Pelvis Flashcards
What the joints and types of joints of the pelvis?
Lumbosacral joint: intervertebral articulation
Hip Joint: synovial ball and socket joint
Sacroiliac Joint: Synovial joints
Pubic Symphysis: Fibro-cartilaginous joint
Obturator Internus Function, Origin and Insertion, Innervation
- Lateral rotation of extended hip joint, abduction of flexed hip
- Medial surface of the greater trochanter of femur
- anterolateral wall of true pelvis
- Nerve to L5, S1
Piriformis Function, origin and insertion, innervation
- Lateral rotation of extended hip joint, abduction of flexed hip
- Origin is anterior border of sacrum, insertion is medial side of trochanter.
- Innervated by L5, S1, and S2
What are the pelvic diaphragm muscles?
levator ani, coccygeus
What is the purpose of the levator ani and coccygeus?
They help with support of the pelvic viscera and sphincter like movement.
What functions do the muscles of the deep perineal pouch usually have?
They mainly have sphincter function.
They are the external urethral sphincter (relaxes during urination),
deep transverse perineal (stabilizes the perineal body)
compressor urethrae (accessory sphincter of the urethr in women)
sphincter urethro-vaginalis accesory sphincter in women)
What are the deep perineal pouch muscle mainly innervated by?
Perineal branches of the pudendal nerve ( S2-S4)
What are the muscles of the anal triangle? What do they do? What is their innervation?
External anal sphincter ( deep, superficial, and subcutaneous part). They close the anal sphincter. They are the Pudendal nerve (S2 and S3), and they branches directly from S4
What are the muscles of the superficial pouch?
They are Ischiocavernosus, bulbospongiosus, and superficial transverse perineal.
The first two help with moving blood into penis/ clitoris. Superficial transverse helps in stabilizing the perineum
How are pelvic diaphragm and respiration related?
Pelvic diaphragm ascends and descends with exhalation and inhalation.
What are psoas and iliacus used for?
Hip flexion and external rotation.
What are the posterior muscles that are extensors?
Biceps femoris, semimembranosus, semitendinosus, gluteus maximus (medius, minimus)
What are the deep 6 lateral hip rotators?
P-GOGO-4.
They are the piriformis, gamellus superior, obdurator internus, gamellus inferior, obdurator externus, and then quadratus femoris
What do the Gluteus Medius do?
It helps with prevent pelvic drop at the opposite side of the swing during walking
What are the IT band muscles?
Tensor fascia latae and gluteus maximus
What do the IT band muscles help with?
Gluteus maximus is a powerful extensor of the femur at the joint. ( L5, S1, S2)
Tensor fasciae latae helps to basically stabilize the knee in extension. (L4, L5)
What are the anterior muscles of the hip?
Quadriceps, sartorius, gracilis, adductors. (all adductors)
What are muscles that are superior to the pelvis?
- rectus abdominus
- quadratus lumborum
- tranverse abdominis
- internal/external oblique
What are the 5 igaments that are important in pelvis?
Sacrospinous ligament, Sacrotuberous ligament, ilio-lumbar ligament, anterior sacro-iliac ligament, inguinal ligament.
What do ligaments do?
They do prevention of motion
What does the iliolumbar ligament do and what are the functions of it?
It attaches from L5 and to the ilia. It stabilizes the anterior motion of the L5 and limits rotation.
Where is the location of the sacrospinous ligament and what is the function?
It goes from the ischial spine to lateral margins of the sacrum and prevents anterior rotation of the sacrum around a transverse axis.
Where is the sacrotubeorus ligament located and what is its function?
It is between the lower sacrum and the ischial tuberosities. It prevents there from anterior rotation on a transverse axis.
Where is the inguinal ligament located?
It is from ASIS to pubic tubercle
What are some hip ligaments?
They are ilio-femoral ligaments, ischiofemoral ligament
What are the types of pelvises present in males and females, which is more common in females/ males?
- Gynecoid ( AP= Transverse) and most
- Android ( heart shaped ) most common male type
- Anthropoid ( AP-transverse) very less in males
- Platypelloid (very less in females and rarely males)
What are the differences between male and female pelvis regarding these:
False Pelvis Pelvic inlet Inlet to Outlet Pelvic Outlet Ischial Tuberosity Sacrum Innominates Pubic Symphysis
- Males deep, females shallow
- heart shaped vs oval
- Longer vs shorter
- smaller vs larger
- inwards vs outward
6 . narrow and long vs wider and shorter
- narrow vs wide
- higher vs lower.
What is relaxin?
It is released the mostly during 8 - 12 weeks of pregnancy. Is implicated in myometrial relaxing. Can cause pelvic dysfunction however.
What is the main consequences of pregnancy on the pelvis?
The main consequences is sacro-iliac joint is widening and there is more mobility. Also in the pubic symphysis as well.
What are the landmarks involved in diagnosing the pelvic dysfunction?
While Standing behind patient:
- iliac crest height
- greater trochanter comparison
- PSIS comparison
- standing flexion test
While sitting:
- medial malleolus comparison
- ASIS comparison and compression testing
- Iliac crest comparison
- Pubic tubercle comparison
What are some of symptoms a pelvic dysfunction patient could have?
- sacroiliac pain
- generalized hip pain
- inguinal/ groin pain
- low back pain
- leg pain
- knee pain
- referred pain to head.neck
What are three things needed to diagnose pelvic dysfunction?
- they would be assessment of anterior landmarks
- assessment of posterior landmarks B/L
- one test of laterality
What are posterior palpatory landmarks?
PSIS, Iliac crests, ischial tuberosities
What are the diagnostic tests of laterality?
standing flexion test and ASIS compression test.
What is standing flexion test? What does it tell you?
It basically tells you that there is something wrong with the sacroiliac spine.
What can iliosacral dysfunctin be caused by?
innominate, pubic, or lower extremity dysfunction affecting SI joint motion.
What is the ASIS compression test?
It tests for lateralization of somatic dysfunction of the innominates. Somatic dysfunction is felt as resistance when adding compression.
What are categories somatic dysfunctions of the pelvis?
Rotations, shears, and flares
Innominate rotations are what/
Movements of the ilium in either an anterior or a posterior direction around a theoretic right-left axis (transverse)
What is the walking cycle, innominates —
normally move anterior when innominate is at toe off, and most posterior is at heel strike
Anterior innominate is when
ASIS is inferior on affected side, and PSIS is superior on affected side
what are the signs and symptoms of anterior innominate rotation?
Sciatica, gluteal pain, hamstring pain/tightness
What are the signs of posterior innominate?
The ASIS is superior, and PSIS is inferior
What are signs of posterior inominate rotation?
Inguinal pain, groin pain, quadriceps tightness, and psoas tightness
MET of anterior rotation vs posterior rotation is:
Anterior rotation: hip extensors used (gluteus maximus)
Posterior rotation: hip flexors
What are innominate shears?
when there is entire movement of bone inferior or superior
What are symptoms of shears?
Pelvic pain, sacroiliac pain, pain at ASIS
What are causes of innominate shears?
Stepping down too hard on foot, missing a step on or a curb, falling on buttocks, sitting unevenly on a surface for extended period of time.
What are innominate flares?
movements of the ilium around a superior inferior axis
Inflared means—
Outflared means—
ASIS towards the midline
ASIS away from the midline
What are causes of inominate flares?
pregnancy, delivery, pelvic compression, ect
MET of innominate inflare includes:
MET of innominate outflare includes:
adductors use
abductors use
What is the relationship between sacrum and the ilia?
The relationship between ilia via three true and three false ligaments.
