PELVIC and THIGH MUSCLES of ORNITHORHYNCHUS by HELGA S

Total Page:16

File Type:pdf, Size:1020Kb

PELVIC and THIGH MUSCLES of ORNITHORHYNCHUS by HELGA S PELVIC AND THIGH MUSCLES OF ORNITHORHYNCHUS By HELGA S. PEARSON University College, London OF recent years attempts to establish homologies between the muscles found in one class of Vertebrates and those in another have been placed on a much sounder basis by the study of the fossil bones of common ancestral forms. These bones often show muscle insertions as well marked as those on the bones of animals living to-day. Moreover, being often intermediate in shape, they indicate how the skeletal differences between living groups have arisen, differences intimately connected with the different position and action of the muscles moving that skeleton. Watson in England, Gregory and Camp in America, were pioneers in this line of work. More recently Romer', using similar methods and also considering the nerve supply, has made a very careful comparative study of the locomotor apparatus in Amphibia, Reptiles and Mammals with especial reference to the mammalian line of descent. Of these three classes he himself dissected three living types, Cryptobranchus, Iguana and Didelphys, but at that time no Monotreme, relying on Westling's descrip- tion of conditions in this group. Recently I have had the opportunity ofdissecting the hind limb musculature of two specimens of Ornithorhynchus (kindly lent me for this purpose by Prof. D. M. S. Watson). I find that, in the light of Romer's results from other groups of vertebrates, many of Westling's homologies can no longer be ac- cepted; moreover they are unaccompanied by any figures. Although since the days of Cuvier and Meckel there have been other, partially illustrated, descrip- tions by Mivart, Alix, Coues, Manners-Smith and Frets, the homologies of these investigators are for the most part equally unacceptable, so that a new and fully illustrated description of these muscles seems to be needed. I have myself dissected specimens of Romer's three types, and also of other lizards and of the marsupial Sarcophilus, and I have had the opportunity of discussing some of the difficult points with Dr Romer himself, convincing myself of the validity of almost all his homologies. Most of the pelvic and thigh muscles of Ornithorhynchus can readily be brought into line with these. As might be expected, they are essentially mammalian in their arrangement but sometimes still suggest a reptilian origin. A few appear to be unique. 1 Romer (1922), "The Locomotor Apparatus of Certain Primitive and Mammal-like Reptiles. Bull. Am. Mu8. Nat. Hist. XLVI. Pelvic and Thigh Mucltes of Ormithorhynchus 153 I. MUSCLES SEEN WITH THE ANIMAL ON ITS SIDE "Cruro-coccygeus." Origin. In front by a few fibres arising from the anterior end of the iliac blade at its internal corner. Then along a short tendinous raphe stretching between this and the spine of the first sacral vertebra superficial to spinalis and semispinalis lumborum. Then along the spines of the first sacral to the fifth caudal vertebrae. Then from the fascia of the tail external to all the tail muscles, and a little way on to the ventral surface of the tail beneath the transverse process of the fifth caudal vertebra (or thereabouts). Insertion. (a) By a wide, flat tendon which passes round the back of the ankle, onto the under surface ofthe foot internal to the origin of gastrocnemius and (in the male) external to the spine. Here it is superficial to all the tendons of the leg muscles. (b) By a partly fleshy, partly tendinous insertion on to the preaxial border of the tibia, internal to gracilis and just distal to the insertion of semimem- branosus and semitendinosus. This enormous muscle is the hardest of all the monotreme muscles to inter- pret. I should judge it to be used by the animal in kicking back the earth scraped outfrom the burrow, and know of nothing that really corresponds to it in any reptile or higher mammal. Against its being part of glutaeus maximus, as it has usually been named (e.g. Manners-Smith', Westling2), is its insertion; this is on the lower leg, to which it passes superficially to biceps, instead of on the femur internal to biceps. Its mode of insertion would seem rather to relate it to a part of the reptilian flexor mass, the origin of which had not travelled down the ilio-ischiadic (mammalian sacro-ischiadic) ligament to the tuber ischii, as that of the semimembranosus and semitendinosus of most mammals has done. It may be related to the cruro-coccygeus of Didelphys, a slender muscle passing from the side of the tail to the lower leg, and represented in various other mammals by slips joining or accompanying semitendinosus or biceps (Romer, p. 573). This, Romer suggests, may further represent the long tendon of the reptilian caudi-femoralis (caudi-femoralis longus). The primitive caudi-femoralis is, as Romer points out, closely associated with the long flexor muscles, inserting into the flexor mass in Urodeles and primitive frogs. Frets3 calls the anterior part of the disputed muscle in Ornithorhynchus glutaeus maximus, the hinder part caudo-femoralis. Biceps [Reptilian ilio-fibularis; Romer, p. 564]. Origin. From the ischial tuberosity. Passes deep to "cruro-coccygeus" and superficial to all the femoral muscles. 1 Manners-Smith (1885), "On some points in the Anatomy of Ornithorhynchlu paradoxwu," Proc. Zool. Soc. 2 Westling (1889), "Anatomische Untersuchungen uber Echidna," Bihang k. Svenska Vet.- Akad. Handlingar, xv. 3 Frets (1910), "tOber den plexus Jumbo-sacralis, U.s.W.," AMorphol. Jahrb. xL. Anatomy ix 11 154 Helga S. Pearsron --BiC. Fig. 1. The right pelvic and thigh muscles of Ornithorhynchu8, as seen with the animal on its side. BIC. =biceps; CLO. =cloacal pouch; COC. =ischio-coccygeus; GAS. =gastro- cnemius; GLU. 1, 2. = glutaeals; PYR. = pyriformis; REC. = rectus; VAS. = vastus; X. = "cruro-coccygeus." Pelvic and Thigh Mumcle8 of Ornithorhynchus 155 Insertion. Into the fascia covering the lower leg muscles on the anterior and external surface of the lower leg. Glutaeals [Reptilian ilio-femoralis; Romer, p. 570]. In Ornithorhynchus there are two glutaeal muscles. (a) ( = " Glutaeus medius " of Westling and Frets). Origin. By a thin tendinous margin immediately under the fleshy origin of " cruro-coceygeus." Passes to the femur superficial to the axial musculature and to the other glutaeal. Insertion. On the posterior (external) border of the femur at the distal extremity of the crest running down that border from the great trochanter. The area of insertion is small, and distal to the long one of the other glutaeal. (b) ( = " Glutaeus minimus " of Westling and Frets). Origin. From nearly the whole of the glutaeal fossa of the ilium. Passes backwards and outwards, covering the origins of rectus and vastus. Insertion. On to the dorsal surface of the great trochanter and the crest running from that trochanter down the posterior (external) border ofthefemur. The first of these two glutaeals, (a), corresponds most nearly to the Eu- therian glutaeus maximus, the second, (b), to a fused glutaeus medius and minimus. In neither of my specimens was there any sign of a division of this second glutaeal into two, as described by Manners-Smith. Pyriformis [Reptilian caudi-ilio-femoralis? Romer, p. 572]. Origin. From the transverse process of the second caudal vertebra just dorsal to the anterior fibres of ischio-coccygeus. Insertion. On the ventral surface of the femur beyond the obturator inser- tions, and close to the most distally inserting part of the glutaeus, on the posterior (external) border of the bone. For this, as for the other muscles from tail to limb, it is hard to find the reptilian equivalent. The American workers have suggested that it is the reptilian caudi-ilio-femoralis (coccygeo-femoralis brevis). This in reptiles "inserts by a tendon into the femur part way down the shaft, reaching the bone between ilio-femoralis and the adductors" (Romer, p. 572). In higher mammals pyriformis inserts on the ventral surface of the great trochanter. The monotreme muscle, although undoubtedly representing the pyrifornis of higher forms, has an insertion some way down the shaft of the femur, in the position of the reptilian caudi-ilio-femoralis. This makes the suggested homology a very probable one. Rectus [= Reptilian caput iliacus triceps or extensor ilio-tibialis; Romer, p. 562]. Origin. From a small area on the ilium immediately in front of the acetabu- lum. There is a distinct tubercle for it at the acetabular end ofthe ridge between the glutaeal and iliac fossae of the ilium. f 11-2 156 Helga S. Pearson Passes between the glutaeals and ilio-psoas and then superficial to vastus. Its insertion may be taken with that of vastus below. Vastus [= Caput femoralis triceps or femoro-tibialis; Romer, p. 564]. Origin. From the whole of the dorsal surface of the femur except for the insertion places of the glutaeals and ilio-psoas on the dorsal surfaces of the two trochanters. The muscle has a thick fleshy body lying between vastus and the femur. Insertion. Together with rectus on the patella and patella ligament. Sartorius [= Caput acetab. triceps or Ambiens; Romer, p. 563]. Origin. From the extremity of the ilio-pectineal spine (the long process projecting forwards from the anterior border of the pubis just below the ilio- pubic symphysis). Insertion. On the front of the knee joint, proximally to and in a line with the insertion of gracilis, and at some little distance beyond the insertion of the adductors. As pointed out by Romer the sartorius of monotremes, like the ambiens of reptiles, arises from the pubis in front of and a little below the acetabulum, instead of from the superior iliac spine as in most higher mammals. Mono- tremes are unique, however, in having the anterior border of the pubis in this region drawn out into what I have termed above the ilio-pectineal spine, and it is from the tip of this spine that sartorius takes origin.
Recommended publications
  • UNJ Dec 2000
    C o n s e rvative Management of Female Patients With Pelvic Pain Hollis Herm a n he primary symptoms of Female patients with hy p e r t o nus of the pelvic musculature can ex p e- h y p e rtonus of the pelvic rience pain; burning in the cl i t o r i s , u r e t h r a , vag i n a , or anu s ; c o n s t i- m u s c u l a t u r e in female p a t i o n ; u r i n a ry frequency and urge n cy ; and dy s p a r e u n i a . P hy s i c a l patients include pain; t h e r a py techniques are effective in treating female patients with Tb u rning in the clitoris, ure t h r a , pelvic pain, and can successfully reduce the major symptoms asso- vagina or anus; constipation; uri- ciated with it. Using a treatment plan individualized for each patient’s n a ry frequency and urgency; and s y m p t o m s , these techniques can provide considerable relief to d y s p a reu nia (DeFranca, 1996). patients with debilitating pelvic pain. T h e re are many names for hyper- tonus diagnoses involving these symptoms including: levatore s ani syndrome (Nicosia, 1985; Salvanti, 1987; Sohn, 1982), ten- alignment and instability are pre- Olive, 1998), vaginal pH alter- sion myalgia (Sinaki, 1977), sent (Lee, 1999).
    [Show full text]
  • Chronic Pelvic Pain & Pelvic Floor Myalgia Updated
    Welcome to the chronic pelvic pain and pelvic floor myalgia lecture. My name is Dr. Maria Giroux. I am an Obstetrics and Gynecology resident interested in urogynecology. This lecture was created with Dr. Rashmi Bhargava and Dr. Huse Kamencic, who are gynecologists, and Suzanne Funk, a pelvic floor physiotherapist in Regina, Saskatchewan, Canada. We designed a multidisciplinary training program for teaching the assessment of the pelvic floor musculature to identify a possible muscular cause or contribution to chronic pelvic pain and provide early referral for appropriate treatment. We then performed a randomized trial to compare the effectiveness of hands-on vs video-based training methods. The results of this research study will be presented at the AUGS/IUGA Joint Scientific Meeting in Nashville in September 2019. We found both hands-on and video-based training methods are effective. There was no difference in the degree of improvement in assessment scores between the 2 methods. Participants found the training program to be useful for clinical practice. For both versions, we have designed a ”Guide to the Assessment of the Pelvic Floor Musculature,” which are cards with the anatomy of the pelvic floor and step-by step instructions of how to perform the assessment. In this lecture, we present the video-based training program. We have also created a workshop for the hands-on version. For more information about our research and workshop, please visit the website below. This lecture is designed for residents, fellows, general gynecologists,
    [Show full text]
  • Perinea] Musculature in the Black Bengal Goat
    J. Bangladesh Agril. Univ. 3(1): 77-82, 2005 ISSN 1810-3030 Perinea] musculature in the Black Bengal goat Z. Hague, M.A. Quasem, M.R. Karim and M.Z.1. Khan Department of Anatomy and Histology, Bangladesh Agricultural University, Mymensingh Abstract With the aim of preparing topographic descriptions and illustrations of the perineaj muscles of the black Bengal does, 12 adult animals were used. The animals were anaesthetized and bled to death by giving incision on the right common carotid artery. Whole vascular system was flashed with 0.85% physiological saline solution and then 10% formalin was injected through the same route for well preservation. After preservation, the muscles of the perineum were surgically isolated, transected and studied. It revealed that muscles of the pelvic diaphragm were M. levator ani and M. coccygeus. The M. levator ani was originated entirely from the sacrosciatic ligament and M. coccygeus from the medial side of the ischiatic spine and from the inside of the sacrotuberal ligament. M. levator ani was poorly developed and was blended with coccygeus for some distance at their insertion. Muscles of the urogenital diaphragm were M. urethralis, M. ischiourethralis and M. bulboglandularis. M. bulboglandularis was a small circular muscle which enclosed the major vestibular gland. Anal musculature of the perineum were M. sphincter ani externus, M. rectococcygeus and M. rectractor clitoridis. M. sphincter ani externus completely encircled the anus. Its fibers crossed ventral to the anus and continued into the opposite labium and the labium on the same side. M. rectococcygeus inserted on th the ventral surface of the 5th and 6 caudal vertebrae.
    [Show full text]
  • Anatomy and Histology of Apical Support: a Literature Review Concerning Cardinal and Uterosacral Ligaments
    Int Urogynecol J DOI 10.1007/s00192-012-1819-7 REVIEW ARTICLE Anatomy and histology of apical support: a literature review concerning cardinal and uterosacral ligaments Rajeev Ramanah & Mitchell B. Berger & Bernard M. Parratte & John O. L. DeLancey Received: 10 February 2012 /Accepted: 24 April 2012 # The International Urogynecological Association 2012 Abstract The objective of this work was to collect and Autonomous nerve fibers are a major constituent of the deep summarize relevant literature on the anatomy, histology, USL. CL is defined as a perivascular sheath with a proximal and imaging of apical support of the upper vagina and the insertion around the origin of the internal iliac artery and a uterus provided by the cardinal (CL) and uterosacral (USL) distal insertion on the cervix and/or vagina. It is divided into ligaments. A literature search in English, French, and Ger- a cranial (vascular) and a caudal (neural) portions. Histolog- man languages was carried out with the keywords apical ically, it contains mainly vessels, with no distinct band of support, cardinal ligament, transverse cervical ligament, connective tissue. Both the deep USL and the caudal CL are Mackenrodt ligament, parametrium, paracervix, retinaculum closely related to the inferior hypogastric plexus. USL and uteri, web, uterosacral ligament, and sacrouterine ligament CL are visceral ligaments, with mesentery-like structures in the PubMed database. Other relevant journal and text- containing vessels, nerves, connective tissue, and adipose book articles were sought by retrieving references cited in tissue. previous PubMed articles. Fifty references were examined in peer-reviewed journals and textbooks. The USL extends Keywords Apical supports .
    [Show full text]
  • Anococcygeal Raphe Revisited: a Histological Study Using Mid-Term Human Fetuses and Elderly Cadavers
    http://dx.doi.org/10.3349/ymj.2012.53.4.849 Original Article pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 53(4):849-855, 2012 Anococcygeal Raphe Revisited: A Histological Study Using Mid-Term Human Fetuses and Elderly Cadavers Yusuke Kinugasa,1 Takashi Arakawa,2 Hiroshi Abe,3 Shinichi Abe,4 Baik Hwan Cho,5 Gen Murakami,6 and Kenichi Sugihara7 1Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan; 2Arakawa Clinic of Proctology, Tokyo, Japan; 3Department of Anatomy, Akita University School of Medicine, Akita, Japan; 4Oral Health Science Center hrc8, Tokyo Dental College, Chiba, Japan. 5Department of Surgery, Chonbuk National University School of Medicine, Jeonju, Korea. 6Division of Internal Medicine, Iwamizawa Kojin-kai Hospital, Iwamizawa, Japan; 7Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. Received: September 21, 2011 Purpose: We recently demonstrated the morphology of the anococcygeal liga- Accepted: October 24, 2011 ment. As the anococcygeal ligament and raphe are often confused, the concept of Corresponding author: Dr. Yusuke Kinugasa, Division of Colon and Rectal Surgery, the anococcygeal raphe needs to be re-examined from the perspective of fetal de- Shizuoka Cancer Center Hospital, velopment, as well as in terms of adult morphology. Materials and Methods: We 1007 Shimonagakubo, Nagaizumi-cho, examined the horizontal sections of 15 fetuses as well as adult histology. From ca- Sunto-gun, Shizuoka 411-8777, Japan. davers, we obtained an almost cubic tissue mass containing the dorsal wall of the Tel: 81-55-989-5222, Fax: 81-55-989-5783 anorectum, the coccyx and the covering skin.
    [Show full text]
  • The Anatomy of the Pelvis: Structures Important to the Pelvic Surgeon Workshop 45
    The Anatomy of the Pelvis: Structures Important to the Pelvic Surgeon Workshop 45 Tuesday 24 August 2010, 14:00 – 18:00 Time Time Topic Speaker 14.00 14.15 Welcome and Introduction Sylvia Botros 14.15 14.45 Overview ‐ pelvic anatomy John Delancey 14.45 15.20 Common injuries Lynsey Hayward 15.20 15.50 Break 15.50 18.00 Anatomy lab – 25 min rotations through 5 stations. Station 1 &2 – SS ligament fixation Dennis Miller/Roger Goldberg Station 3 – Uterosacral ligament fixation Lynsey Hayward Station 4 – ASC and Space of Retzius Sylvia Botros Station 5‐ TVT Injury To be determined Aims of course/workshop The aims of the workshop are to familiarise participants with pelvic anatomy in relation to urogynecological procedures in order to minimise injuries. This is a hands on cadaver course to allow for visualisation of anatomic and spatial relationships. Educational Objectives 1. Identify key anatomic landmarks important in each urogynecologic surgery listed. 2. Identify anatomical relationships that can lead to injury during urogynecologic surgery and how to potentially avoid injury. Anatomy Workshop ICS/IUGA 2010 – The anatomy of the pelvis: Structures important to the pelvic surgeon. We will Start with one hour of Lectures presented by Dr. John Delancy and Dr. Lynsey Hayward. The second portion of the workshop will be in the anatomy lab rotating between 5 stations as presented below. Station 1 & 2 (SS ligament fixation) Hemi pelvis – Dennis Miller/ Roger Goldberg A 3rd hemipelvis will be available for DR. Delancey to illustrate key anatomical structures in this region. 1. pudendal vessels and nerve 2.
    [Show full text]
  • Innervation of the Levator Ani and Coccygeus Muscles of the Female Rat
    THE ANATOMICAL RECORD PART A 275A:1031–1041 (2003) Innervation of the Levator Ani and Coccygeus Muscles of the Female Rat RONALD E. BREMER,1 MATTHEW D. BARBER,2 KIMBERLY W. COATES,3 1,4 1,4,5 PAUL C. DOLBER, AND KARL B. THOR * 1Research Services, Veterans Affairs Medical Center, Durham, North Carolina 2Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 3Department of Obstetrics and Gynecology, Scott and White Clinic, Temple, Texas 4Department of Surgery, Duke University Medical Center, Durham, North Carolina 5Dynogen Pharmaceuticals, Inc., Durham, North Carolina ABSTRACT In humans, the pelvic floor skeletal muscles support the viscera. Damage to innervation of these muscles during parturition may contribute to pelvic organ prolapse and urinary incontinence. Unfortunately, animal models that are suitable for studying parturition-in- duced pelvic floor neuropathy and its treatment are rare. The present study describes the intrapelvic skeletal muscles (i.e., the iliocaudalis, pubocaudalis, and coccygeus) and their innervation in the rat to assess its usefulness as a model for studies of pelvic floor nerve damage and repair. Dissection of rat intrapelvic skeletal muscles demonstrated a general similarity with human pelvic floor muscles. Innervation of the iliocaudalis and pubocaudalis muscles (which together constitute the levator ani muscles) was provided by a nerve (the “levator ani nerve”) that entered the pelvic cavity alongside the pelvic nerve, and then branched and penetrated the ventromedial (i.e., intrapelvic) surface of these muscles. Inner- vation of the rat coccygeus muscle (the “coccygeal nerve”) was derived from two adjacent branches of the L6-S1 trunk that penetrated the muscle on its rostral edge.
    [Show full text]
  • Pelvic Wall Joints of the Pelvis Pelvic Floor
    ANATOMY OF THE PELVIS Prof. Saeed Abuel Makarem OBJECTIVES • By the end of the lecture, you should be able to: • Describe the anatomy of the pelvis regarding (bones, joints & muscles). • Describe the boundaries and subdivisions of the pelvis. • Differentiate the different types of the female pelvis. • Describe the pelvic walls & floor. • Describe the components & function of the pelvic diaphragm. • List the blood & nerves & lymphatic of the pelvis. The bony pelvis is composed of four bones: • Two hip bones, which form the anterior and lateral walls. • Sacrum and coccyx, which form the posterior wall. • These 4 bones are lined by 4 muscles and connected by 4 joints. • The bony pelvis with its joints and muscles form a strong basin-shaped structure (with multiple foramina), that contains & protects the lower parts of the alimentary & urinary tracts and internal organs of reproduction. 3 FOUR JOINTS 1- Anteriorly: Symphysis pubis (2nd cartilaginous joint). 2- Posteriorlateraly: Two Sacroiliac joints. (Synovial joins) 3- Posteriorly: Sacrococcygeal joint (cartilaginous), between sacrum and coccyx. 4 The pelvis is divided into two parts by the pelvic brim. Above the brim is the False or greater pelvis, which is part of the abdominal cavity. Pelvic Below the brim is the True or brim lesser pelvis. The False pelvis is bounded by: Posteriorly: Lumbar vertebrae. Laterally: Iliac fossae and the iliacus. Anteriorly: Lower part of the anterior abdominal wall. It supports the abdominal contents. 5 The True pelvis has: • An Inlet. • An Outlet. and a Cavity. The cavity is a short, curved canal, with a shallow anterior wall and a deeper posterior wall.
    [Show full text]
  • The Ilio-Coccygeus Muscle
    ogy: iol Cu ys r h re P n t & R y e s Anatomy & Physiology: Current m e o a t r a c n h Guerquin, Anat Physiol 2017, 7:S6 A Research ISSN: 2161-0940 DOI: 10.4172/2161-0940.S6-002 Review Article Open Access The Ilio-Coccygeus Muscle (ICM) Does it have an Enabling Role in Urination? Bernard Guerquin* General Hospital, Avenue of Lavoisier, CS20184, Orange 84100, France *Corresponding author: Guerquin B, General Hospital, Avenue de Lavoisier, CS20184, Orange 84100, France, Tel: +3304 901124 53; E-mail: [email protected] Received Date: January 20, 2017; Accepted Date: February 01, 2017; Published Date: February 10, 2017 Copyright: © 2017 Guerquin B. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract An analysis of the literature has allowed for a redefinition of the anatomy of the ilio-coccygeus muscle (ICM) its insertions and its trajectory, the direction of its fibers and its relation to the base of the bladder. Static MRI studies have revealed its V-shaped appearance, while dynamic MRI has been used to visualize its concave contraction into a dome-shape that provides support to the levator plate, raising the base of the bladder. Histological studies have shown that the percentage of type I muscle fibers is 66% to 69%, which is comparable to the type I fiber content of the pubovisceral muscle (PVM), thus reflecting both its postural role as well as functions based on frequent voluntary contractions.
    [Show full text]
  • Architectural Design of the Pelvic Floor Is Consistent with Muscle Functional Subspecialization
    Int Urogynecol J (2014) 25:205–212 DOI 10.1007/s00192-013-2189-5 ORIGINAL ARTICLE Architectural design of the pelvic floor is consistent with muscle functional subspecialization Lori J. Tuttle & Olivia T. Nguyen & Mark S. Cook & Marianna Alperin & Sameer B. Shah & Samuel R. Ward & Richard L. Lieber Received: 24 April 2013 /Accepted: 6 July 2013 /Published online: 1 August 2013 # The International Urogynecological Association 2013 Abstract human cadavers (mean age 85 years, range 55–102). Funda- Introduction and hypothesis Skeletal muscle architecture is mental architectural parameters of skeletal muscles [physio- the strongest predictor of a muscle’s functional capacity. The logical cross-sectional area (PCSA), normalized fiber length, purpose of this study was to define the architectural proper- and sarcomere length (Ls)] were determined using validated ties of the deep muscles of the female pelvic floor (PFMs) to methods. PCSA predicts muscle-force production, and nor- elucidate their structure–function relationships. malized fiber length is related to muscle excursion. These Methods PFMs coccygeus (C), iliococcygeus (IC), and parameters were compared using repeated measures analysis pubovisceral (PV) were harvested en bloc from ten fixed of variance (ANOVA) with post hoc t tests, as appropriate. Significance was set to α=0.05. Results PFMs were thinner than expected based on data report- L. J. Tuttle ed from imaging studies and in vivo palpation. Significant dif- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA ferences in fiber length were observed across PFMs: C=5.29±0.32 cm, IC=7.55±0.46 cm, PV=10.45±0.67 cm O.
    [Show full text]
  • Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region
    TUTORIAL Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region Gail Apte, PT, ScD*; Patricia Nelson, PT, ScD†; Jean-Michel Brisme´e, PT, ScD*; Gregory Dedrick, PT, ScD*; Rafael Justiz III, MD‡; Phillip S. Sizer Jr., PT, PhD* *Center for Rehabilitation Research, Texas Tech University Health Science Center, Lubbock, Texas; †Department of Physical Therapy, Eastern Washington University, Spokane, Washington; ‡Saint Anthony Pain Management, Oklahoma City, Oklahoma, U.S.A. n Abstract: Chronic pelvic pain is defined as the presence symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, of pain in the pelvic girdle region for over a 6-month per- groin or abdominal region) can be followed to establish a iod and can arise from the gynecologic, urologic, gastro- basis for managing the specific pain generator(s) and man- intestinal, and musculoskeletal systems. As 15% of women age tissue dysfunction. n experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective eval- Key Words: myofacial pain, pelvic pain, signs and symp- uation and management strategies of this condition are toms, female examination necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain condi- tions, including a careful history-taking and clinical exami- INTRODUCTION nation. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central Pain in the pelvic region can arise from musculoskele- sensitization of the nervous system associated with the tal, gynecologic, urologic, gastrointestinal, and/or neu- chronicity of the symptoms, as well as the potential influ- rological conditions.
    [Show full text]
  • A Vaginal Approach to Pelvic Floor Prolapse
    30 O B .GYN. NEWS • December 1, 2007 M ASTER C LASS A Vaginal Approach to Pelvic Floor Prolapse n a recent Master Class the pubic bones and the sacrum. Posterior to the spine is searcher and much-sought-after lecturer. As this year’s sci- (OB.GYN. NEWS, Aug. 1, the sacrospinous ligament with the overlying coccygeus entific program chairman of the American Association I2007, p. 24), abdominal muscle. The sacrospinous ligament marks the posterior of Gynecologic Laparoscopists’ Global Congress of Min- sacral colpopexy via a laparo- limit of the pelvic diaphragm. imally Invasive Gynecology, I invited Dr. Sand to present scopic approach was featured Because he is a nationally recognized expert in the vagi- a surgical tutorial on the vaginal approach to prolapse. for the treatment of vaginal nal approach to pelvic floor prolapse, I have asked Dr. Pe- Just as the participants found his discussion interesting and vault prolapse. However, for ter Sand to discuss vaginal vault suspension, the evolu- informative, I am sure our readers will feel the same. ■ the gynecologic surgeon who tion of the procedure, and the prevailing literature that BY CHARLES E. is more adroit with vaginal compares this technique with abdominal sacral colpopexy. DR. MILLER is clinical associate professor, University of MILLER, M.D. surgery, sacrospinous vaginal Dr. Sand is currently a professor of ob.gyn. at North- Chicago and University of Illinois at Chicago and President vault suspension also offers a western University, Chicago, and the director of urogy- of the AAGL. He is a reproductive endocrinologist in private safe and effective remedy for this disorder.
    [Show full text]