Week 6 finished Flashcards
Pelvic Girdle Pain Regan is a 29 year-old tiler with his own small business. He has played soccer for much of his life but has recently given up due to low back and gluteal pain during and particularly after playing. He comes to your clinic complaining of sharp, grabbing pain over the left SIJ and an ache deep in the left buttock that he thinks might extend into the thigh at times. His pain worsens with sitting for long periods and running but eases when lying down.
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- Which bones form the pelvis?
2 Innominate bones: - Ilium - Ischium - Pubis And the Sacrum and coccyx
- Ensure that you are familiar with the major sections and landmarks of the innominate.
Done
- What are the true pelvis and the false pelvis?
The pelvis is divided by the pelvic brim, (sacral promontory to the pubic symph, angled at about 55 degrees to horizontal. It is formed by the pubic symphysis, pubic crest, the arcuate line of the ilium, sacral promontory
- Pelvis major (or false pelvis)
o part of the abdo cavity, contains abdominal organs
o Anterior= abdo wall, posterior= L5/S1
- Pelvis minor (or true pelvis)
o is the pelvic cavity and contains the pelvic organs
o true pelvis is not in main stream lymphatic flow from legs to abdomen
o bordered posteriorly by the sacrum and coccyx, anteriorly by pubic bone and symphysis and laterally by the parts of the ilium and ischium.
o Inferior border of the pelvis minor is the diamond shaped pelvic outlet.
4. How does the pelvis differ between sexes?
5. What are the functions of the sacro-iliac joint (SIJ)?
Transmission of weight between the spine and the lower limb.
Other functions:
o Widening of the pelvis during childbirth,
o Allowing movement during locomotion and absorbing shock, particularly in instances of impact to the pelvis.
6. What ligaments support the SIJ?
Iliolumbar ligaments
Anterior sacroiliac ligaments
Posterior sacroiliac ligaments
Accessory ligaments
Interosseous ligaments
Sacrospinous ligament
Sacrotuberous ligament
- these ligaments prevent nutation of the sacrum on the innominates but limiting posterior movement of the sacral apex.
- What are the major structures giving support to the pubic symphysis?
Muscles:
- Rectus abdominis
- Adductors
Ligaments:
- Superior and inferior arcuate ligaments
- Posterior ligament
Fibrocartilage disc between the articular surfaces
8. What is the relevance of the thoracolumbar region to pubic symphysis function?
Muscular slings that originate in the thoracolumbar region are essential for support of the pubic symphysis.
Abdominal muscles attach directly to the pubic symphysis and therefore are essential for normal function.
Increased or decreased lumbar lordosis changes the angle of the pubic symphysis, thus affecting function.
Dysfunction in the thoracolumbar region affecting the movement either SIJ will in turn affect the torsion movement of each pubic articulation.
Thoracolumbar fascia forms the fascial connections of the abdominal muscle layers, which in turn attach anteriorly to the pubic crest and superior pubic ramus.
9. What structures form the pelvic diaphgram?
Levator ani:
- puborectalis
- pubococcygeus
- iliococcygeus
Ischiococcygeus/Coccygeus
10. What are major ligaments supporting the hip? In which position are they all taut?
Ligament of the head of the femur
Iliofemoral ligament
- Y shaped, reinforces joint capsule anteriorly.
- ASIS to intertrochanteric line.
- Taut in extension
Pubofemoral ligament
- Pubic ramus to the intertrochanteric fossa.
- Taut in extension and abduction
Ischiofemoral ligament
- Posterior surface of acetabular rim and labrum to the the medial surface of the greater trochanter
- Taut in extension and internal rotation
They are all taut in extension.
- What is the role of ligamentum teres?
Intra-articular extra synovial accessory joint structure.
Runs between the fovea and the edges of the acetabular notch and the intervening acetabular labrum.
It is taut in abduction and flexion.
It is the sit4e of main passage from blood and nutrients into the femoral head.
- What is the nerve supply to the hip?
Femoral (L2-L4)
Obturator (L2-L4)
Superior Gluteal Nerve (L4-S1)
Nerve to quadratus femoris (L4-S1)
- What is the function of the acetabular labrum?
Increases the articular surface of the acetabulum while still remaining flexible.
Helps to maintain stability of the femoral head in the acetabulum by increasing the joint articulating surface of the pelvis.
- List the muscles (and nerves of these muscles if you can) which cause each of the major hip motions.
FLEXION:
- Psoas (ant. rami of lumbar plexus L1-L3)
- Iliacus (femoral nerve L2-L4)
- Rectus femoris (femoral nerve L2-L4)
- Sartorius (femoral nerve L2-L4)
- Gracilis (obturator nerve L2-L4)
- TFL (superior gluteal nerve L4-S1)
EXTENSION:
- Gluteus Maximus (Inferior gluteal nerve L5-S2)
- Biceps Femoris
(Short head = common fibular branch of sciatic (L5-S3)
(Long head = tibial branch of sciatic (L4-S3)
- Semimembranosus (tibial branch of sciatic nerve L4-S3)
- Semitendinosis (tibial branch of sciatic nerve L4-S3)
- Adductor Magnus (hamstrings part) (tibial part of sciatic nerve L4-S3)
ADDUCTION:
- Adductor Magnus (adductor part) (obturator nerve L2-L4)
- Adductor Brevis (obturator nerve L2-L4)
- Adductor Longus (obturator nerve L2-L4)
- Gracilis (obturator nerve L2-L4)
- Pectineus (obturator nerve L2-L4)
- Obturator externus (obturator nerve L2-L4)
ABDUCTION:
- TLF (superior gluteal nerve L4-S1)
- Gluteus medius (superior gluteal nerve L4-S1)
- Gluteus minimus (superior gluteal nerve L4-S1)
EXTERNAL ROTATION:
- Piriformis (nerve to piriformis S1-S2)
- Obturator externus (obturator nerve L2-L4)
- Superior gemellus (nerve to obturator internus L5-S2)
- Obturator internus (nerve to obturator internus L5-S2)
- Inferior gemellus (nerve to quadratus femoris L4-S1)
- Quadratus femoris (nerve to quadratus femoris L4-S1)
- Gluteus maximus (inferior gluteal nerve L5-S2)
INTERNAL ROTATION:
- TFL (superior gluteal nerve L4-S1)
- Gluteus medius (superior gluteal nerve L4-S1)
- Gluteus maximus (superior gluteal nerve L4-S1)
