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Reproductive System I > Pelvic and Perineal Osteology/ Arthrology Lecture (Dr. Olinger) > Flashcards

Pelvic and Perineal Osteology/ Arthrology Lecture (Dr. Olinger) Flashcards

1
Q

Helpful Note: The Pelvis

A
  • The Pelvis, or Pelvic cavity is the region of the trunk inferoposterior to the Abdomen, between the Pelvic Brim and Pelvic Diaphragm.
  • The Pelvis is also the transition point between trunk and Lower Extremity.
  • The Perineum is the area of the trunk between the Thighs and Buttocks, from the Coccyx to the Pubis, inferior to the Pelvic Diaphragm.
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2
Q

Coxal Bone (Hip Bones, Innominate Bones, Pelvic Bone, Os Coxa)

A
  1. ILIUM (superior part of the Coxal Bone)
  2. PUBIS (inferoanterior part of the Coxal Bone)
  3. ISCHIUM (inferoposterior part of the Coxal Bone)
  4. ACETABULUM (lateral aspect, made up of all three parts of the Coxal Bone)
  5. OBTURATOR FORAMEN (formed by Superior and Inferior Pubic Rami, the Ischial Ramus and the Body of the Ischium)
  6. ILIOPUBIC EMINENCE (at Iliopubic junction, projects anteriorly)
  7. ISCHIOPUBIC RAMUS (area of overlap between the Ischial Ramus and Inferior Pubic Ramus)
  8. LINEA TERMINALIS (Coxal contribution to the Pelvic Brim, composed of the Arcuate Line of the Ilium and Pecten Pubis)
  9. PUBIC ARCH (Bony arch between Right and Left Inferior Pubic and
    Ischial Rami, the apex of the Pubic arch is at the Pubic Symphysis)
  10. SUBPUBIC ANGLE (angle immediately inferior to the Pubic Symphysis)
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3
Q

ILIUM (superior part of the Coxal Bone)

A

A. ILIAC ALA
1. Anterior Gluteal Line (lateral aspect)

  1. Posterior Gluteal Line (lateral aspect)
  2. Inferior Gluteal Line (lateral aspect)

B. ILIAC FOSSA (medial aspect, contains the Iliacus M.)

C. ARCUATE LINE (medial aspect, one of three component to the Pelvic Brim, one of two components of the Linea Terminals)

D. AURICULAR SURFACE of the Ilium (medial aspect, articulates with the Auricular Surface of the Sacrum)

E. ILIAC CREST (along the superior edge of the Iliac Ala)
1. ILIAC TUBERCLE (projects superiorly)

  1. ILIAC TUBEROSITY (medial aspect)

F. ANTERIOR SUPERIOR ILIAC SPINE (superior attachment for the
Inguinal L.)

G. ANTERIOR INFERIOR ILIAC SPINE

H. POSTERIOR SUPERIOR ILIAC SPINE

I. POSTERIRO INFERIOR ILIAC SPINE

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4
Q

Pubis (inferoanterior part of the Coxal Bone)

A

A. BODY (anterior most part of the Pubis)
1. Pubic Symphyseal Surface (articulates with contralateral Coxal Bone to form the Pubic
Symphysis)

  1. Pubic Crest (anterior aspect)
  2. Pubic Tubercle (on the lateral aspect of the PubicCrest)

B. SUPERIOR PUBIC RAMUS (projects toward Acetabulum)
1. Pectin Pubis (Pectineal Line, continuous with the Arcuate line of the Ilium forming the Linea Terminalis, and coxal part of the Pelvic Brim)

  1. Obturator Crest (ridge on the lateral aspect of the Superior Pubic Ramus)
  2. Obturator Groove (inferior to the Obturator Crest, continuous with the Obturator Foramen, transmits Obturator N., A. and V.)

C. INFERIOR PUBIC RAMUS (projects toward Ischial Ramus)

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5
Q

Ischium (inferoposterior part of the Coxal Bone)

A

A. BODY OF THE ISCHIUM (posterior to the Obturator Foramen, Anterior to the Ischial Spine)
1. Ischial Spine (projects posteriorly between Greater and Lesser Sciatic Notches)

  1. Ischial Tuberosity (posteroinferiorly directed roughened area)
  2. Greater Sciatic Notch (posterior edge of the Ischium, inferior to the Iliac Ala, superior to the Ischial Spine)
  3. Lesser Sciatic Notch (posterior edge of the Ischium, between Ischial Spine and Ischial Tuberosity)

B. ISCHIAL RAMUS (projects toward Inferior Pubic Ramus)

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6
Q

Acetabulum (lateral aspect, made up of all three parts of the Coxal
Bone)

A

A. ACETABULAR NOTCH (inferior gap in the Acetabular Rim)

B. ACETABULAR FOSSA (depression in the central Acetabulum)

C. LUNATE SURFACE (smooth surface around the Acetabular Fossa)

D. RIM (surrounds the Acetabulum)

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7
Q

Helpful Note: The Bony Pelvis

A
  • The Bony Pelvis includes the Paired Coxal Bones, The Sacrum and the Coccyx.
  • The Pelvic Girdle describes the paired Coxal Bone, which are joined anteriorly at the Pubic Symphysis.
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8
Q

Sacrum (5 fused vertebrae)

A
  1. Base (superior surface of S1)
  2. Dorsal Surface (rough and convex)
  3. Ventral Surface (smooth and concave)
  4. Sacral Canal (continuation of Vertebral Foramina, transmits Cauda Equine)
  5. Apex (narrow inferior end)
    a. Articular Facet for Coccyx
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9
Q

Base of Sacrum

A

A. SUPERIOR ARTICULATING PROCESS (projects superiorly, articulates with Inferior Articulating Process of L5)

B. SACRAL PROMONTORY (anteriorly projecting edge of the Vertebral Body of S1, sacral contribution to the Pelvic Brim)

C. VERTEBRAL BODY OF S1 (articulates with Vertebral Body of L5)

D. SACRAL ALA (project laterally, contributes to the Pelvic Brim)
1. AURICULAR SURFACE (Articular Surface of the Sacrum, articulates with the Auricular Surface of the Ilium)

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10
Q

Dorsal Surface of Sacrum

A

A. MEDIAN SACRAL CREST (fused Spinous Processes)

B. MEDIAL (Intermediate) SACRAL CREST (fused Articulating Processes)

C. LATERAL SACRAL CREST (fused Transverse Processes)

D. SACRAL TUBEROSITY (lateral to the Lateral Sacral Crest, forms the
fibrous articulation with the Iliac Tuberosity)

E. POSTERIOR (Dorsal) SACRAL FORAMINA (smaller than Anterior
Sacral Foramina, transmit Dorsal Ramus of Sacral Spinal nerves)

F. SACRAL HIATUS (resultant gap left by absence of Lamina and Spinous Process of S5)

G. SACRAL CORNUA (project inferiorly, Inferior Articulating Processes of S5)

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11
Q

Ventral Surface of Sacrum

A

A. TRANSVERSE LINES (4, represent fusion of Sacral Vertebrae)

B. ANTERIOR (Ventral/ Pelvic) SACRAL FORAMINA (larger than Posterior Sacral Foramina, transmit Ventral Ramus of Sacral Spinal nerves)

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12
Q

Clinical Note: Spondylolisthesis

A
  • Abnormal anteriorly directed separation of the L5 vertebral segment from the Sacrum.
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13
Q

Clinical Note: Spondylolysis

A
  • When the Vertebral Arche SEPARATES from the VERTEBRAL BODY
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14
Q

Helpful Note: Bony Pelvis has a Superior and Inferior Pelvic Aperture

A
  • The Bony Pelvis has a Superior and Inferior Pelvic Aperture.
  • The SUPERIOR Pelvic Aperture (Pelvic Inlet) exists at the Pelvic Brim, between the Greater and Lesser Pelves, and is formed by the Sacral Promentory, Superior edge of the Sacral Ala, Arcuate Line of the Ilium, Pectin Pubis, posterior edge of the Pubic crest and superior edge of the Pubic Symphysis.
  • The INFERIOR Pelvic Aperture (Pelvic Outlet) is bound by the inferior edge of the Pubic Symphysis, Inferior Pubic and Ischial Rami, Ischial Tuberosities, Sacrotuberous Ls. and the Coccyx.
  • The PELVIC CANAL is the passage between the two Apertures.
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15
Q

Coccyx (3-5 fused vertebrae, embryological remnant)

A
  1. COCCYGEAL CORNUA (articulate with Sacral Cornua)
  2. TRANSVERSE PROCESS (present only on the superior most Coccygeal Segment)
  3. TIP (inferior projection)
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16
Q

Helpful Note: Sexual differences in Pelves: Males vs Females

A
  • MALES have thicker, heavier Pelves, a deeper greater Pelvis, narrower and deeper lesser Pelvis, Android Pelvic Inlet, small Pelvic Outlet, narrow Pubic Arch, round Obturator Foramen and large Acetabulum.
  • FEMALES have thinner, lighter Pelves, a shallow greater Pelvis, wide and shallow lesser Pelvis, Gynecoid Pelvic Inlet, large Pelvic Outlet, wide Pubic Arch, oval-shaped Obturator Foramen and small Acetabulum.
17
Q

Clinical Note: Pelvic Shapes

A
  • Pelvic Shapes include the:
    1) ANDROID (classically Male)

2) GYNECOID (classically Female)
3) ANTHROPOID (elongated anterior to posterior)
4) PLATYPELLOID (elongated laterally)

18
Q

Clinical Note: Pelvic Diameters

A
  • Pelvic Diameters (Conjugates) are important measurements obstetrically to determine the capacity of a female to bear a child.
19
Q

Clinical Note: Pelvic Fractures

A
  • PELVIC FRACTURES or crush fractures almost always involve multiple fractures given that the articulated Pelvis is a bony ring and therefore difficult to break in only one place.
  • The SUPERIOR and INFERIOR PUBIC RAMI are often broken on both side as a result of this kind of injury.
20
Q

Chondrology

A

INTERPUBIC DISC:
- Fibrocartilaginous disc between right and left Pubic
Symphyseal Surfaces

21
Q

L5 Vertebral Segment and Sacrum (Lumbosacral Joint; Intervertebral Joint: Symphysis; Zygopophyseal Joint: Planar Synovial)

A

1) ANTERIOR LONGITUDINAL L. (travels on the ventral surface of the vertebral bodies, onto the Ventral Surface of the Sacrum)
2) POSTERIOR LONGITUDINAL L. (travels on the dorsal surface of the vertebral bodies, onto the anterior wall of the Sacral Canal)
3) LIGAMENTUM FLAVUM (pale yellow fibers which travel on the ventral surfaces of vertebral laminae, onto the posterior wall of the Sacral Canal)
4) INTERSPINOUS L. (absent)
5) INTERTRANSVERSE L. (absent)
6) SUPRASPINOUS L. (absent)

7) ILIOLUMBAR L. (travels from the L5 Transverse Processes to the IliacCrest)
a. Lumbosacral L. (travels from L5 Transverse Process and Body to the Sacral Ala)

8) INTERVERTEBRAL DISC
a. Annulus Fibrosis (tough fibrous outer region)

b. Nucleus Pulposus (soft gelatinous inner portion)

22
Q

Pelvic Girdle (Pubic Symphysis: Symphysis)

A

1) OBTURATOR MEMBRANE (stretched across the Obturator Foramen)
2) INGUINAL L. (from the Pubic Tubercle of the Pubis to the Anterior Superior Iliac Spine of the Ilium)

  1. PUBIC SYMPHYSIS (union between the symphyseal surfaces of Right
    and Left Pubic bones, which are separated by a Fibrocartilaginous Disk)
    a. SUPERIOR Pubic L.

b. INFERIOR Pubic L. (sometimes called the Arcuate Pubic L.)
c. INTERPUBIC DISK (see Chondrology)
4. TRANSVERSE ACETABULAR L. (stretches across the Acetabular Notch)

23
Q

COXAL BONE and SACRUM

A
  • SACROILIAC: Compound Joint; anteriorly between Auricular surface of the Sacrum and
  • ARTICULAR SURFACE of the Ilium: PLANAR Synovial; posteriorly between the Sacral and ISCHIAL TUBEROSITIES: FIBROUS SYNDESMOSIS

1) SACROSPINOUS L. (from ventral
Sacrum to Ischial Spine)

2) SACROTUBEROUS L. (from ventral Sacrum to Ischial Tuberosity)

3) POSTERIOR SACROILIAC L. (arranged into two distinct parts)
a. LONG POSTERIOR SACROILIAC L. (two bands that originate from the
Posterior Superior Iliac Spine and Median Sacral Crest (S3,4) then blend inferiorly with the Sacrotuberous L.)

b. SHORT POSTERIOR SACROILIAC L. (originates from the Median
Sacral Crest (S1,2) inserting on to the posterior surface of the Iliac Crest and Iliac Tuberosity)

4) ANTERIOR SACROILIAC L.
5) INTEROSSEOUS SACROILIAC L. (deep to the Posterior Sacroiliac L.)

24
Q

Sacrum and Coccyx (Sacrococcygeal; Symphysis)

A
  1. ANTERIOR Sacrococcygeal L.

2. POSTERIOR Sacrococcygeal L.

25
Q

Helpful Hint: The Sacrotuberous L. and Sacrospinous L.

A
  • The SACROTUBEROUS L. and SACROSPINOUS L. produce the ligamentous borders which produce the GREATER Sciatic FORAMEN and LESSER Sciatic FORAMEN from the GREATER Sciatic NOTCH and LESSER Sciatic NOTCH.
26
Q

PERITONEUM (dips down out of the Abdomen into the Pelvis to cover, but not surround the Pelvic Viscera)

A
  1. In the MALE (covers the superior and lateral aspects of the Urinary Bladder and Rectum)
    a. PARAVESICLE FOSSAE (depressed areas lined with Peritoneum on either side of the Urinary Bladder)

b. PARARECTAL FOSSAE (depressed areas lined with Peritoneum on either side of the Rectum)
c. RECTOVESICLE POUCH (depressed area lined with Peritoneum between the Rectum and Urinary Bladder)

  1. In the FEMALE (covers the superior and lateral aspects of the Urinary Bladder, Uterus, Uterine Tubes, Ovaries and Rectum)
    a. PARAVESICLE FOSSAE (depressed areas lined with Peritoneum on either side of the Urinary Bladder)

b. BROAD LIGAMENT of the UTERUS (double layer of Peritoneum (Mesentery), extends from the Lateral Pelvic Walls to the Uterus, ENCLOSING the Uterus, Uterine Tubes, Round L. of the Uterus and Ligament of the Ovary, described as having THREE PARTS, also includes the Suspensory L. of the Ovary):
1. MESOMETRIUM (part of the Broad L. that supports the UTERUS, also surrounds the Ligament of the Ovary and the Round L. of the Uterus)

  1. MESOALPINX (part of the Broad L. that supports the UTERINE TUBES)
  2. MESOVARIUM (part of the Broad L. that supports the OVARIES)
  3. SUSPENSORY LIGAMENT of the OVARY (prolonged lateral extension from the Ovary enclosing the Ovarian Vessels)
    c. PARARECTAL FOSSAE (depressed areas lined with Peritoneum on either side of the Rectum)
    d. VESICOUTERINE POUCH (depressed area lined with Peritoneum between the Urinary Bladder and the Uterus)
    e. RECTOUTERINE POUCH (cul-de-sac, of Douglas; depressed area lined with Peritoneum between the Uterus and the Rectum)
27
Q

MEMBRANOUS PELVIC FASCIA (possesses parietal and visceral

components)

A

A) PARIETAL PELVIC FASCIA (lines the muscular walls of the Pelvis: Obturator Internus M., Piriformis M., Levator Ani Ms. and Coccygeus M.)
1. OBTURATOR FASCIA (lines the pelvic side of the Obturator
Internus M., is continuous superiorly with Transversalis Fascia, forms the walls of the Pudendal Canal, forms the Tendinous Arch of the Levator Ani Ms.)

B) VISCERAL PELVIC FASCIA (surrounds Pelvic Viscera, except where the Pelvic viscera penetrates the Pelvic Diaphragm, where the Parietal and Visceral layers come together to form the Tendinous Arch of Pelvic Fascia)

  1. TENDINOUS ARCH of PELVIC FASCIA
    a. PUBOPROSTATIC L. (anterior part; ♂)

b. PUBOVESICLE L. (anterior part, ♀)

c. SACROGENITAL L. (posterior part)
i. RESTOPROSTATIC L. (♂)
ii. UTEROSACRAL L. (♀)

28
Q

PELVIC FASCIA and SPACES (continuation of Endoabdominal Fascia into the
Pelvis, described as having a Membranous component and an Endopelvic component)

A

1) MEMBRANOUS PELVIC FASCIA (possesses parietal and visceral
components)

2) ENDOPELVIC FASCIA (comprised of Loose and Condensed parts)

29
Q

ENDOPELVIC FASCIA (comprised of Loose and Condensed parts)

A

A) LOOSE ENDOPELVIC FASCIA (fat filled potential spaces)
1. RETROPUBIC SPACE (Prevesical Space; between Pubis and Urinary Bladder, continuous posterolaterally with the Paravesical Space)

  1. PARAVESICAL SPACE (between Obturator Fascia and
    anterior part of the Hypogastric Sheath, separated from the Pelvirectal Space by the Hypogastric Sheath)
  2. PALVIRECTAL SPACE (surrounding the Rectum, separated into anterior and posterior parts by the Lateral Rectal L.)
  3. RETRORECTAL SPACE (Presacral Space; between the Sacrum and the Rectum, continuous anterolaterally with the Pelvirectal Space)

B) CONDENSED ENDOPELVIC FASCIA (increased density of Collagen and Elastic Fibers, responsible for compartmentalizing the Loose Endopelvic Fascia)
1. HYPOGASTRIC SHEATH (thick band of condensed fascia,
serves as conduit for nerves and vessels going from the Lateral Pelvic Wall to Pelvic Viscera, including the Ureters and in the male the Ductus Deferens, is divided into anterior, middle and posterior Lamina)
a. LATERAL L. of the BLADDER (extension of the Hypogastric Sheath to the Urinary Bladder)

b. MIDDLE LAMINA of the HYPOGASTRIC SHEATH
i. RETROVESICAL Septum (♂; between the Rectum and Urinary Bladder)

ii. TRANSVERSE Cervical L. (Cardinal L.; extension of the Hypogastric Sheath to the Cervix of the Uterus)
c. LATERAL RECTAL L. (extension of the Hypogastric Sheath to the posterior aspect of the Rectum)

30
Q

Helpful Note: Perineum

A
  • The Perineum is a QUADRANGULAR SPACE when viewed from the inferior aspect. The Four points of the Quadrangle are the PUBIC SYMPHYSIS (anteriorly), the COCCYX (posteriorly) and the TWO ISCHIAL TUBEROSITIES (laterally).
  • If a line is drawn between the two Ischial Tuberosities the Quadrangle is divided into two triangular spaces, the UROGENITAL TRIANGLE (anteriorly) and the ANAL TRIANGLE (posteriorly).
31
Q

Perineal Fascia and Spaces

A
  1. ANAL TRIANGLE

2. UROGENITAL TRIANGLE

32
Q

Anal Triangle

A

A). ISCHIOANAL FOSSA (around the wall of the Anal Canal, inferior to the Pelvic Diaphragm, narrow superiorly, wide inferiorly, filled with fat and loose connective tissue that allows for expansion of the Anal Canal during defecation)

B). PUDENDAL CANAL (space inside Obturator Fascia which transmits the Internal Pudendal A., V. and Pudendal N.)

33
Q

Urogenital Triangle

A

A). PERINEAL MEMBRANE (extends between the two sides of the Pubic Arch, covers the anterior portion of the Inferior
Pelvic Aperture)

B). SUPERFICIAL PERINEAL FASCIA (continuous with the Superficial Fascia of the Abdomen, made up of a Fatty and Membranous component):
1. FATTY (Superficial) SUPERFICIAL PERINEAL FASCIA (in the Female forms the fatty layers of the Labia Majora and the Mons Pubis, replaced by the Penis and Scrotum in the Male)

  1. MEMBRANOUS (Deep) SUPERFICIAL PERINEAL FASCIA (forms the Dartos Fascia of the Penis and Scrotum)

C). DEEP PERINEAL FASCIA (in the Female exists primarily as
Perineal Membrane, in the Male makes up the Deep Fascia of the Penis and Perineal Membrane)

D). SUPERFICIAL PERINEAL POUCH (between Membranous Superficial Perineal Fascia and the Perineal Membrane):
1. CONTENTS in the MALE (BULB and CRURA of the Penis, SUPERFICIAL Perineal Muscles, PROXIMAL SPONGY URETHRA, branches of the Internal Pudendal A. and V., and of the Pudendal N.)

  1. CONTENTS in the FEMALE (Crura of the Clitoris, Bulbs of
    the Vestibule, Superficial Perineal Muscles, Greater Vestibular Glands, branches of the Internal Pudendal A. and V., and of the Pudendal N.)

E). DEEP PERINEAL POUCH (Open superiorly, lies inferoanteriorly to the Urinary Bladder):
1. CONTENTS in the MALE (Membranous Urethra, Muscles of the Urogenital Diaphragm, Bulbourethral Glands)

  1. CONTENTS in the FEMALE (Muscles of the Urogenital Diaphragm)
    - Neurology

Reproductive System I (18 decks)

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