Pelvis: Difference between revisions

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<div class="editorbox"> '''Original Editor '''- [[User:User Name|User Name]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
<div class="editorbox"> '''Original Editor '''- [[User:User Name|User Name]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


=== Description ===
== Description ==
[[File:Gray241.png|alt=Bones of the pelvis|thumb|348x348px]]The pelvis consists of the sacrum, the coccyx,the ischium, the ilium, and the pubis. <ref name=":1">White, TD., Black, MT., Folkens, PA. Human osteology. Academic press; 2011.</ref><ref name=":0">Lewis CL, Laudicina NM, Khuu A, Loverro KL. The human pelvis: Variation in structure and function during gait. The Anatomical Record. 2017 Apr;300(4):633-42.</ref> The structure of the pelvis supports the contents of the abdomen while also helping to transfer the weight from the spine to the lower limbs.<ref name=":2">Magee DJ. Orthopedic physical assessment. Elsevier Health Sciences; 2013 Dec 4.</ref> During gait, the joints within the pelvis work together to decrease the amount of force transferred from the ground and lower extremities to the spine and upper extremities.<ref name=":2" />
[[File:Gray241.png|alt=Bones of the pelvis|thumb|348x348px]]The pelvis consists of the sacrum, the coccyx, the ischium, the ilium, and the pubis.<ref name=":1">White TD, Black MT, Folkens PA. [https://books.google.co.za/books?hl=en&lr=&id=oCSG2mYlD90C&oi=fnd&pg=PP1&dq=+.+Human+osteology.+&ots=VnpEcJPCWD&sig=Ful9Jtenlzzw4M4nniLS00LstnM#v=onepage&q=.%20Human%20osteology.&f=false Human osteology.] Academic press; 2011.</ref><ref name=":0">Lewis CL, Laudicina NM, Khuu A, Loverro KL. [https://anatomypubs.onlinelibrary.wiley.com/doi/pdf/10.1002/ar.23552 The human pelvis: Variation in structure and function during gait.] The Anatomical Record 2017;300(4):633-42.</ref> The structure of the pelvis supports the contents of the abdomen while also helping to transfer the weight from the spine to the lower limbs.<ref name=":2">Magee DJ. [https://books.google.co.za/books?hl=en&lr=&id=cxu0BQAAQBAJ&oi=fnd&pg=PP1&dq=Orthopedic+physical+assessment.&ots=mqGLvPFASn&sig=Jf3KLqp1lfiYQYoeVU2fMhEhhvs#v=onepage&q=Orthopedic%20physical%20assessment.&f=false Orthopedic physical assessment.] Elsevier Health Sciences; 2013.</ref> During [[gait]], the joints within the pelvis work together to decrease the amount of force transferred from the ground and lower extremities to the spine and upper extremities.<ref name=":2" />
   
   
{{#ev:youtube|3v5AsAESg1Q|300}}<ref>Anatomy Zone. Bones of the Pelvis. Available from: https://youtu.be/3v5AsAESg1Q [last accessed 27/01/2020]</ref>
{{#ev:youtube|3v5AsAESg1Q|300}}<ref>Anatomy Zone. Bones of the Pelvis. Available from: https://youtu.be/3v5AsAESg1Q [last accessed 27/01/2020]</ref>


== Osteology: ==
== Osteology  ==
[[File:Innominate bone.jpg|thumb|349x349px]]
[[File:Innominate bone.jpg|thumb|349x349px]]
* sacrum
* Sacrum
* coccyx
* Coccyx
* two innominate bones, which consist of the:
* Two innominate bones, which consist of the:
** ischium
** Ischium
** ilium
** Ilium
** pubis<ref name=":1" />
** Pubis<ref name=":1" />
=== Joint Articulations: ===
=== Joint Articulations ===
There are three articulations within the pelvis:  
There are three articulations within the pelvis:  
* inferiorly between the sacrum and the coccyx
* Inferiorly between the sacrum and the coccyx
* posteriorly between the sacrum and each ilium ([[Sacroiliac joint|sacroiliac (SI) joint]])
* Posteriorly between the sacrum and each ilium ([[Sacroiliac joint|sacroiliac (SI) joint]])
* anteriorly between the pubic bodies (pubic symphysis).<ref name=":0" />
* Anteriorly between the pubic bodies (pubic symphysis).<ref name=":0" />
'''Other articulations:'''  
'''Other articulations:'''  


The pelvis and femur articulate via the acetabulum<ref name=":1" />  
The pelvis and [[femur]] articulate via the acetabulum<ref name=":1" />  
=== Ligaments: ===
=== Ligaments ===
[[File:Bony-pelvis-2.jpg|thumb|420x420px]]
[[File:Bony-pelvis-2.jpg|thumb|420x420px]]


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* Posterior pubic ligament  
* Posterior pubic ligament  


=== Muscles: ===
=== Muscles ===
There are 36 muscles that attach to the sacrum or innominates. The purpose of these muscles is primarily to provide stability to the joint not to produce movement.<ref>Calvillo O., Skaribas I., Turnispeed J., Anatomy and pathophysiology of the SIJ, current science, 2000 (LOE 2A)</ref>
There are 36 muscles that attach to the sacrum or innominates. The purpose of these muscles is primarily to provide stability to the joint not to produce movement.<ref>Calvillo O, Skaribas I, Turnipseed J. [https://link.springer.com/article/10.1007/s11916-000-0019-1 Anatomy and pathophysiology of the sacroiliac joint.] Current review of pain 2000;4(5):356-61.</ref>


Muscles that attach to the sacrum or innominates are:
[[Muscle|Muscles]] that attach to the sacrum or innominates are:
{| class="wikitable" style="text-align: center;"
{| class="wikitable" style="text-align: center;"
|Adductor brevis
|[[Adductor Brevis|Adductor brevis]]
|Adductor longus
|Adductor longus
|[[Adductor Magnus|Adductor magnus]]
|[[Adductor Magnus|Adductor magnus]]
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|[[Gluteus Minimus|Gluteus minimus]]
|[[Gluteus Minimus|Gluteus minimus]]
|-
|-
|Gracilis
|[[Gracilis]]
|[[Iliacus]]
|[[Iliacus]]
|Inferior gemellus
|[[Gemellus Inferior|Inferior gemellus]]
|[[Internal Abdominal Oblique|Internal oblique]]
|[[Internal Abdominal Oblique|Internal oblique]]
|[[Latissimus Dorsi Muscle|Latissimus dorsi]]
|[[Latissimus Dorsi Muscle|Latissimus dorsi]]
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|[[Pelvic Floor Anatomy|Levator ani]]
|[[Pelvic Floor Anatomy|Levator ani]]
|Multifidus
|Multifidus
|Obturator internus
|[[Obturator Internus|Obturator internus]]
|Obturator externus
|[[Obturator Externus|Obturator externus]]
|Pectineus
|[[Pectinus Muscle|Pectineus]]
|-
|-
|[[Pelvic Floor Anatomy|Levator ani]]
|[[Pelvic Floor Anatomy|Levator ani]]
|[[Piriformis]]
|[[Piriformis]]
|[[Psoas Minor|Psoas minor]]
|[[Psoas Minor|Psoas minor]]
|Pyramidalis
|[[Pyramidalis muscle|Pyramidalis]]
|Quadratus femoris
|[[Quadratus Femoris|Quadratus femoris]]
|-
|-
|[[Quadratus Lumborum|Quadratus lumborum]]
|[[Quadratus Lumborum|Quadratus lumborum]]
|[[Rectus Abdominis|Rectus abdominis]]
|[[Rectus Abdominis|Rectus abdominis]]
|Rectus femoris
|[[Rectus Femoris|Rectus femoris]]
|Sartorius
|[[Sartorius]]
|Semimembranosus
|[[Semimembranosus]]
|-
|-
|Semitendonosus
|[[Semitendinosus|Semitendonosus]]
|[[Pelvic Floor Anatomy|Sphincter urethrae]]
|[[Pelvic Floor Anatomy|Sphincter urethrae]]
|[[Pelvic Floor Anatomy|Superficial transverse perineal ischiocavernous]]
|[[Pelvic Floor Anatomy|Superficial transverse perineal ischiocavernous]]
|Superior [[Gemellus Superior|gemellus]]
|[[Gemellus Superior|Superior gemellus]]
|[[Tensor Fascia Lata|Tensor fascia lata]]
|[[Tensor Fascia Lata|Tensor fascia lata]]
|-
|-
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|}
|}


== Sex-specific differences: ==
== Sex-specific differences ==
The female pelvis consists of a wider sacrum and a wider subpubic angle when compared to males. The female pelvis’ ischial spines are also less prominent than the male’s ischial spines.<ref name=":3">Kurki HK. Pelvic dimorphism in relation to body size and body size dimorphism in humans. Journal of Human Evolution. 2011 Dec 1;61(6):631-43.</ref><ref name=":4">Meindl RS, Lovejoy CO, Mensforth RP, Carlos LD. Accuracy and direction of error in the sexing of the skeleton: implications for paleodemography. American Journal of Physical Anthropology. 1985 Sep;68(1):79-85.</ref><ref name=":5">Tague RG. Sexual dimorphism in the human bony pelvis, with a consideration of the Neandertal pelvis from Kebara Cave, Israel. American Journal of Physical Anthropology. 1992 May;88(1):1-21.</ref> The male pelvis’ sacrum is generally longer and more curved with a narrower sub-pubic arch.<ref name=":5" /> In females a wider pelvic aperture is needed as it functions as the birth canal during labour.<ref>Abitbol MM. The shapes of the female pelvis. Contributing factors. The Journal of reproductive medicine. 1996 Apr;41(4):242-50.</ref><ref name=":3" /><ref>Lovejoy CO. The natural history of human gait and posture: part 2. Hip and thigh. Gait & posture. 2005 Jan 1;21(1):113-24.</ref><ref name=":4" /><ref>Rosenberg KR. The evolution of modern human childbirth. Am J Phys Anthropol. 1992;35(S15):89–124.</ref>
The female pelvis consists of a wider sacrum and a wider subpubic angle when compared to males. The female pelvis’ ischial spines are also less prominent than the male’s ischial spines.<ref name=":3">Kurki HK. [https://www.sciencedirect.com/science/article/abs/pii/S0047248411001679 Pelvic dimorphism in relation to body size and body size dimorphism in humans.] Journal of Human Evolution 2011;61(6):631-43.</ref><ref name=":4">Meindl RS, Lovejoy CO, Mensforth RP, Carlos LD. [https://s3.amazonaws.com/academia.edu.documents/48786250/Accuracy_and_Direction_of_Error_in_the_S20160912-8250-ox8gbo.pdf?response-content-disposition=inline%3B%20filename%3DAccuracy_and_direction_of_error_in_the_s.pdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-A Accuracy and direction of error in the sexing of the skeleton: implications for paleodemography.] American Journal of Physical Anthropology 1985;68(1):79-85.</ref><ref name=":5">Tague RG. [https://onlinelibrary.wiley.com/doi/abs/10.1002/ajpa.1330880102 Sexual dimorphism in the human bony pelvis, with a consideration of the Neandertal pelvis from Kebara Cave, Israel.] American Journal of Physical Anthropology 1992;88(1):1-21.</ref> The male pelvis’ sacrum is generally longer and more curved with a narrower sub-pubic arch.<ref name=":5" /> In females a wider pelvic aperture is needed as it functions as the birth canal during labour.<ref name=":3" /><ref name=":4" /><ref>Rosenberg KR. [https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajpa.1330350605 The evolution of modern human childbirth.] American Journal of Physical Anthropology.1992;35(S15):89-124.</ref><ref>Lovejoy CO. [https://www.researchgate.net/profile/Owen_Lovejoy/publication/51367382_The_natural_history_of_human_gait_and_posture_Part_2_Hip_and_thigh/links/5cd6ee9592851c4eab969302/The-natural-history-of-human-gait-and-posture-Part-2-Hip-and-thigh.pdf The natural history of human gait and posture: part 2. Hip and thigh.] Gait & posture 2005;21(1):113-24.</ref><ref>Abitbol MM. [https://europepmc.org/article/med/8728076 The shapes of the female pelvis. Contributing factors.] The Journal of reproductive medicine 1996;41(4):242-50.</ref>


== Clinical Examination: ==
== Clinical Examination  ==


=== Assessment: ===
=== Assessment ===
*Prior to the assessment of the sacroiliac joint both the [[Lumbar Examination|lumbar spine]] and [[Hip Anatomy|hip]] should be assessed and any underlying pathologist should be ruled out.
Prior to the assessment of the sacroiliac joint both the [[Lumbar Examination|lumbar spine]] and [[Hip Anatomy|hip]] should be assessed and any underlying pathologist should be ruled out.


=== Special Tests: ===
=== Special Tests ===


==== SI Joint stress tests ====
==== SI Joint stress tests ====
* Anterior Gapping test
* Anterior gapping test
* [[Sacroiliac Distraction Test|Sacroiliac Distraction test]]
* [[Sacroiliac Distraction Test|Sacroiliac distraction test]]
* Sacrotuberous Ligament Stress test
* Sacrotuberous ligament stress test
* Sacral Compression test
* Sacral compression test
* Rotational Stress test
* Rotational stress test


==== [[Leg Length Discrepancy|Leg Length tests]] ====
==== [[Leg Length Discrepancy|Leg Length tests]] ====
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* Seated Flexion test (Piedallu's Sign)
* Seated Flexion test (Piedallu's Sign)
* [[Supine Long Sitting Test|Supine long sitting test]]
* [[Supine Long Sitting Test|Supine long sitting test]]
* [[Sign of the Buttock]]
* [[Sign of the Buttock|Sign of the buttock]]
* [[Posterior pelvic pain provocation test (aka Thigh Thrust aka Posterior Shear)|Posterior Pelvic Pain Provocation test]]
* [[Posterior pelvic pain provocation test (aka Thigh Thrust aka Posterior Shear)|Posterior pelvic pain provocation test]]
* [[Gaenslen Test|Gaenslen test]]
* [[Gaenslen Test|Gaenslen test]]
* Yeoman's test
* Yeoman's test
* [[FABER Test|FABER (Figure-Four) test]]
* [[FABER Test|FABER (Figure-Four) test]]
* Fortin Finger Test
* Fortin Finger Test
* [[Straight Leg Raise Test|Straight Leg Raise - 70-90deg]]
* [[Straight Leg Raise Test|Straight leg raise]]
* [[Stork Test|Gillet's test (Stork test)]]
* [[Stork Test|Gillet's test (Stork test)]]


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== Pathology/Injury  ==
== Pathology/Injury  ==


*[[Pubic Symphysis Dysfunction|Pubic Symphysis Dysfunction]]  
*[[Pubic Symphysis Dysfunction|Pubic symphysis dysfunction]]  
*[[Spondyloarthritis]]  
*[[Spondyloarthritis]]  
*[[Pregnancy Related Pelvic Pain|Pregnancy Related Pelvic Pain]]  
*[[Pregnancy Related Pelvic Pain|Pregnancy related pelvic pain]]  
*[[Pelvic Fractures|Pelvic Fractures]]
*[[Pelvic Fractures|Pelvic fractures]]
*[[Sacroiliitis]]
*[[Sacroiliitis]]


Revision as of 15:57, 31 May 2020

Original Editor - User Name Top Contributors - Nicole Hills, Wanda van Niekerk, Kim Jackson, Shaimaa Eldib, Lucinda hampton, Rachael Lowe, Leana Louw, Admin, George Prudden and Joao Costa

Description[edit | edit source]

Bones of the pelvis

The pelvis consists of the sacrum, the coccyx, the ischium, the ilium, and the pubis.[1][2] The structure of the pelvis supports the contents of the abdomen while also helping to transfer the weight from the spine to the lower limbs.[3] During gait, the joints within the pelvis work together to decrease the amount of force transferred from the ground and lower extremities to the spine and upper extremities.[3]

[4]

Osteology[edit | edit source]

Innominate bone.jpg
  • Sacrum
  • Coccyx
  • Two innominate bones, which consist of the:
    • Ischium
    • Ilium
    • Pubis[1]

Joint Articulations[edit | edit source]

There are three articulations within the pelvis:

  • Inferiorly between the sacrum and the coccyx
  • Posteriorly between the sacrum and each ilium (sacroiliac (SI) joint)
  • Anteriorly between the pubic bodies (pubic symphysis).[2]

Other articulations:

The pelvis and femur articulate via the acetabulum[1]

Ligaments[edit | edit source]

Bony-pelvis-2.jpg

Ligaments of the Pelvis[edit | edit source]

  • Iliolumbar ligament
  • Lateral lumbosacral ligament
  • Sacrotuberous ligament
  • Sacrospinous ligament

Sacroiliac Ligaments[edit | edit source]

  • Ventral/Anterior sacroiliac ligament
  • Dorsal/Posterior sacroiliac ligament
  • Interosseous sacroiliac ligament

Sacrococcygeal Ligaments[edit | edit source]

  • Ventral/Anterio sacrococcygeal ligament
  • Dorsal sacrococcygeal ligament
  • Lateral sacrococcygeal ligament

Pubic Symphysis Ligaments[edit | edit source]

  • Superior pubic ligament
  • Inferior pubic ligament
  • Anterior pubic ligament
  • Posterior pubic ligament

Muscles[edit | edit source]

There are 36 muscles that attach to the sacrum or innominates. The purpose of these muscles is primarily to provide stability to the joint not to produce movement.[5]

Muscles that attach to the sacrum or innominates are:

Adductor brevis Adductor longus Adductor magnus Biceps femoris - long head Coccygeus
Erector Spinae External oblique Gluteus maxiumus Gluteus medius Gluteus minimus
Gracilis Iliacus Inferior gemellus Internal oblique Latissimus dorsi
Levator ani Multifidus Obturator internus Obturator externus Pectineus
Levator ani Piriformis Psoas minor Pyramidalis Quadratus femoris
Quadratus lumborum Rectus abdominis Rectus femoris Sartorius Semimembranosus
Semitendonosus Sphincter urethrae Superficial transverse perineal ischiocavernous Superior gemellus Tensor fascia lata
Transversus abdominus

Sex-specific differences[edit | edit source]

The female pelvis consists of a wider sacrum and a wider subpubic angle when compared to males. The female pelvis’ ischial spines are also less prominent than the male’s ischial spines.[6][7][8] The male pelvis’ sacrum is generally longer and more curved with a narrower sub-pubic arch.[8] In females a wider pelvic aperture is needed as it functions as the birth canal during labour.[6][7][9][10][11]

Clinical Examination[edit | edit source]

Assessment[edit | edit source]

Prior to the assessment of the sacroiliac joint both the lumbar spine and hip should be assessed and any underlying pathologist should be ruled out.

Special Tests[edit | edit source]

SI Joint stress tests[edit | edit source]

Leg Length tests[edit | edit source]

  • Prone test
  • Standing leg length test
  • Functional leg length test

Other Special Tests[edit | edit source]

Outcome Measures[edit | edit source]

Pathology/Injury[edit | edit source]

Resources:[edit | edit source]

  1. ↑ 1.0 1.1 1.2 White TD, Black MT, Folkens PA. Human osteology. Academic press; 2011.
  2. ↑ 2.0 2.1 Lewis CL, Laudicina NM, Khuu A, Loverro KL. The human pelvis: Variation in structure and function during gait. The Anatomical Record 2017;300(4):633-42.
  3. ↑ 3.0 3.1 Magee DJ. Orthopedic physical assessment. Elsevier Health Sciences; 2013.
  4. ↑ Anatomy Zone. Bones of the Pelvis. Available from: https://youtu.be/3v5AsAESg1Q [last accessed 27/01/2020]
  5. ↑ Calvillo O, Skaribas I, Turnipseed J. Anatomy and pathophysiology of the sacroiliac joint. Current review of pain 2000;4(5):356-61.
  6. ↑ 6.0 6.1 Kurki HK. Pelvic dimorphism in relation to body size and body size dimorphism in humans. Journal of Human Evolution 2011;61(6):631-43.
  7. ↑ 7.0 7.1 Meindl RS, Lovejoy CO, Mensforth RP, Carlos LD. Accuracy and direction of error in the sexing of the skeleton: implications for paleodemography. American Journal of Physical Anthropology 1985;68(1):79-85.
  8. ↑ 8.0 8.1 Tague RG. Sexual dimorphism in the human bony pelvis, with a consideration of the Neandertal pelvis from Kebara Cave, Israel. American Journal of Physical Anthropology 1992;88(1):1-21.
  9. ↑ Rosenberg KR. The evolution of modern human childbirth. American Journal of Physical Anthropology.1992;35(S15):89-124.
  10. ↑ Lovejoy CO. The natural history of human gait and posture: part 2. Hip and thigh. Gait & posture 2005;21(1):113-24.
  11. ↑ Abitbol MM. The shapes of the female pelvis. Contributing factors. The Journal of reproductive medicine 1996;41(4):242-50.
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