Pelvic Wall

Department of human Anatomy and Embryology

Faculty of Medicine
Mansoura National University, Egypt
 Intended Learning Outcomes (ILOs)

1. Identify the specific features and articulations of

pelvic wall bones.
2. Identify the origin, insertion and functions of pelvic
wall muscles.
3. Identify the Blood supply and nerve supply of
pelvic wall.
 Agenda
1. What are the specific features and joints pelvic
wall?
2. What are the attachment and functions of pelvis
muscles?
3. What is the main arterial supply of pelvis?
 Bones of the Pelvis
4 bones:
o 2 Hip bones.
o Sacrum.
o Coccyx.
 HIP BONE
❖ Formed of 3 bones articulating together in the
acetabulum

➢ Ileum

➢ Pubic bone

➢ ischium
 Medial View Lateral View
Iliac crest Iliac crest

ASIS
Iliac Fossa ASIS
PSIS

AIIS AIIS
PIIS

Greater Sciatic Notch

acetabulum
Ischial spine

Obturator Lesser Sciatic Notch Obturator

foramen foramen Inferior
Pubic Ramus
Inferior
Pubic Ramus Ischial Ramus
Ischial Ramus
 SACRUM
o The fused five sacral vertebrae.
o Inverted triangle.
➢ Base: Articulates with the fifth lumbar vertebra.
Sacral promontry: the projecting anterior margin of S1 vertebra.
Ala of sacrum: on each side of sacral promontry.
➢ Apex: Articulates with the coccyx.

➢ 4 Surfaces:
▪ Anterior (Pelvic surface): Has 4 anterior sacral foramina on each side.
▪ Posterior surface shows:
➢ posterior sacral foramina (4 on each side).
➢ Sacral hiatus: the lower end of sacral canal.
➢ Spinous tubercles: the fused sacral spines.

▪ 2 Lateral surfaces: articulates with the ilium through the upper wide part named (Auricular surface) .
 SACRUM
Sacral
Ala of sacrum promontry

Anterior
Sacral
foramina
 SACRUM
Sacral Canal

Posterior
Sacral
foramina Spinous tubercles

Sacral Hiatus
 Joints of the pelvis
4 joints
2 Sacroiliac joint
Synovial plane

Sacrococcygeal joint Symphysis pubis

Secondary cartilaginous Secondary cartilaginous
 Ligaments of the pelvis
o Sacroilliac ligaments:
▪ Connect sacrum with the ilium.

o Sacrospinous ligament:
▪ Connect sacrum & Coccyx
with ischial spine.

o Sacrotuberous ligament:
▪ Connect sacrum & Coccyx
with ischial tuberosity.
❖ Pelvic inlet (Pelvic brim):
Extends between sacral promontary
& upper margin of symphysis pubis.

❖ Pelvic outlet:
Extends between tip of coccyx &
lower margin of symphysis pubis.

❖ Pelvic Cavity:
Extends between pelvic inlet & outlet.

❖ Perineum:
Lower part of pelvic cavity
overlying pelvic outlet.
 False pelvis True pelvis

True pelvis

Lies above the pelvic brim.
➢ Lies below the pelvic brim.
➢ Has:
o Pelvic Inlet
o Pelvic Cavity
o Pelvic Outlet
 Muscles of the pelvis
1)Muscles of the wall of
the pelvis:
1.Obturator internus.

ll

La
al wa
2.Piriforms.

t
Pelvic floor

e r
2)Muscles of the floor of
(pelvic
Levator anidiaphragm)
& coccygeus

a
the pelvis

l
Later

w
[Pelvic diaphragm]

a
1.Levator ani.

l l
2.Coccygeus
 Muscles of the wall of pelvis
Obturator Internus

• Origin:
Obturator membrane.
• Insertion:
Greater trochanter of
femur.
The muscle is covered
with obturator fascia.
Obturator
Obturator
membrane
fascia
 Muscles of the wall of pelvis
Piriformis Muscle
• Origin:
Anterior surface of
sacrum.
• Insertion:
Greater trochanter of
femur.
 Muscles of the floor of pelvis
Levator Ani
Origin:
1. Body of pubis
1
2. White line
3. Ischial spine
2

Levator Ani
3 3
2
 Muscles of the floor of pelvis
Levator Ani Urethra

Insertion:
▪ Anterior fibers (Levator prostate or vagina
sphincter vaginae): inserted in
perineal body.

▪ Middle fibers (puborectalis):

Form U shaped loop around anorectal
junction.

▪ Posterior fibers: inserted in

anococcygeal body & tip of coccyx
 Muscles of the floor of pelvis
Levator Ani
Nerve supply:
1-pelvic surface……S4
2-perineal surface….inferior rectal.
Action:
▪ Together with abdominal diaphragm
increase intra abdominal tension to help in
defecation and micturition.
▪ Support the pelvic viscera.
▪ Additional sphincter to anal canal.
▪ Support prostate in male and act as
sphincter for vagina in female.
 Muscles of the floor of pelvis
Coccygeus

Origin:
Ischial spine
Insertion:
last piece of sacrum
&
First piece of coccyx
Action:
Support coccyx during
defecation or labor.
 Internal Iliac Artery
Origin: Internal Iliac Artery

One of two terminal

branches of common
iliac opposite sacroiliac
joint.

Termination:
At upper border of
greater sciatic notch by
dividing into anterior
and posterior divisions.
 Internal Iliac Artery
Branches:

▪ Posterior division:
✓ Illiolumbar artery.
✓ lateral sacral artery.
✓ superior gluteal
artery.
 Internal Iliac Artery
Branches:

▪ Anterior division:
✓ Obturator artery.
✓ Umbilical artery.
✓ Inferior vesical in male
or
vaginal in female.
✓ Uterine artery.
✓ Middle rectal artery.
✓ Inferior gluteal artery.
✓ Internal pudedal artery.
Internal Iliac Artery
 Internal Pudendal Artery
Origin:
▪ One of two terminal branches of
Anterior division of internal iliac
artery.
Course :
▪ pass from greater sciatic notch to
lesser sciatic notch behind ischial
spine then enters pudendal canal.
Termination:
▪ Ends below symphysis pubis by
dividing into deep & dorsal arteries
of penis.
Branches:
✓ Inferior rectal artery
✓ Perineal artery.
✓ Artery of bulb.
✓ Deep artery of penis.
✓ Dorsal artery of penis
 Internal Pudendal Artery
Origin:
▪ One of two terminal branches of
Anterior division of internal iliac
artery.
Course :
▪ pass from greater sciatic notch to
lesser sciatic notch behind ischial
spine then enters pudendal canal.
Termination:
▪ Ends below symphysis pubis by
dividing into deep & dorsal arteries
of penis.
Branches:
✓ Inferior rectal artery
✓ Perineal artery.
✓ Artery of bulb.
✓ Deep artery of penis.
✓ Dorsal artery of penis
 Nerves of pelvis (Sacral plexus)

Formation:
Lumbosacral trunk
and ventral rami of
upper 4 sacral
nerves.

Termination:
divides into sciatic
and pudendal
nerves.
 Nerves of pelvis (Sacral plexus)
Branches:
1-To L.L through greater sciatic notch:
• Sciatic nerve.
• Posterior cutaneous nerve of
the thigh.
• Superior gluteal nerve.
• Inferior gluteal nerve.
• Nerve to Quadratus femoris.
• Nerve to Obturator internus.

2-To pelvic muscles, viscera and

perineum:
• Nerve to the piriformis.
• Pudendal nerve.
• Pelvic splanchnic nerves
(parasympathetic).
 Nerves of pelvis (Sacral plexus)
Branches:
1-To L.L through greater sciatic notch:
• Sciatic nerve.
• Posterior cutaneous nerve of
the thigh.
• Superior gluteal nerve.
• Inferior gluteal nerve.
• Nerve to Quadratus femoris.
• Nerve to Obturator internus.

2-To pelvic muscles, viscera and

perineum:
• Nerve to the piriformis.
• Pudendal nerve.
• Pelvic splanchnic nerves
(parasympathetic).