:


&

Pelvic Cavity and Wall

Dr. Valera November 20, 2013
Transcribed by: Katrina Marie Kabigting, 1D

PELVIS

Definition
-
Basin-shaped ring of bones and is more correctly
applied to the skeleton (coxal bones, sacrum, coccyx).
-
Divided by the pelvic brim or the iliopectineal line
into a false pelvis (major or greater pelvis) above
and a true pelvis (minor or lesser pelvis) below.
-
An outlet at the inferior portion
-
An inlet where the pelvic brim is located
-
Normally tilted when in the anatomic position
Vertical: the anterior superior iliac spine
is in the same vertical plane or axis as the
pubic tubercle
Horizontal: coccyx will be in the same
horizontal plane as the superior border of
the symphysis pubis
The axis of the pelvic cavity running
through the central point of the inlet and
the outlet almost parallels the curvature of
the sacrum

OSSEUS PELVIS
-
The bilateral innominate hip bone and the sacrum
posteriorly
o Innominate bone:
Ilium most superior portion
Ischium most inferior portion
following the normal anatomic position
Pubis most anterior portion
Point of reference is the acetabulum
o Sacrum forms the posterior border of the
pelvis

Figure 1. The sacrum. The sacrum is composed of 5 sacral bones during
intrauterine development. It is fused into one sacrum in adults. The
ridges between the sacral foramina serve as lines of fusion of the sacral
bones. The sacrum provides strength and stability to the pelvis and
transmits the weight of the body to the pelvic girdle, the bony ring
formed by the hip bones and sacrum, to which the lower limbs are
attached.

Coccyx inferoposterior portion

Made up of two bones that will be

fused to form the coccyx.

In females, the joint between the

coccyx and sacrum relaxes during
delivery.
The pelvic basin structure is composed of the two
hipbones, and the sacrum. Anteriorly, there is an
articulation of the two hipbones via the symphysis
pubis with intervening cartilage.
o

5 *?d!Y@H4


=

  
Y

Joints

Figure 2. The joints of the pelvic girdle.

1.

Sacrococcygeal joint a cartilaginous joint between

the sacrum and the coccyx reinforced by the anterior,
lateral, and posterior ligaments. Fibrocartilage and
ligaments join the apex of the sacrum to the base of
the coccyx. The anterior and posterior
sacrococcygeal ligaments are long strands that
reinforce the joint (Moore, Dalley, & Agur, 2010).

2. Pubic symphysis a fibrocartilaginous joint between
the pubic bones in the median plane. The ligaments
joining the bones are thickened at the superior and
inferior
margins of the symphysis, forming superior
)*:6,1!$@$<4/$+$0  M 


8 2  
and
inferior pubic ligaments.
 
,0 :    &' M 
 2
8  

& 



 4' , $0 2
: 
 2
  



The superior pubic ligament connects the

J : K4*,
superior aspects of the pubic bodies and
interpubic disc, extending as far laterally as
the pubic tubercles.
The inferior (arcuate) pubic ligament is a
thick arch of fibers that connects the inferior
aspects of the joint components, rounding off
the subpubic angle as it forms the apex of the
pubic arch (Moore, Dalley, & Agur, 2010).

3. Lumbosacral joints the joint between the vertebra
L5 and the base of the sacrum, joined by an
intervertebral disc and supported by the iliolumbar
ligaments.

4. Sacroiliac joint union of sacrum and iliac part of
pelvic bone

Reinforced by ligamentous support to make it

strong because it carries the entire upper body
)*:6,1!$A$-

C
/404&2&

/
0$+$0
weight. This is the strongest possible joint in the
2   &
  4' 
  M 
 *,0
 '
body.
   '
 ?
 2 @

 
    '


Ligaments:
2: 
'

: 
& 2



: 
& 2
 
a) Sacrotuberous ligament will run from
2 
 ? 2
'
 @ 

  
  2 :'
the sacrum to the ischial tuberosity
& 
, $%0 2
& 4 &
 
  2
 
b) Sacrospinous ligament will run from the
+

 
'2'  '
& : <

 
sacrum to the spinous process of the

M 

 & ',$0*'
 2
: &


ischium

 

8 2

 

  M 
,0
&2 *
c) Iliolumbar ligament from the ilium to the




  &2  &
:&

 '
:
lumbar portion
   '
 '
2  &8

,
d) Dorsal sacroiliac ligament
e) Ventral sacroiliac ligament
f) Interosseous ligament

Figure 3. The ligaments of the hip joint.

)*:6,1!$ $
04/$0 '
 2M 
? *:

 
1

2%
? *:@,


2%
? *:@,
Birth canal bony pelvis made up of sacrum and pelvic girdle.
Obturator
Round
Oval
When we talk about the birth canal, we are referring
foramen
to the pelvic outlet. This is supported by the pelvic
Acetabulum
Large
Small
diaphragm (i.e. levator ani and coccygeus muscles).
Greater
sciatic Narrow
(~70), Almost 90
These muscles not only support pelvic visceral organs,
notch
inverted V
but in child delivery as well.
Table 1. Comparison of male and female bony pelves.
A multiparous female has a relatively lax pelvic

diaphragm.
Composition of Walls:

-
Supporting frameworks are:
Divisions:
o Bones
1. False or greater pelvis contains abdominal parts
o Joints
2. True or lesser pelvis visceral organs
o Ligaments

o Membranes
Viewed from above, at the inferior portion of cavity is the outlet

or the birth canal. This is closed by the pelvic diaphragm (i.e.
Membranes fascia that lines the pelvic cavity
levator ani, coccygeus muscle) which serves as the floor.
-
Continuation of the posterior abdominal fascia


Boundaries:
1. Obturator membrane located at the lateral wall of
False pelvis:
the pelvic cavity. It covers the obturator internus
Posteriorly:
lumbar vertebra
)*:6,1!$?$04&$+$0:&& &
 ' M 
:
*

muscle.
Lateral: iliac fossa and iliacus muscle

:  2
:: , $3 ' 2
:&&


Anteriorly: anterior abdominal wall
 
 ,/
 
 
:  2
::  & 7 
 
M 

True pelvis 2  
,
Pelvic inlet is the superior rim of the pelvic cavity
and is otherwise known as the iliopectineal line. It is
bounded:
18* :*,1
Posteriorly: sacral promontory
Laterally: Iliopectineal line
8

'

/)0

Anteriorly: symphysis pubis
Measured using transverse, oblique, and antero-
posterior (conjugate diameters) to determine whether

 '
 22:
* 2  4 & 

 4 2
birth delivery is normal or via caesarian section.


& &4 2
 2
  
8,0 4
& *6'+,%

Figure 5. Mid-sagittal section of the pelvic cavity. The obturator
Pelvic
outlet a diamond-shaped aperture bounded
membrane does not cover the entire lateral wall because of the
 
   +*
2 +%: 2 *.  
obturator foramen or Alcocks canal in the superior portion. This
by the coccyx, the ischial tuberosities, and the
:
8,0/4
  2 
&?6',+,+@H
 4 

& &
area is devoid of membrane because this serves as the passageway
pubic arch. The inferior portion of the cavity closed
of nerves and blood vessels.
  4 *
4
,
//?  2 #@4
by
the pelvic and urogenital diaphragms.

The outermost portion is the urogenital
* &
7
2 4'  4& 22
?6',+,@,
2. Perineal membrane area where the urogenital
diaphragm.
triangle of the perineum is located

o Lower portion: anal triangle

Figure 4. A picture showing the variations in the male and female
pelves. The gynecoid pelvis (B) is the normal female type; its pelvic inlet
typically has a rounded oval shape and a wide transverse diameter. The
android pelvis
(A), however, is most common for males.
)*:6,1 !$"$

,

Figure 6. The perineum. The perineum is a diamond-shaped region

divided into two by dividing an imaginary line at the level of the ischial
tuberosity. The upper portion is the urogenital triangle, whereas the
lower portion is the anal triangle.

Pelvic Fascia connective tissue covering from the posterior

Bony Pelvis
Male
Female
abdominal wall
General s/0/?
 
  2 
  * '2 
  2 *@
tructure Thick and heavy
Thin and light
1. Visceral covers the visceral organs
Greater p
2
  2 
  &4 4
'  28,2  2


 
elvis
Deep
Shallow
"?
2. Parietal covers the walls of pelvic cavity
Lesser pelvis
Narrow and deep, Wide and shallow,
a. Obturator internus fascia
tapering
cylindrical
b. Fascia of the pelvic diaphragm
Pelvic inlet
Heart-shaped,
Oval and rounded,
c. Superficial layer of urogenital diaphragm
narrow
wide

Pelvic outlet
Comparatively
Comparatively
Pelvic cavity muscles
small
large
1. Obturator internus covers the lateral wall of the
Pubic arch and Narrow (<70)
Wide (>80)
pelvic cavity
subpubic angle

Origin: obturator membrane and brim of

obturator foramen
Insertion: greater trochanter of the femur
Nerve: Nerve to obturator internus
Action: lateral rotator of femus and abducts
it when the hip joint is flexed
Obturator fascia lines the obturator
internus. It fuses with the periosteum
superiorly except at the area of obturator
canal and inferiorly where it thickens and
forms the arcus tendinous. It forms the
sidewall of the ischio-rectal fascia.

Piriformis serves as an important landmark in the
pelvic cavity because in the area where this muscle is
located, it divides the sciatic foramen into the greater
and lesser sciatic foramen. Important vessels and
nerves pass through these.
a. Origin: 2nd, 3rd, and 4th sacrum passes thru
the greater sciatic foramen
b. Insertion: greater trochanteric process of
the femur
c. Nerve: 1st and 2nd sacral nerves
d. Action: lateral rotator of femus and abducts
it when the hip joint is flexed

Pelvic diaphragm forms the pelvic floor and
supports all of the pelvic viscerae.

Formed by the levator ani and coccygeus

muscles and their fascial coverings.

Lies posterior and deep to the urogenital

diaphragm as well as medial and deep to
the ischiorectal fossa.

Raises the entire pelvic floor.

Flexes the anorectal canal during

defecation and hels the voluntary control of
micturition.

2.

3.

Figure 7. Superior view of the pelvic diaphragm. The pelvic

diaphragm is composed of two muscles: the coccygeus and the levator ani
muscles. The coccygeus muscle has its origins from the ischial spine and
inserts towards the sacrum and the coccyx. It is innervated by the sacral
nerve. The levator ani muscle is composed of three muscles, the
iliococcygeus, pubococcygeus, and the puborectalis, all of which will have
a control over the rectal opening. This acts as a sphincter in bowel
movement.

a)

b)

Coccygeus muscle:
Origin: ischial spine
Insertion: sacrum and coccyx
Nerve: sacral nerve
Action: Forms small part of pelvic
diaphragm that supports pelvic viscera;
flexes coccyx

Levator ani muscle:
Origin: pubic bone, obturator fascia (arcus
tendinous), ischial spine

Insertion: median raphe (anococcygeal

ligament),
coccyx,
and
anterior
sacrococcygeal ligament
Nerve: Pelvic side lower sacral nerve,
Perineal side inferior hemorrhoidal nerve
Action:
o Muscular support of pelvic viscera
o Levator ani constricts the rectum and
pulls it forward hence acting as a
sphincter
o Assists the abdominal muscles to
increase intra-abdominal pressure
(defecation, vomiting, and forceful
respiration)
o In the female sphincter vagina and
important in parturition. This supports
the head of the baby during expulsion
efforts of the uterus and abdominal
muscles.

The pelvic floor of multiparous females is relatively lax. In

cases wherein pregnancies occur on a yearly basis, the pelvic
floor does not have enough time to recover its muscle tone. It
is suggested that there should be at least a three-year gap
between pregnancies to allow for the muscles of the pelvic
diaphragm to recuperate from the laxity brought about by
the pressure inside the abdominal and pelvic cavities during
delivery.

Boundaries

Anterior Pelvic Wall: Pubic bone (pubic rami and symphysis
pubis)
-
Relatively the shallowest of all the areas in the pelvic
cavity.

Posterior Pelvic Wall: sacrum and coccyx, piriformis muscle,
parietal pelvic fascia that covers from the posterior abdominal
wall down to the pelvic cavity.
-
The posterior pelvic wall is considered the most
extensive of all the pelvic walls because it is in this
area where the blood vessels and the sacrolumbar
nerves will be coming out.

Lateral Pelvic Wall: hip bone below the pelvic inlet, obturator
membrane and fascia, obturator internus muscle,
sacrotuberous and sacrospinous ligaments

Inferior Pelvic Wall (floor): Pelvic diaphragm (divides the
pelvic cavity from the perineum)

Blood vessels
Internal iliac arises from the common iliac
o Bifurcates into the anterior and posterior
divisions of the internal iliac.
o The anterior branch supplies the anterior
part of the pelvic cavity and gives off seven
branches (i.e. inferior gluteal, internal
pudendal, umbilical, obturator, inferior
vesical, middle rectal, and uterine arteries).
o The posterior branch supplies the
posterior part and gives off three branches
(i.e. superior gluteal, iliolumbar, and lateral
sacral arteries).
Medial sacral artery relatively small from the
posterior aspect of the abdominal aorta before
bifurcating to become the iliac arteries
Superior rectal artery direct continuation of the
inferior mesenteric artery
Ovarian artery comes from the abdominal aorta
and crosses the proximal end of the external iliac. It

will insert towards the suspensory ligament before

reaching the ovary.
Veins accompany the arterial blood supply.

Nerve supply
From the 4th, 5th ventral rami of the lumbar plexus
and the first four ventral rami of the sacral plexus.
As it goes down from the vertebral body, it will now
enter the pelvic cavity via the sciatic foramen with the
piriformis serving as the landmark.