1: Pelvic and Perineal Osteology and Arthrology

Question 1

What is the dividing line in between the abdomen and the pelvis?

Answer 1

Pelvic brim

Question 2

Where is the true pelvis located?

Answer 2

In between the pelvic brim and the pelvic diaphragm.

Question 3

What is the linea terminalis made up of?

Answer 3

1. Arcuate line of thte ilum
2. Pectin pubis

Question 4

What is the linea terminalis?

Answer 4

Coxal contribution to the pelvic brim; made up of the arcuate line of the ilium and the pecten pubis.

Question 5

What is the transition point between the trunk and LE?

Answer 5

pelvis

Question 6

What makes up the iliac ala?

Answer 6

• 1. Anterior gluteal line of the ilium
• 2. Posterior gluteal line of the ilium
• 3. Inferior gluteal line of the ilium

Question 7

What are the parts of the coxal bone?

Answer 7

• 1. Ilium
• 2. Pubis
• 3. Ischium

Question 8

What makes up the bony pelvis?

Answer 8

• 1. Paired coxal bones
• 2. Sacrum
• 3. Coccyx

Question 9

What is the pelvic girdle?

Answer 9

Paired coxal bones, which are joined anteriorly at the pubic symphysis.

Question 10

What is the difference between the pubic arch and the supubic angle?

Answer 10

• Pubic arch -> bony arch in between the R/L inferior pubic and ischial rami
• Subpubic angle -> the angle that the pubic arch creates

Question 11

CN: Describe L5 spondylolysis and L5 spondylothesis.

Answer 11

• L5 Spondyloysis -> separation of the vertebral arch from the vertebral body.
• L5 spondylolisthesis -> anterior displacement of L5 from the sacrum

Question 12

What makes up the pelvic canal?

Answer 12

The pelvic canal is the passageway in between the superior pelvic aperture and the inferior pelvic aperture.

• Superior pelvic aperture (pelvic inlet) is located at the pelvic brim, between the greater and lesser pelvis.
• Inferior pelvic aperature (pelvic outlet)

Question 13

What are the sexual diferences in M and F pelvis?

Answer 13

• Males: thicker, heavier, a deeper greater pelvis, narroer and deeper lesser pelvis, android pelvic inlet, small pelvic outlet, narrow pubic arch, round obturator foramen and large acetabulum.
• Females have thinner, lighter pelvis, a shallow greater Pelvis, wide and shallow lesser Pelvis, Gynecoid Pelvic Inlet, large Pelvic Outlet, wide Pubic Arch, oval-shaped Obturator Foramen and small Acetabulum.

Question 14

Classic pelvis shapes in M and W are called what?

Answer 14

• M: android
• W: Gynecoid

Question 15

What are the abnormal pelvic shapes that may cause childbirth do be difficult?

Answer 15

1. Anthropoid (elongated anterior to posterior).
2. Platypelloid (elongated laterally)

Question 16

How do we measure to determine if a woman is a good candidate for vaginal childbirth?

Answer 16

Measure pelvic diameters (conjugates)

Question 17

CN: Pelvic fractures (crush fractures)

Answer 17

Pelvis fractures almost always involves multiple fractures because the articulated pelvis is a bony ring and hard to break in only 1 place. Bc of this, the superior and inferior pubic rami are often broken on both sides.

Question 18

What do we have to know for chondrology of the pelvis?

Answer 18

Interpubic disc is a fibrocartilaginous disc in between the L/R pubic symphyseal surfaces.

Question 19

What type joint is the lumbosacral joint?

Answer 19

In between L5 and sacrum

Intervertebral joint: symphysis

Zygopophyseal joint (in between the articular processes): planar synovial

Question 20

What ligaments make up the lumbosacral joint?

Answer 20

• 1. Anterior longitudinal L - ventral surface of the vertebral bodies
• 2. Posterior longitudinal L- dorsal surface of the vertebral bodies, on the anterior wall of the sacral canal
• 3. Ligamentum flavum- travel on the posterior wall of the sacral canal, ventral to the vertebral laminae
• 4. Iliolumbar L (goes from L5 TP -> iliac crest)
• 5. lumbosacral (foes from L5 TP -> body of the sacral ala)

Question 21

What ligaments are absent from the lumbosacral joint?

Answer 21

• 1. Interspinous L.
• 2. Intertransverse L.
• 3. Supraspinous L.

Question 22

What joint makes up the pelvic girdle?

Answer 22

• Pubic symphysis: symphysis

Question 23

What makes up the pelvic girdle?

Answer 23

• 1. Obturator membrane
• 2. Inguinal L.
• 3. Pubic symphysis
• 4. Transverse acetular L: stretches across the acetabular notch

Question 24

What holds together the pubic symphysis?

Answer 24

1. Superior pubic L

2. Inferior pubic L.

3. Interpubic disk

Question 25

What is the sacroiliac joint and what type of joint is it?

Answer 25

SI joint connects the ilium of the coxal bone and the sacrum. 1. Compound joint (planar synovial and fibrous syndesmosis): * Planar synovial: between the auricular surface of the sacrum and articular surface of the ilium * Fibrous syndesmosis: posteriorly between the sacral and ischial tuberosities

Question 26

What holds the **SI joint** together?

Answer 26

**1. Sacrospinous L: ventral sacrum -\> ischial spine** **2. Sacrotuberous L: ventral sacrum -\> ischial tuberosity.** **3. Posterior Sacroiliac L, which is made up of two parts:** * **a. Long posterior sacroiliac L** * **b. Short posterior sacroiliac L.** **4. Anterior sacroiliac L.** **5. Interosseous sacroiliac L.**

Question 27

Which L make the borders that creates the **_greater/lesser sciatic foramen_** from the **_greater/lesser sciatic notch_**?

Answer 27

**1. Sacrotuberous L.** **2. Sacrospinous L.**

Question 28

What kind of joint is the **sacrococcygeal joint** and what ligaments hold it together?

Answer 28

Sacrococcygeal joint is a **symphysis joint.** Held together by: 1. **_anterior sacrococcygeal L_** 2. **_posterior sacrococcygeal L_**

Question 29

What is the **peritoneum**?

Answer 29

* Peritoneum is a membrane that dips down out of the abdomen -\> pelvis -\> back up and covers, but does not surround the pelvic viscera (organs).

Question 30

In a **male**, what does the **peritoneum** cover and form?

Answer 30

In males, the peritoneum covers the bladder and rectum, forming * 1. **Paravesical fossa-** depressed area on either side of the bladder lined with peritoneum * 2. **Pararectal fossa** - depressed area on either side of the rectum lined with peritoneum * 3. **Rectovesical pouch**- depressed area between the rectum and bladder lined with peritoneum

Question 31

In a **female**, what does the **peritoneum** cover?

Answer 31

* **1. Bladder** * **2. Uterus** * **3. Uterine tubes** * **4. Ovaries** * **5. Rectum**

Question 32

In a **female**, what does the **peritoneum** form?

Answer 32

1**. Paravesical fossa**-depressed area on either side of the bladder lined with peritoneum 2. **Pararectal fossa**- depressed area on either side of the bladder lined with peritoneum 3. **Vesicouterine pouch**- pouch between the bladder and uterus lined with peritoneum 4. **Rectouterine pouch**- pouch between the uterus and the rectum lined with peritoneum 5. **Broad ligament of the uterus** made up of 3 parts

Question 33

In a **female**, one of the things the peritoneum forms is the **broad ligament of the uterus**. What is this and what is it made up of?

Answer 33

In a female, the broad ligament of the uterus is a _double layer of peritoneum (mesentrary) that has 3 parts + the suspensory L of the ovary_ * 1. **Mesometrium**- covers the uterus, L of the ovary and round liagment of the uterus. * 2. **Mesosalpinx**- covers the uterine tubes * 3. **Mesovarium**- covers the ovaries. * 4. **Suspensory. L of the ovary**- lateral extension from the ovary that has the ovarian vessels

Question 34

What are the two types of **pelvic fascia**?

Answer 34

* **1. Membranous pelvic fascia** * **2. Endopelvic fascia**

Question 35

Describe the components of the **membranous pelvic fascia.**

Answer 35

There are two types of [membranous pelvic fascia]: * 1. **Parietal membranous pelvic fascia**, which lines the muscular walls of the pelvis such as the obturator internus m., piriformis m., levator ani m., and coccygeus m. * 2. **Visceral membranous pelvic fascia**- surrounds internal organs, except at the tendinous arch of the pelvic fascia (where the parietal and visceral layers come together.

Question 36

What are the two types of _**parietal membranous pelvic fascia**?_

Answer 36

1. **Obturator fascia**- lines the pelvic side of the obturator internus m. and forms the _pudendal canal (which transmits pudendal N/A_ and _tendinous arch of the levator ani ms._ 2. **Tendinous arch of the pelvic fascia**, which is made up of * _In males_: **puboprostatic L** (anterior part) and sacrogenital L (posterior ), called the **rectoprostatic L** in M. * _In females:_ **pubovesicle L** (anterior part) and sacrogenital L (posterior), called the **uterosacral L** in F.

Question 37

In M, what makes up the **Tendinous arch of the pelvic fascia?**

Answer 37

In males: 1. puboprostatic L (anterior part) 2. sacrogenital L (posterior ), called the rectoprostatic L in M.

Question 38

In F, what makes up the ## Footnote **Tendinous arch of the pelvic fascia?**

Answer 38

In females: 1. pubovesicle L (anterior part) 2. sacrogenital L (posterior), called the uterosacral L in F.

Question 39

Describe the endopelvic fascia.

Answer 39

Endopelvic fascia is made up of ## Footnote **1. _Loose endopelvic fascia (fat filled spaces)_** **2. _Condensed endopelvic fascia (aka hypogastric sheath)_**, which has alot of collagen and elastic fibers and compartmentalizes the loose endopelvic fascia.

Question 40

What makes up the **loose endopelvic fascia**?

Answer 40

* 1. **Retropubic space:** continuous with the paravesical space and located in between the pubis and bladder * 2**. Paravesical space:** between Obturator Fascia and anterior part of the Hypogastric Sheath, separated from the Pelvirectal Space by the Hypogastric Sheath * 3. **Pelvirectal space:** surrounds the rectum * 4. **Retrorectal space:** continous with the pelvirectal space and located between the sacrum and rectum

Question 41

What makes up the **_condensed endopelvic fascia_**?

Answer 41

Aka our hypogasdtric sheath. It is a. A. thick band. of. collagen and elastin. that. will compartmentalize. the loose endopelvic fascia. It. serves as a. conduit for. nerves. and vessels from. the. lateral pelvic. wall -\> pelvic. organs. It is divided into three. parts. * 1. Anterior lamina -\> _lateral L of the bladder (goes to bladder)_ * 2. Middle lamina-\> _transverse cervical L (goes to cervix)_ in F and _rectovesical septum (between the rectum and bladder)_ in M * 3. Posterior lamina -\> _lateral rectal L (goes to posterior aspect of rectum)._

Question 42

When the **perineum** is viewed from an inferior aspect, what does it make?

Answer 42

**Quadrangular space.** The 4 points of it. are: * Anterior: _pubic symphysis_ * Posterior: _coccyx_ * Laterally: _both ischial tuberosities_

Question 43

The 4 points of the quadrangular space are: * Anterior: pubic symphysis * Posterior: coccyx * Laterally:both ischial tuberosities What happens if a line is drawn in between the two ischial tuberosities?

Answer 43

the quadrangle is divided into two triangular spaces: * **the Urogenital Triangle (anteriorly)** * **the Anal Triangle (posteriorly).**

Question 44

What is located in the **anal triangle**?

Answer 44

1. **Ischioanal fossa** -around the wall of the anal canal and filled with fat and LCT that allows the anal canal to expand when you poop. 2. **Pudendal canal-** a space inside the obturator fascia where the i_nternal pudental A, V_ and _pudendal N_ pass through.

Question 45

What is located inside the **_urogenital triangle_**?

Answer 45

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