cartilage that covers the end of both pubic bones
Histological classification
Secondary cartilaginous
Function
Relatively immobile to maintain pelvic stability, especially when standing on one limb
Movements possible
Nil
* Hormones soften the ligaments to allow for very little movement during child birth so pelvis can widen a little bit more
Sacroiliac joint
Definition
Articulating surfaces
Histological classification
Function
Movements possible
Position of the line of gravity in relation to SIJ, describe the effect this has on this joint
Definition
Sacroiliac joint - joins appendicular (ilium) to axial (sacrum) skeleton
Articulating surfaces
Oracular surface of ilium & oracular surface of sacrum
Histological classification
Synovial (anterior)
Fibrous (posterior)
* Highly congruent
* Significant ligamentous support (ligaments are dense, fibrous connective tissue)
Function
Very little movement in general
Movements possible
Nutation - anterior tilt movement of the upper sacrum (moves down & forward)
* Caused by bodyweight
* Anterior aspect of the sacrum moves inferiorly (and slightly anteriorly)
* Coccyx moves superiorly and posteriorly
Counter nutation - opposite movement of nutation, sacrum moves up & backward
Position of LOG: anterior
Effect of gravity at joint: pelvic tilt anteriorly (nutation)
Ligaments of the pelvis
Sacrotuberous ligament
Sacrospinous ligament
Sacrotuberous ligament
Attachments
Functions
Position in relation to the sacrum
Attachments
Ischial tuberosity & sacrum
Functions
Limits nutation of SIJ
Posterior ligament to help stabilise sacroiliac joint
Crosses sacroiliac joint, which limits mutation
Position in relation to the sacrum
Runs anterior & inferior to the sacrum
Openings - GSF & LSF
Sacrospinous ligament
Attachments
Functions
Position in relation to the sacrum
Attachments
Ischial spine & sacrum
Functions
Limits nutation of SIJ
Position in relation to the sacrum
Posterior ligament to help stabilise sacroiliac joint
Runs anterior & inferior to the sacrum
Vessels of the pelvis
Abdominal aorta
Common iliac artery (R + L)
Internal iliac artery
-Obturator - making their way to the lower limb
-Gluteal (super & inf) - making their way to the lower limb
External iliac artery
Femoral artery
Abdominal aorta
runs alongside
origin
course
termination
Runs alongside the inferior vena cava (but is to the left)
Origin
Thoracic aorta
Course
Thoracic aorta, through lower abdomen, to top of false pelvis @L4/5
Termination
Branches into
* R common iliac
L common iliac - further divides
Right vs left common iliac artery
Right common iliac artery
* Pass more oblique across body of last lumbar vertebra
* Separated from the bodies of L4 & L5 by juncture of 2 common iliac veins & inferior vena cava
Left common iliac artery
* Rests on bodies of L4 & L5
* Partly medial to & partly in front of L common iliac vein
Common iliac artery
Origin
Termination
Origin
Abdominal aorta @L4 vertebra
Termination
Left common iliac artery branches into
* Internal iliac - goes into the true pelvis
* External iliac - remains in the false pelvis
Internal iliac artery
Origin
Termination
Origin
Left common iliac artery, goes into true pelvis
Termination
Branches into
* ‘Visceral’
* Obturator - making their way to the lower limb
* Gluteal (super & inf) - making their way to the lower limb
External iliac artery
Origin
Termination
Origin
Left common iliac artery, goes into false pelvis & runs with external iliac vein
Termination
Femoral artery = name once it passes underneath the inguinal ligament and exits the pelvis, in the thigh where the femur is.
Femoral artery
Origin
Origin
Continuation of external iliac artery, under inguinal ligament
Pelvic vein names
Same name as arteries
All tributaries of inferior vena cava
Tributaries - drain into, supply blood to lower abdomen, pelvic region & lower limbs
External iliac vein
Origin
Termination
Relationships
Origin
Continuation of femoral vein proximal to inguinal ligament
Termination
Tributary of common iliac vein (L & R)
Relationships
Through false pelvis
Accompanies external iliac artery & femoral nerve
Inferior vena cava
Inferior vena cava - formed by the junction of 2 common iliac veins at L5
* Runs alongside the inferior vena cava (but is to the right)
Spinal nerve
Spinal nerve - ventral & dorsal root combined, exits the vertebral canal via the intervertebral foramen
Principle NP8 All spinal nerves divide into dorsal & ventral primary rami:
Ventral ramus
Ventral primary rami - anterior branch of the spinal nerve, leading to the spinal cord
* Supply all other somatic structures including the limbs
* forms plexus that makes up the nerves coming down to the lower limb
* Each ventral ramus divides into anterior & posterior divisions
spinal cord vs corda equina
Spinal cord - spinal nerves above L2
Corda equina - spinal nerves below L2 & exit down at the lower lumbar & sacral levels
Structures attached to the spinal nerve
Sympathetic ganglion - enlarged bit of tissue
Sympathetic trunk - length of neural tissue running inferiorly & superiorly down LS plexus, follows vertebral column
GSA, GSE & GVE
GSAs - travel towards CNS (spinal cord) from body
e.g. Carrying sensory info from skin on the back
GSEs - travel to body from CNS (spinal cord)
e.g. Innervating muscle of the knee joint
GVEs - travel to body from CNS (spinal) cord and in this case, via the sympathetic ganglion
e.g. Pre- and post-ganglionic sympathetic GVE stimulating sweat glands in the armpit
Lumbosacral plexus
lumbar plexus & sacral plexus together, comes from L2-L4, L4/5 - S1-4
Lumbar plexus
Formed by
Major branches
Formed by
Lumbar ventral rami (L2, L3 & L4)
* L2-4 ventral rami
Major branches
* Femoral nerve
* Obturator nerve
* Lateral cutaneous nerve of the thigh (LCNT)
Sacral plexus
Formed by
Major branches
Formed by
Lumbosacral trunk
Lumbar ventral rami (L4, L5)
Sacral ventral rami (S1, S2, S3)
* L4-S3 ventral rami
Major branches
* Sciatic nerve (tibial + common peroneal)
* Gluteal nerves (sup & inf)
* Posterior cutaneous nerve of the thigh (PCNT)
Branches of the lumbar plexus
Obturator nerve
Femoral nerve
Lateral cutaneous nerve of the thigh (LCNT)
Obturator nerve
Origin
Course
Location of innervated muscles
Major action of innervated muscles
Branch of the lumbar plexus
Origin
Anterior divisions of the L2-L4 ventral rami
Course
Originates in lower abdomen, travels through false pelvis to the true pelvis
Then, exits the pelvis anteriorly through the obturator canal into medial thigh
Location of innervated muscles
Medial thigh
Major action of innervated muscles
Hip adduction
Flexion, adduction, internal rotation = anterior divisions of anterior primary rami
Femoral nerve
Origin
Course
Location of innervated muscles
Major action of innervated muscles
Branch of the lumbar plexus
Origin
Posterior divisions of the L2-L4 ventral rami
Course
Originates in lower abdomen, travels through false pelvis & under inguinal ligament w external iliac a&v
Then, exits the pelvis anteriorly through the opening under (deep) inguinal ligament into anterior thigh
Location of innervated muscles
Anterior thigh
Major action of innervated muscles
Knee extension (from quadriceps)
Extension, abduction, external rotation = posterior divisions of anterior primary rami
anterior divisions of anterior primary rami actions
FAI
Flexion, adduction, internal rotation
posterior divisions of anterior primary rami
Extension, abduction, external rotation
Lateral cutaneous nerve of the thigh (LCNT)
origin is branches from L2 & L3 only
Branches of the sacral plexus
Sciatic (Common peroneal/fibular + Tibial)
Superior gluteal nerve
Inferior gluteal nerve
Posterior cutaneous nerve of the thigh (PCNT)
Sciatic nerve
common peroneal/fibular + tibial nerves travelling together for a short time, but never innervates a particular muscle
* Emerges in gluteal region, later divide in the lateral thigh separately
Common peroneal/fibular
Origin
Course
Location of innervated muscles
Major action of innervated muscles
Origin
Posterior divisions of the L4-S3 ventral rami
Course
Originates in lower abdomen as sciatic nerve, exits the pelvis posteriorly through the GSF into the anterior leg
Location of innervated muscles
Anterior leg
Major action of innervated muscles
Dorsiflexion (true extension) ankle
Tibial
Origin
Course
Location of innervated muscles
Major action of innervated muscles
Origin
Anterior divisions of the L4-S3 ventral rami
Course
Originates in lower abdomen as sciatic nerve, exits the pelvis anteriorly through the GSF into the posterior thigh/leg
Location of innervated muscles
Posterior thigh/leg
Major action of innervated muscles
Knee & ankle flexion
Superior gluteal nerve
Origin
Course
Location of innervated muscles
Major action of innervated muscles
Origin
Posterior divisions of the L4-S1 ventral rami
Course
Originates in lower abdomen, exits the pelvis posteriorly through the GSF into the gluteal region (posterior)
Location of innervated muscles
Gluteal region
Major action of innervated muscles
Hip abduction - supplies the gluteus medius, gluteus minimus & TFL muscles
Inferior gluteal nerve
Origin
Course
Location of innervated muscles
Major action of innervated muscles
Origin
Posterior divisions of the L5-S2 ventral rami
Course
Originates in lower abdomen, exits the pelvis posteriorly through the GSF into the gluteal region (posterior)
Location of innervated muscles
Gluteal region
Major action of innervated muscles
Hip extension - travels beneath the piriformis to supply the gluteus maximus
Posterior cutaneous nerve of the thigh (PCNT)
branches from S2 & S3 only
Muscles of the pelvis
Muscles of the pelvis - includes psoas & iliacus (iliopsoas) as the major muscles, also includes obturator internus & piriformis (notes in muscles of the gluteal region)
Iliacus
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Femoral nerve
(L2, L3)
Proximal attachment
Iliac fossa
Distal attachment
Lesser trochanter of femur (join to form iliopsoas)
Position & orientation in relation to joint(s) crossed
Anterior & slightly medial to hip jt
Vertical orientation
Function
Hip flexion
Weak hip adduction
Psoas major
Innervation
Proximal attachment
Distal attachment
Position & orientation in relation to joint(s) crossed
Function
Innervation
Anterior rami
L1-L3
Proximal attachment
Lumbar vertebrae TPs
Lateral bodies & intervening IVDs
Distal attachment
Lesser trochanter of femur (join to form iliopsoas)
Position & orientation in relation to joint(s) crossed
Anterior & slightly medial to hip jt
Vertical orientation
Function
Hip flexion
Weak hip adduction
