Pelvis Anatomy Flashcards
1
Q
What type of joint is the pubic symphysis?
A
- Amphiarthrodial joint (allows for slight mvmt)
2
Q
Iliolumbar ligament
A
- Spans b/w transverse processes of L4 and L5 to inner lip of the iliac crest
- Lower border of the thoracolumbar fascia
- Stabalizes the lumbar spine at the L/S jxn
- preventing anterior displacement
3
Q
Iliolumbar ligament pain radiation areas
A
- Inguinal area
- Inner thigh
- Lateral upper thigh
4
Q
4 Types of Pelvises
A
- Gynecoid
- Android
- Anthropoid
- Platypelloid
5
Q
Gynecoid pelvis
A
- 1 of 4 types of pelvises
- More classically a female pelvis
- Ideal for birth
6
Q
Android pelvis
A
- 1 of 4 types of pelvises
- More classically a male pelvis
- Most birthing difficulty
7
Q
Anthropoid pelvis
A
- 1 of 4 types of pelvises
- Ape pelvis
- Problematic w/ certain positions of fetal head engagement
8
Q
Platypelloid pelvis
A
- 1 of 4 types of pelvises
- Head engages later, but usually ok after that
9
Q
Female pelvis
A
- Larger, oval pelvic inlet
- Greater distance b/w ischial spines-larger outlet
- Wider greater sciatic notch
- Shorter, wider sacrum curved posteriorly
- Moreso anteriorly-facing acetabula, placed wider apart
- forward and inward leg swing in diff. planes (swinging hips)
10
Q
Male pelvis
A
- Heart shaped inlet
- sacral promontory projects further posteriorly
- Sides converge from inlet to outlet
- ischial spines close together-small outlet
- Larger ischial spines and tuberosities
- Higher iliac crests
- deep greater/false pelvis
- Moreso laterally-facing acetabula
- leg swing is anterior-posterior in a single plane
11
Q
Ideal standing posture effects on pelvis
A
- Pelvis level and the hips neutral
- ASIS and pubic symphysis are in the same plane
- PSIS and ASIS are in the same plane
- Center of gravity is posterior to femoral head
- Posterior weight is counteracted by:
- ligamentous structures
- close-packing of hip joint in extension
- hip flexors (sometimes)
12
Q
Exaggerated kyphosis/lordosis standing effects on pelvis
A
- Classic upper and lower cross imbalance
13
Q
Flat back standing effects on pelvis
A
- Hamstrings maintain upright posture by pulling pelvis posterior
- Bad posture, tight hamstrings
14
Q
Swayback standing effects on pelvis
A
- Gravitational line is further posterior to hips
- Requires no increased muscle activity
- Ligamentous structures take the weight, may become stretched
15
Q
Patterns seen with poor posturing
A
- Tight: upper traps and levator scap, pecs, erector spinae, iliopsoas
- Weak: deep neck flexors, rhomboids and serratus anterior, abdominals, glutes
16
Q
Pelvic activities during gait cycle
A
2 activites during gait
- Pelvic rotation
- occurs in the transverse plane (on vertical axis)
- approx. 8 degrees
- increased leg reach
- decreases work by decreasing hip extension and flexion
- Pelvic tilt
- lateral lowering (sidebending) of the pelvis in stance phase
- decreases vertical motion of the rest of the body
17
Q
Pelvic floor responsibility
A
- Maintains structural integrity of pelvic viscera and lower abdomen
- Helps in controlling urination and defecation
- urethral meatus and rectal sphincter
- Mechanism of sexual function
18
Q
Pelvic floor layers
A
Cephalad to caudad
- Endopelvic fascia
- connect the pelvic organs to pelvic walls
- Pelvic diaphragm
- levator ani muscles
- coccygeus muscle
- arcus tendineus
- levator plate
- Urogenital diaphragm
- deep transverse perinei
- perineal membrane
- perineal body
19
Q
Levator Ani muscles
A
Located caudad to endopelvic fascia
- Iliococcygeus
- Pubococcygeus
- Puborectalis
20
Q
Levator Ani muscles function
A
- Keep urogenital hiatus closed by compressing the urethra, vagina and rectum against the pubic bone, pulling the pelvic floor and organs in a cephalic direction
- coccygeus also aids in this
21
Q
Pelvic diaphragm
A
- Levator ani and assoc. fascia together
22
Q
Urogenital hiatus
A
- Opening b/w the levator ani muscles thru which the urethra, vagina and rectum pass
- Orifice thru which prolapse occurs, esp in females
- Supported anteriorly by the pubic bones and the levator ani muscles, and posteriorly by the perineal body and external anal sphincter
23
Q
Pelvic floor/ diaphragm function
A
- Maintains pelvic organ support
- Maintains urinary and fecal continence
- via urethral and anal sphincter control, urinary
24
Q
Pelvic floor/ diaphragm dysfunctional effects
A
- Incontinence
- Prolapse
- Rectal/vaginal/pelvic floor pain
- can have large neg. impact on QOL (often clinical assoc. w/ Interstitial Cystitis (IC) aka Painful Bladder Syndrome (PBS))
- intense dyspareunia or pain w/ any penetration
- inability to sit or stand for long periods; can lead to employment disability
25
Q
High tone pelvic floor dysfunction OMT
A
- Not recognized in males
- OMT directed at the external pelvis/sacrum, as well as internal
- OMT is very helpful in this condition (direct inhibition via intra-rectal or intra-vaginal route)
26
Q
Pathology of pelvic floor prolapse
A
- Vaginal childbirth, advancing age, increased BMI
- most consistent risk factors
- ~50% of parous women have prolapse
- not all prolapses are problematic, but 10-20% of affected women seek help b/c of symptoms
- # of urethral striated muscle fibers declines w/ age (the longer we live the weaker or pelvic floor becomes)
27
Q
Symptoms of prolapse
A
- Heaviness or dragging sensation in vagina
- Uncomfortable bulge or a lump protruding from the vagina
- LBP; dull
- Dyspareunia; uterine prolapse, which can be compounded by vaginal dryness in postmenopausal women
- Bladder and bowel problems often co-exist
- urinary hesitancy
- slow urinary flow rate and incomplete emptying
- urinary urgency and frequency when a cystocele is present
- constipation may be a symptom of rectocele
- incomplete fecal emptying or the need to manually assist defecation (direct extraction or “splinting”)
28
Q
Most common type of pelvic floor dysfunction
A
- Stress urinary incontinence
* involuntary leakage w/ increased abdominal pressure (effort, exertion, sneezing, coughing, laughing)
29
Q
Post partum effects on the pelvic floor
A
- Pubococcygeus is most susceptible to stretch injury during vaginal birth
- Pudendal nerve provides innervation to external genitalia, sphincters of bladder and rectum
30
Q
Pelvic floor trigger points
A
- Levator ani and coccygeus
- Obturator internus
31
Q
T10-T11 Autonomics-Sympathetics
A
- Kidneys, gonads, upper ureter, adrenals
32
Q
T12-L2 Autonomics-Sympathetics
A
- Lower ureters, uterus, vagina, clitoris, vas deferens, prostate, bladder, urethra, fallopian tubes, seminal vesicles, sphincter, trigone
33
Q
Vagus Autonomics-Parasympathetics
A
- Kidney, upper ureter, ovaries, testes
34
Q
S2-4 Autonomics-Parasympathetics
A
- Lower ureter, bladder, prostate
