Pelvic And Perineal Arthrology Flashcards
What structures are present in the pelvic girdle?
Obturator membrane, pubic symphysis, inguinal L, transverse acetabular L
What is the obturator membrane?
Stretched across the obturator foramen
What is the inguinal L?
From the pubic tubercle of the pubis to the ASIS
What is the pubic symphysis?
Union b/w the symphyseal surfaces of right and left pubic bones which are separated by a fibrocartilaginous disc
Include the superior pubic L, inferior pubic L, inter pubic disc
What is the transverse acetabular L?
Stretches across the acetabular notch
What is the lumbosacral joint?
L5 vertebra and sacrum
Intervertebral joint
Symphysis, zygopophyseal joint, planar synovial
Includes the anterior longitudinal L, posterior longitudinal L, Ligamentum flavum, thoracolumbar fascia, iliolumbar L, lumbosacral L
What is the sacroiliac joint?
Coxal bone and sacrum
Compound joint anteriorly b/w auricular surface of the sacrum and Articular surface of the ilium
Planar synovial posteriorly b/w sacral and Ischial tuberosities
Fibrous syndesmosis
Includes sacrospinous L, sacrotuberous L, posterior (long and short) and anterior sacroiliac L, interosseous sacroiliac L
What is the sacrospinous L?
From ventral sacrum to ischial spine
What is the sacrotuberous L?
From ventral sacrum to ischial tuberosity
What is the posterior sacroiliac L?
Two distinct parts
Long posterior sacroiliac L (two bands from the PSIS and median sacral crest which blend inferiorly with the sacrotuberous L)
Short L (originates from median sacral crest inserting onto posterior surface of iliac crest and iliac tuberosity)
What do the sacrotuberous and sacrospinous L form?
The ligamentous borders which produce the greater sciatic foramen and lesser sciatic foramen from the greater and lesser sciatic notch
What is the peritoneum?
Dips down out of the abdominal into the pelvis to cover but not surround the pelvic viscera
Describe male peritoneum
Covers the superior and lateral aspects of the urinary bladder and rectum
Includes the paravesicle fossa, pararectal fossa, rectovesicle pouch
What is the paravesicle fossa?
Depressed areas lined with peritoneum on either side of the urinary bladder
Present in males and females
What is the pararectal fossa?
Depressed areas lined with peritoneum on either side of the rectum
Present in males and females
What is the rectovesicle pouch?
Depressed area lined with peritoneum b/w the rectum and urinary bladder
Present in males
Describe the peritoneum of a female
Covers the superior and lateral aspects of the Urdu art bladder, uterus, uterine tubes, ovaries and rectum
Includes the paravesicle fossa, broad L of the uterus, pararectal fossa, vesicouterine pouch, rectouterine pouch
What is the broad L of the uterus?
Double layer of peritoneum
Extends from the lateral pelvic walls to the uterus enclosing the uterus, uterine tubes, round L of uterus, and ligament of the ovary
Has three parts + the suspensory L of ovary
What are the three parts of the broad L of the uterus?
Mesometrium, mesosalpinx, mesovarium
What is mesometrium?
Part of the broad L that supports the uterus
Also surrounds the ligament of the ovary and round L
What is the mesosalpinx?
Part of the broad L that supports the uterine tubes
What is the mesovarium?
Part of the broad L that supports the ovaries
What is the suspensory ligament of the ovary?
Prolonged lateral extension from the ovary enclosing the ovarian vessels
What is the vesicouterine pouch?
Depressed area lined with peritoneum b/w the urnary bladder and uterus
What is the rectouterine pouch?
Cul de sac of Douglas
Depressed area lined with peritoneum b/w uterus and rectum
What are the components of membranous pelvic fascia?
Parietal pelvic fascia including obturator fascia and tendinous arch of pelvic fascia + visceral pelvic fascia
What is parietal pelvic fascia?
Lines the muscular walls of the pelvis including the obturator internus, piriformis, levator ani and coccygeus muscles
Includes obturator fascia and tendinous arch of pelvic fascia
What is obturator fascia?
Lines the pelvic side of the obturator internus M
Continuous superiorly with transversalis fascia
Forms the walls of the pudendal canal
Forms the tendinous arch of the levator ani M
What is the tendinous arch of pelvic fascia?
Made of the puboprostatic L (anterior part in males), pubovesicle (anterior part in females) and the sacrogenital L (composed of rectoprostatic L in males and uterosacral* L in females)
What is the visceral pelvic fascia?
Surrounds pelvic viscera except where the pelvic viscera penetrate the pelvic diaphragm and the parietal and visceral layers come together to form the tendinous arch of pelvic fascia
Which two ligaments can become damaged during pregnancy/child birth?
Uterosacral and transverse cervical L
What are the two components of pelvic fascia?
Membranous pelvic fascia + endopelvic fascia
What is endopelvic fascia?
Composed of loose and condensed parts
What is loose endopelvic fascia?
Fat filled potential spaces
Includes retropubic space, paravesical space, pelvirectal space, retrorectal space
What is the retropubic space?
Prevesical space
Between pubis and urinary bladder
Continuous posterolaterally with the paravesical space
What is the paravesical space?
Between obturator fascia and anterior part of the hypogastric sheath
Separated from the pelvirectal space by the hypogastric sheath
What is the pelvirectal space?
Surrounding the rectum
Separated into anterior and posterior parts by the lateral rectal L
What is the rectorectal space?
Presacral sapce
Between the sacrum and rectum
Continuous anterolaterally with the pelvirectal space
What is condensed endopelvic fascia?
Increased density of collagen and elastic fibers
Responsible for compartmentalizing the loose endopelvic fascia
Includes hypogastric sheath
What is the hypogastric sheath?
Thick band of condensed fascia
Serves as conduit for nerves and vessels going from the lateral pelvic wall to the pelvic viscera including the uterus and in the male the ductus deferens
Divided into anterior, middle and posterior lamina
What is the lateral L of the bladder?
Extension of the hypogastric sheath to the urinary bladder
What is the middle lamina of the hypogastric sheath?
Includes rectovesical septum in males between the rectum and urinary bladder
And the transverse cervical L (cardinal L) which is an extension of the hypogastric sheath to the cervix
What is the lateral rectal L?
Extension of the hypogastric sheath to the posterior aspect of the rectum
What is the perineum?
A quadrangular space when viewed from the inferior aspect Pubic symphysis (anterior), the coccyx (posteriorly), the two ischial tuberosities (laterally) Divided into two triangular spaces including the urogenital triangle (anterior) and anal triangle (posterior)
What is the anal triangle?
Includes the ischioanal fossa and pudendal canal
What is the ischioanal fossa?
Around the wall of the anal canal inferior to the pelvic diaphragm
Narrow superiorly, wide inferiorly
Filled with fat and loose CT that allows for expansion of the anal canal during defecation
What is the pudendal canal?
Space inside the obturator fascia which transmits the internal pudendal A, V and pudendal N
What is the urogenital triangle?
Includes the perineal membrane, superficial perineal fascia, deep perineal fascia, superficial and deep perineal pouch
What is the perineal membrane?
Extends between the two sides of the pubic arch
Covers the anterior portion of the inferior pelvic aperture
What is the superficial perineal fascia?
Continuous with the superficial fascia of the abdomen
Made up of fatty and membranous component
Fatty fascia forms the fatty layers of the labia major and mons pubis, replaced by penis and scrotum in the male
Membranous fascia forms dartos fascia and penis + scrotum
What is the deep perineal fascia?
In the female exists as the perineal membrane
In the male makes up the deep fascia of the penis and perineal membrane
What is the superficial perineal pouch?
Between membranous superficial perineal fascia and perineal membrane
What are the contents of the superficial perineal pouch in the male?
Bulb and crura of penis, superficial perineal muscles, proximal spongy urethra, branches of internal pudendal A and V, and of the pudendal N
What are the contents of the superficial perineal pouch in the female?
Crura of clitoris, bulbs of the vestibule, superficial perineal muscles, greater vestibular glands, branches of internal pudendal A and V, and of the pudendnal N
What is the deep perineal pouch?
Open superiorly and lies inferoanteriorly to the urinary bladder
What are the contents of the deep perineal pouch in the male?
Membranous urethra, muscles of the urogenital diaphragm, bulbourethral glads
What are the contents of the deep perineal pouch in the female?
Muscles of the urogenital diaphragm
