THE PELVIS

BY: RAJA BASIL ADEEL (ug

code:2103110)
 WHAT IS THE PELVIS

WHAT IS THE PELVIS?

Ø Hipbone is a bowl like structure that
supports the weight of the body
Ø Part of Appendicular Skeleton located
below abdomen and above the thighs
Ø The Bones of the pelvis are supported by
many joints and ligaments that help the
pelvis function
Ø Holds the body upright and allows you to
run and walk
Ø Women have a wider pelvis than men and
this helps during pregnancy

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 WHAT IS THE PELVIS

WHAT IS THE PELVIS?

Ø Hipbone is a bowl like structure that
supports the weight of the body
Ø Part of Appendicular Skeleton located
below abdomen and above the thighs
Ø The Bones of the pelvis are supported by
many joints and ligaments that help the
pelvis function
Ø Holds the body upright and allows you to
run and walk
Ø Women have a wider pelvis than men and
this helps during pregnancy

This Photo by Unknown Author is licensed under CC BY-SA

BONES OF THE PELVIS Bones of the pelvis
Ø Consists of Right and Left Pelvic Bones,
Sacrum, and Coccyx
Ø Irregular in shape in the classification of
bone
Ø 2 major parts are separated by an oblique
line of the medial surface of the pelvic bone,
Pelvic bone above this line represents the
lateral wall of the false pelvis and below this
line is the lateral wall of the true pelvis
Ø The lateral Surface has a large articular
socket acetabulum
Ø Inferior to the acetabulum is large obturator
foramen closed by obturator membrane
Ø The posterior Margin of bone is marked by
2 notches greater sciatic notch and a lesser
sciatic notch separated by an ischial spine
then terminates as large ischial tuberosity
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 BONES OF PELVIS
PELVIC BONE
Pelvic Bone is composed of three components
ilium, pubis, and ischium
ILIUM
Ø Most Superior in Position
Ø Separated into upper and lower parts by a
ridge on medial surface
Ø Anteriorly ridge is rounded and is called
arcuate line ,Posteriorly Ridge is sharp
Ø Portion of Ilium inferior to arcuate line is
pelvic part of ilium and contributes to wall of
true pelvis
Ø Upper Part of Ilium expands to form a flat
fan shaped wing which provides bony
support for False Pelvis
Ø Anteromedial surface of wing is concave
and forms iliac fossa 5
 Bones of pelvis

PUBIS
Ø Anterior and Inferior Part of Pelvic Bone
Ø Has a body and 2 rami (arms)
Ø The body is flattened dorsoventrally and has
a rounded pubic crest on its superior surface
that ends laterally as a pubic tubercle
Ø Superior Pubic Ramus projects
posterolaterally from the body and joins with
ilium and ischium at its base
Ø Inferior Pubic Ramus projects laterally to
join with ramus of ischium

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 BONES OF PELVIS
ISCHIUM
Ø Posterior and Inferior parts of the pelvic
bone
It has:
Ø A large body that projects superiorly to join
with the ilium and superior ramus of pubis
Ø Ramus that projects anteriorly to join with
inferior ramus of pubis
Ø Most Prominent feature is large tuberosity
Ischial Tuberosity on posteroinferior aspect
of bone

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 Bones of pelvis

SACRUM
Ø Formed by the fusion of 5 sacral vertebra
Ø The base of the Sacrum Articulates with
vertebra L5
Ø The apex of the Sacrum Articulates with the
coccyx
Ø The superior surface of the sacrum by the
superior aspect of vertebra S1 and is
flanked on each side by a wing-like
transverse process called ala
Ø The anterior edge of the vertebral body
projects forward as the promontory
Ø The anterior Surface is concave
Ø The posterior Surface is convex
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 BONES OF THE PELVIS

COCCYX
Ø Formed by 4 fused coccygeal vertebrae
Ø Shaped like an inverted triangle
Ø Superior Surface bears a facet and 2 horns
or cornua
Ø Cornua one on each side projects upward to
articulate the downward projecting cornua
from sacrum

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 JOINTS OF THE PELVIS
SACRO-ILIAC JOINTS
Ø Transmit forces from lower limbs to the
JOINTS OF THE PLEVIS vertebral column
Ø Synovial Joints between L-shaped
There are 3 major joints of the pelvis and they articular facets on the lateral surface of
are: the sacrum and iliac part of the pelvic
• Lumbosacral Joints bone
Ø Stabilized by 3 ligaments:
• Sacro-Iliac Joints • Anterior Sacroiliac ligament
• Pubic Symphysis Joints • Interosseous Sacro Iliac Ligament
• Posterior Sacro iliac ligament
LUMBOSACRAL JOINTS
Ø Formed between vertebra L5 and sacrum PUBIC SYMPHYSIS JOINT
Ø Has 2 zygapophysial joints between Ø Lies Anteriorly between adjacent surfaces
adjacent inferior and superior articular of pubic bones
processes Ø Covered by hyaline cartilage and is linked
across the midline to adjacent surfaces by
Ø Has intervertebral disc that joins bodies of
fibrocartilage
vertebrae L5 and S1 Ø Surrounded by interwoven layers of
Ø Reinforced by strong iliolumbar and collagen fibers and 2 major ligaments:
lumbosacral ligaments • Superior Pubic ligament
• Inferior Pubic Ligament
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 LIGAMENTS OF THE PELVIC WALL
LIGAMENTS OF THE PELVIC WALL
SACRO-TUBEROUS LIGAMENT
The walls of the pelvic cavity consist of the sacrum, Ø Triangular
coccyx, pelvic bones, two ligaments, and two Ø Superficial to Sacrospinous ligament
muscles. Ø Laterally apex is attached to the medial
Sacrospinous Ligament and Sacro-tuberous margin of the ischial tuberosity
ligaments are major components of lateral pelvic Ø The base extends from the posterior
walls, these ligaments stabilize the sacrum on pelvis superior iliac spine onto the dorsolateral
bones and convert greater and lesser sciatic notches surface of the coccyx
into foramina
SACROSPINOUS LIGAMENT
Ø Smaller of the two ligaments
Ø Triangular
Ø Apex is attached to the ischial spine
Ø The base is attached to related margins of the
sacrum and coccyx
Ø The greater sciatic foramen lies superior to the
sacrospinous ligament and ischial spine and the
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lesser sciatic foramen is inferior to it
 MUSCLES OF PELVIC WALL
MUSCLES OF THE PELVIC WALL
PIRIFORMIS
Two Muscles, Obturator Internus and
Ø Triangular
Piriformis contribute to the lateral walls of the
Ø Originates from the anterior
pelvic cavity
surface of the sacrum between
OBTURATOR INTERNUS anterior sacral foramina
Ø Insertion from the medial side of
Ø Flat Fan-shaped muscle
the superior border of greater
Ø Originates from the deep surface of the trochanter of femur
obturator membrane and associated regions Ø Innervation from branches of S1
of the pelvic bone that surrounds the and S2
obturator foramen Ø Function is abduction of flexed
Ø Insertion is the medial surface of the greater
hip
trochanter of the femur
Ø Innervation is from nerve to obturator
internus L5, S1
Ø Function is lateral rotation of extended hip
joint and abduction of flexed hip
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 ANTICOAGULANTS SYSTEM

ANTICOAGULANTS SYSTEM
Anticoagulants prevent unnecessary
coagulation and blood clotting and have
several mechanisms in place for this
Ø Antithrombin is an inhibitor of serine
proteases and inhibits thrombin, Factor XIIa,
Factor Xia, and Factor Xa
Ø Tissue Factor Pathway inhibitor inhibits the
tissue factor which doesn’t allow the
extrinsic pathway to occur
Ø Protein C is a serine protease that is Vitamin
K dependent and degrades Factor VIII and
V
Ø Plasmin by cleavage of Plasminogen
degrades fibrin and destroys clots
Ø Prostacyclin inhibits platelet activation 13
APERTURES OF THE PELVIC WALL
Each Lateral Surface of the pelvic wall has 3 major
apertures through which structures pass between the
pelvic cavity and other regions
OBTURATOR CANAL
Ø The Top of obturator foramen is bordered by
obturator membrane , associated obturator muscles
and superior pubic ramus
APERTURES OF THE PELVIC WALL
LESSER SCIATIC FORAMEN
Ø Formed by lesser sciatic notch, ischial spine,
sacrospinous and sacrotuberous ligaments
Ø Acts as communication region between gluteal
and perineum region
Ø Obturator internus muscle passes through this

Ø Obturator nerve and vessels pass from the pelvic

cavity to the thigh through this canal
GREATER SCIATIC FORAMEN
Ø Major Route of communication between the pelvic
cavity and lower limb
Ø Formed by a greater sciatic notch in the pelvic bone,
sacrotuberous and sacrospinous ligaments, and
spine of ischium
Ø Piriformis muscle passes through this dividing it into
2 parts, one where the superior gluteal nerve
passes and the other where the inferior gluteal
nerve, sciatic nerve, and pudendal nerve passes 14
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 PELVIC DIAPHRAGM
PELVIC DIAPHRAGM
The muscular Part of the pelvic floor is shaped
like a bowl and attached superiorly to the COCCYGEUS
pelvic wall. Consists of Levator Ani and Ø Origin from the ischial spine and the
coccygeus muscles pelvic surface of the sacrospinous
ligament
LEVATOR ANI Ø Insertion from the lateral margin of the
Ø Originates in a line around the pelvic wall coccyx and related border of sacrum
beginning on the posterior aspect of the Ø Innervation from branches from
pubic bone and extending across the anterior rami of S3 and S4
obturator internus muscle
Ø Insertion, anterior part is attached to the
superior surface of the perineal membrane,
Posterior part is on the other side around
the anal canal along the anococcygeal
ligament
Ø Innervation is from branches direct from the
anterior ramus of S4 and by an inferior
rectal branch of pudendal nerve S2-S4
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 PELVIC DIAPHRAGM
PELVIC DIAPHRAGM
The muscular Part of the pelvic floor is shaped
like a bowl and attached superiorly to the COCCYGEUS
pelvic wall. Consists of Levator Ani and Ø Origin from the ischial spine and the
coccygeus muscles pelvic surface of the sacrospinous
ligament
LEVATOR ANI Ø Insertion from the lateral margin of the
Ø Originates in a line around the pelvic wall coccyx and related border of sacrum
beginning on the posterior aspect of the Ø Innervation from branches from
pubic bone and extending across the anterior rami of S3 and S4
obturator internus muscle
Ø Insertion, anterior part is attached to the
superior surface of the perineal membrane,
Posterior part is on the other side around
the anal canal along the anococcygeal
ligament
Ø Innervation is from branches direct from the
anterior ramus of S4 and by an inferior
rectal branch of pudendal nerve S2-S4
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SACROILIITIS
Sacroiliitis is a painful condition that affects CLINICAL IMPORTANCE
one or both sacroiliac joints. These joints sit
where the lower spine and pelvis meet. CAUSES
Sacroiliitis can cause pain and stiffness in the Causes for sacroiliac joint issues include:
buttocks or lower back, and the pain might go Ø Injury
down one or both legs. Standing or sitting for a Ø Arthritis
long time or climbing stairs can make the pain Ø Pregnancy
worse Ø Infection
Ø Sacroiliac joint pain can be difficult to
diagnose as other conditions can cause DIAGNOSIS
similar symptoms It can be mistaken for Ø During the physical exam, a doctor
other causes of low back pain. It's been might press on the hips and buttocks to
linked to a group of diseases that cause find the pain. Moving legs into different
inflammatory arthritis of the spine. positions gently stress the sacroiliac
Ø pain can be aggravated with prolonged joints.
sitting or standing, standing on one leg, stair Ø Imaging tests
climbing, going from sitting to standing, and Ø Numbing shots
with running.

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TREATMENT
• Pain relievers. CLINICAL IMPORTANCE
• Muscle relaxers
• Biologics
• Physical Therapy

SURGICAL AND OTHER PROCEDURES

- If other methods haven't relieved pain, a
Doctor might suggest:
• Shots into the joint
• Radiofrequency denervation
• Electrical stimulation
• Joint fusion

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THANK YOU FOR
LISTENING
BY: RAJA BASIL ADEEL (ug
code:2103110)