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Anatomy of the Pelvis
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Sacrotuberous ligament is a flat band of immense strength; it blends with the posterior sacroiliac ligament and attaches to the posterior border of the ilium, posterior superior and inferior spines and to the transverse tubercles of the sacrum below the auricular surface and upper part of the coccyx. From this extensive attachment, the ligament extends to the medial surface of the ischial tuberosity. A forward prolongation from the ischial attachment of this ligament attaches to a curved bony ridge termed as “falciform process”. This ligament is considered to be a remnant or degenerated tendon of the long head of the biceps femoris. It provides attachment to the gluteus maximus on the posterior surface. It is pierced by perforating cutaneous nerves and branches of inferior gluteal vessels and coccygeal nerves.
Pelvic Fracture
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
APC II – Pubic symphysis widening >2.5 cm. There has been disruption of the sacrospinous and sacrotuberous ligaments, as well as the anterior SI ligaments. The strong posterior SI ligaments remain intact and subsequently there is no loss of vertical stability.
The Bladder (BL)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Sacrotuberous ligament: Provides support and resiliency to the sacroiliac region. Demonstrates broad attachments to the ilium, sacrum, coccyx, and ischium.1 The ligament closely associates with the long head of the biceps femoris muscle as well as other ligaments and muscles.
Ten-Step Surgical Approach to Management of Pathology of the Ischiorectal Fossa—A Review of the Literature and Application in a Rare Pelvic Schwannoma
Published in Journal of Investigative Surgery, 2022
Sarah Louise Smyth, Sunanda Dhar, Miss Lucy Cogswell, Hooman Soleymani majd
The transichiorectal approach provides direct access to Alcock’s canal with minimal pelvic muscle and ligament disruption [5, 7]. The procedure requires an in-depth knowledge of the pelvic anatomical spaces [4]. The pudendal nerve arises from the S2-4 sacral nerve and travels forward laterally in the pelvis within the obturator internus fascial sheath [8]. It has both motor and sensory functions. The ischiorectal fossa is a pyramidal space lateral to the anal canal and below the pelvic diaphragm with the apex at the anal canal and obturator fascia boundary, and the base at the perineal surface. It is bound medially by the levator ani, external anal sphincter and anal fascia, laterally by the ischial tuberosity and obturator internus muscle, anteriorly by the urogenital diaphragm fascia and Colles’ transverse perineal muscle fascia and posteriorly by the gluteus maximus and sacrotuberous ligament [2, 9]. It contains the internal pudendal, posterior labial and inferior rectal vessels and nerve, the perineal S4 branch, the perforating cutaneous nerve and lymphatic tissue [1, 3].
Physiotherapist management of a patient with spastic perineal syndrome and subsequent constipation: a case report
Published in Physiotherapy Theory and Practice, 2021
Shankar Ganesh, Mritunjay Kumar
The effect of the intervention on constipation and pain may be related to the biomechanical and neurophysiological effects of the interventions used. The tightness of the piriformis muscles and the associated sacral torsion might have put undue pressure on the sacrotuberous ligament or on the innominate bones (Steiner, Staubs, Ganon, and Buhlinger, 1987; TePoorten, 1969). Literature has reported that the extension of coccyx is associated with defecation and flexion of coccyx controls the downward movement of feces (Baheti, Sanjay, Sanjeeva, and Gehdoo, 2017). As the coccyx is dependent upon the sacrum for movement, flexion of the sacrum results in the apex of the coccyx moving posterior and vice versa. The sacrococcygeal joint thus functions as one functional unit with the L5 vertebra through the sacrospinous ligament. The coccyx, therefore, flexes as the L5 flexes and extends with L5 extension (Giammatteo and Giammatteo, 2003). The posteroanterior mobilization force applied at L5 during the mobilization procedure produces extension (Kulig et al., 2007) and hence extension at the coccyx. This might have further improved the mobility of coccyx and in-turn defecation.
Influence of psychiatric disorders and chronic pain on the surgical outcome in the patient with chronic coccydynia: a single institution’s experience
Published in Neurological Research, 2020
Kristopher A. Lyon, Jason H. Huang, David Garrett
Given the strong association of psychiatric disorders in patients suffering from coccydynia, it is reasonable to consider a neuroanatomic reason that may relate these variables. Closely associated with the coccyx, the coccygeal plexus arises from the ventral primary rami of the S4, S5, and Co1 nerve roots along with contributions from the sacral sympathetic trunk [18]. The coccygeal plexus then goes on to give rise to nerves that innervate the sacrococcygeal joint, anococcygeal ligament, sacrotuberous ligament, and inconsistently, the coccygeus muscle [19]. Overactivity of these nerves may lead to increased tension or spasm of the muscles or tendons taking their origin off the coccyx. Therefore, as part of the pre-operative workup, many patients often seek physical therapy to include intra-rectal digital massage of the levator ani, coccygeus, and pyriformis muscles with or without nerve blocks using corticosteroids or local anesthetics injected into this region [20].