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A. Pelvis 1. Name the Innominate Bones

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A. Pelvis 1. Name the Innominate Bones A. Pelvis 1. Name the innominate bones (those that are fused together and don’t move). There are two innominate bones, and each innominate bone contains three bones that are fused together. The three bones are the ilium, ischium, and pubis. They are placed laterally (on the side) on the pelvis, and each innominate bone has an acetabulum where the three bones fuse around it. The acetabulum is the concave surface of the pelvis, where the head of the femur meets with the pelvis to form the hip joint. 2. Describe the sacrum. The sacrum is a triangular shaped bone that has a superior base and an inferior apex. The anterior side of the sacrum is concave, while the posterior surface is convex. The sacrum consists of five vertebrae fused together. Attached by the sacroiliac joints, the sacrum lies between the innominate bones. The sacral promontory is the anterior and superior edge of the sacrum’s base (first sacral vertebra), and it protrudes forward forming the concavity. This protrusion into the cavity of the pelvis reduces the anteroposterior diameter of the pelvic inlet. If the sacral promontory was pushed backwards, it would widen the pelvic inlet and increase its diameter. 3. Describe the coccyx. The coccyx, or tailbone, is the final segment of the vertical column. It is also triangular and looks like a shortened tail at the bottom of the spine. It is composed of four vertebrae. The sacrococcygeal joint is between the superior side of the first coccygeal vertebra and the inferior side of the fifth sacral vertebra. 4. Give the difference between the primary and accessory ligaments. There are four primary ligaments and two accessory ligaments. The four primary ligaments are: 1. The anterior sacroiliac ligament - these are short and transverse, running from the ilium to the sacrum, more specifically, the preauricular sulcus of the ilium. The preauricular sulcus is observed as a female characteristic in the pelvic, and it is a groove near the sacrum. This ligament inserts into the anterior side of the ala of the sacrum. 2. The interosseous sacroiliac ligament - are short and transverse bands of ligaments that lie deep to the posterior ligament. The run from the posterior surface of the ilium, horizontally to the sacrum. 3. The short posterior sacroiliac ligaments - are strong transverse bands that lie behind the interosseous ligaments. 4. The long posterior sacroiliac ligaments - are each attached from the posterior superior iliac spine to the tubercles of the third and fourth sacral vertebrae. The two accessory ligaments are: 1. The sacrotuberous ligaments - are long ligaments originating from the ischial tuberosity (sit bones) and inserting into the posterior inferior iliac spine and posterior superior iliac spine. This ligament is also known as an extension to the posterior sacroiliac ligament. Basically, it is in the posterior inferior pelvis, between the sacrum and sit bones. 2. The sacrospinous ligament - is a triangle shaped transverse ligament, and is attached from the fifth sacral and first coccygeal vertebrae to the ischial spine. 5. What is the sacroiliac joint? The sacroiliac joint or SI joint is between the ilium bones and the sacrum of the pelvis. It is a synovial joint (an egg white like fluid to reduce friction between cartilage during movement), and permits a small degree of movement. The SI joint also is contained by a capsule (an envelope surrounding a synovial joint) that is weak. The joint’s stability is maintained by muscles and ligaments around it. 6. Describe the Symphysis Pubis. The symphysis pubis is a secondary cartilaginous joint located near the left and right superior rami pubic bone, near the midline of the body. This joint is not a synovial joint, so it does not contain a capsule. There is very little movement from this joint, and it is in front of and below the bladder. Below the symphysis pubis is the arcuate pubic ligament, which is a strong inferior ligament in the pubic arch. 7. What is the sacrococcygeal Joint and why is it important? The sacrococcygeal joint lies between the inferior fifth sacral vertebrae and the superior first coccygeal vertebrae. It is a synovial joint, so there is movement involved, allowing for extension and flexion of the sacrum and coccyx. During parturition, when there is extension, it allows the fetal head to fit and engage more due to the increased anteroposterior diameter of the pelvic outlet. If coccyx didn’t extend back, it would be a much tighter outlet for the baby to pass through. If this is over extended, the small cornua, (connecting bone between the coccyx and sacrum) may break. Due to it being a synovial joint, it is surrounded by a weak capsule that must be reinforced by anterior, posterior, and lateral sacrococcygeal ligaments 8. How does the mobility of the pelvis change during pregnancy? Progesterone and relaxin both increase the flexibility of the sacroiliac joints and the symphysis pubis during pregnancy. The joints also undergo hyperemia (an increase in blood flow to different tissues) and ligament softening. Excessive movement of the pubic symphysis can lead to pain and difficulty in walking. The pubic bones may separate one to 12 millimeters. The pelvis is an incredible structure, because it is designed for its flexibility to allow a fetus to smoothly pass through it, allowing bones to move and extend. 9. What are the differences in the male and female pelvis? The female and male pelvis are both born the same, and develop at puberty in the presence of hormones and gonads. There are many differences between the two, and can be easily noticed and differentiated. The female pelvic cavity is much shallower compared to a deep male pelvic cavity. This allows for a quicker passage for the fetus. The female iliac crest with respect to the pelvis is shorter, while the males is higher and taller. The female pelvic bones are lighter and thinner than the denser rougher males’. The pubic arch differences in subpubic angles vary, where the females is much wider, typically at an 80 degree angle or above, and the males is less than or equal to 70 degrees. The male arch is closer to the shape of a “V,” while the female is like the shape of an “L.” The female pelvic inlet is an oval shape, while the males is heart-shaped. The sacrums are different too, where the female sacrum is wider, shorter, and curved, with the coccyx being straighter. The male sacrum is longer, and straighter, and the coccyx curves forward. 10. Explain how the adolescent female and adult female pelvis differ. How and why does this happen? The pelvis of an adolescent girl is much smaller than that of a mature woman. An adolescent girl’s growth in height is at a different rate than her pelvic growth. For instance, within the first year after she has her first menstrual cycle, her stature will rapidly decelerate, and stops within one or two years. While her pelvic basin grows much more slowly and steadily during late adolescence. Her pelvis will also change shape, from an anthropoid (resembling the male pelvis) to a gynecoid (more circular, narrower female shape). A woman's complete growth and development of her pelvis isn't indicated by a mature reproductive system, or peak adult statute. B. Pelvic Floor 1. What is the pelvic floor and what are its functions? The pelvic floor is a funnel-shaped structure and divides the pelvic cavity above and the perineal space below. It is composed of muscle fibers of the levator ani, the coccygeus muscle, and is covered completely by connective tissue parietal fascia. The urethra and vagina pass through an anterior gap called the urogenital hiatus. The rectum and anal canal pass through the rectal hiatus, which is posterior to the urogential hiatus. It’s functions are to: 1. Support the pelvic viscera in humans. The pelvic viscera includes the bladder, distal ends of the ureters, rectum, and reproductive organs. 2. Contract the diaphragm muscles, abdominal wall, and pelvic floor all together in order to build effective intra abdominal pressure. 3. Help the anterior rotation of the fetal presenting part during parturition, and direct it downward and forward along the birth canal. 2. Part of the pelvic floor consists of the Levator Ani. This is further subdivided into two main muscles. One of these is the pubococcygeus muscle. What is this muscle and what does it do/why is it important? Ensure you cover all three sections completely. The pubococcygeus muscle is a hammock-like muscle that stretches from the pubic bone to the coccyx forming the floor of the pelvic cavity and supporting the pelvic organs. It is a very important, dynamic, and specialized part of the pelvic floor. It’s in the midline of the pelvis and is perforated by the urethra, vagina, and rectum. This muscle is often damaged during delivery. It originates from the anterior medial portion of the pubis, and inserts posteriorly to the sacrum. It contains three different sections: the pubovaginalis, puborectalis, and pubococcygeus proper. 1. The pubovaginalis muscle - is the most medial section, and is shaped like a horseshoe with its opening facing anteriorly. It acts as a sling, wrapped around the vagina to support the female pelvic organs. It supports the vagina because the vagina itself helps to support the uterus and appendages, bladder and urethra, and rectum. This muscle inserts into the sides and back of the vagina and ends at the central point of the perineum. Uterovaginal prolapse is likely to happen as a result of tearing or overstretching the pubovaginalis. This muscle also acts as the vaginal sphincter, and vaginismus, is the condition of it spasming.
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