Pelvis Anatomy

Question 1

What type of joint is the pubic symphysis?

Answer 1

• Amphiarthrodial joint (allows for slight mvmt)

Question 2

Iliolumbar ligament

Answer 2

• 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

Question 3

Iliolumbar ligament pain radiation areas

Answer 3

• Inguinal area
• Inner thigh
• Lateral upper thigh

Question 4

4 Types of Pelvises

Answer 4

• Gynecoid
• Android
• Anthropoid
• Platypelloid

Question 5

Gynecoid pelvis

Answer 5

• 1 of 4 types of pelvises
• More classically a female pelvis
• Ideal for birth

Question 6

Android pelvis

Answer 6

• 1 of 4 types of pelvises
• More classically a male pelvis
• Most birthing difficulty

Question 7

Anthropoid pelvis

Answer 7

• 1 of 4 types of pelvises
• Ape pelvis
• Problematic w/ certain positions of fetal head engagement

Question 8

Platypelloid pelvis

Answer 8

• 1 of 4 types of pelvises

- Head engages later, but usually ok after that

Question 9

Female pelvis

Answer 9

• 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)

Question 10

Male pelvis

Answer 10

• 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

Question 11

Ideal standing posture effects on pelvis

Answer 11

• 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)

Question 12

Exaggerated kyphosis/lordosis standing effects on pelvis

Answer 12

• Classic upper and lower cross imbalance

Question 13

Flat back standing effects on pelvis

Answer 13

• Hamstrings maintain upright posture by pulling pelvis posterior
• Bad posture, tight hamstrings

Question 14

Swayback standing effects on pelvis

Answer 14

• Gravitational line is further posterior to hips
• Requires no increased muscle activity
• Ligamentous structures take the weight, may become stretched

Question 15

Patterns seen with poor posturing

Answer 15

• Tight: upper traps and levator scap, pecs, erector spinae, iliopsoas
• Weak: deep neck flexors, rhomboids and serratus anterior, abdominals, glutes

Question 16

Pelvic activities during gait cycle

Answer 16

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

Question 17

Pelvic floor responsibility

Answer 17

• Maintains structural integrity of pelvic viscera and lower abdomen
• Helps in controlling urination and defecation
  
  • urethral meatus and rectal sphincter
• Mechanism of sexual function

Question 18

Pelvic floor layers

Answer 18

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

Question 19

Levator Ani muscles

Answer 19

Located caudad to endopelvic fascia

• Iliococcygeus
• Pubococcygeus
• Puborectalis

Question 20

Levator Ani muscles function

Answer 20

• 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

Question 21

Pelvic diaphragm

Answer 21

• Levator ani and assoc. fascia together

Question 22

Urogenital hiatus

Answer 22

• 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

Question 23

Pelvic floor/ diaphragm function

Answer 23

• Maintains pelvic organ support
• Maintains urinary and fecal continence
  
  • via urethral and anal sphincter control, urinary

Question 24

Pelvic floor/ diaphragm dysfunctional effects

Answer 24

• 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

Question 25

High tone pelvic floor dysfunction OMT

Answer 25

- 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)

Question 26

Pathology of pelvic floor prolapse

Answer 26

- 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)

Question 27

Symptoms of prolapse

Answer 27

- 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")

Question 28

Most common type of pelvic floor dysfunction

Answer 28

- Stress urinary incontinence | * involuntary leakage w/ increased abdominal pressure (effort, exertion, sneezing, coughing, laughing)

Question 29

Post partum effects on the pelvic floor

Answer 29

- Pubococcygeus is most susceptible to stretch injury during vaginal birth - Pudendal nerve provides innervation to external genitalia, sphincters of bladder and rectum

Question 30

Pelvic floor trigger points

Answer 30

- Levator ani and coccygeus | - Obturator internus

Question 31

T10-T11 Autonomics-Sympathetics

Answer 31

- Kidneys, gonads, upper ureter, adrenals

Question 32

T12-L2 Autonomics-Sympathetics

Answer 32

- Lower ureters, uterus, vagina, clitoris, vas deferens, prostate, bladder, urethra, fallopian tubes, seminal vesicles, sphincter, trigone

Question 33

Vagus Autonomics-Parasympathetics

Answer 33

- Kidney, upper ureter, ovaries, testes

Question 34

S2-4 Autonomics-Parasympathetics

Answer 34

- Lower ureter, bladder, prostate