Pelvis and perineum
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
The hip bone is formed from three fused bones: the ilium, the ischium and the pubis. Anteriorly the two hip bones join at the pubic symphysis. The pelvic brim (or pelvic inlet) is formed by the superior edge of the sacrum (with the sacral promontory in the midline), the arcuate line of the ilium, the superior ramus and body of the pubis and the pubic symphysis; this is the boundary between the true pelvis or pelvic cavity, inferior to the brim, and the false pelvis, bounded laterally by the wings of the ilium, which is the part above the brim and more properly belongs to the abdominal cavity. Note: When the bony pelvis is correctly orientated, it is tilted forwards so that the anterior superior iliac spines and the superior aspect of the pubic symphysis are in the same vertical plane (as when holding the bony pelvis against a wall with these bony points touching the wall). The pelvic cavity runs posteriorly almost at a right angle to the abdominal cavity.
Lower limb
Aida Lai in Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Attachments of adductor magnus– origin (adductor part): ischiopubic ramus– origin (hamstring part): ischial tuberosity– insertion (adductor part): post. femur, linea aspera– insertion (hamstring part): adductor tubercle– nerve SS (adductor part): obturator n. (L2–4)– nerve SS (hamstring part): sciatic n. (L2–4)– function: adduct and medially rotate thigh
Pelvic Exenteration: Radical Perineal Approaches and Sacrectomies
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
For anterior compartment tumors abutting or infiltrating the pubic bone, a more radical margin than in Chapter 6.11 becomes necessary for the excision of the anterior compartment. Wide exposure, but not incision, of anterior levator muscles are performed out to the inferior ramus of the pubic bone and extended back to the ischial tuberosity. The adductor and gracilis muscles are separated from their attachments to the lateral border of the inferior pubic rami with diathermy and extended through the obturator fascia into the exposed pelvis. The inferior pubic ramus is transected free from the ischial bone (Figure 6.12.12, Line A) and anteriorly from the pubis (Figure 6.12.12, Line D) with an oscillating saw or, alternatively, a Gigli saw can be used. If the pubis and symphysis needs excising this can be done partially for the inferior half (Figure 6.12.12, Line B) or the whole central pubis can be excised (Figure 6.12.12, Line E combined with Line A). Excision of the ischial tuberosity (Figure 6.12.12, Line C) can be performed from the perineal lithotomy approach with preservation of the whole pubic bone.
Usefulness of magnetic resonance imaging to diagnose greater trochanteric-ischial impingement
Published in Baylor University Medical Center Proceedings, 2021
Munif Hatem, Kathryn E. Canavan, RobRoy L. Martin, Jonathan Dawkins, Hal David Martin
Extra-articular impingement between the femur and ischium is a cause of hip pain and is reported both in native hips and following hip surgery.1–7 Impingement between the lesser trochanter and the ischium occurs at terminal hip extension,1–3 while greater trochanteric-ischial impingement (GTI) occurs with the hip positioned in mid-flexion, abduction, and external rotation (FABER).5,8 This position is similar to that observed during squatting, sitting with legs crossed, or during intercourse. Sciatica may also be provoked by the compression of the sciatic nerve between the GT and the ischium.9 The purpose of this study was to assess the diagnostic parameters for GTI in magnetic resonance imaging (MRI). A secondary purpose was to identify threshold values for abnormal greater trochanteric-ischial and greater trochanteric-hamstring distances.
Long-term radial extracorporeal shock wave therapy for neurogenic heterotopic ossification after spinal cord injury: A case report
Published in The Journal of Spinal Cord Medicine, 2022
Yun Li, Yulan Zhu, Zhen Xie, Congyu Jiang, Fang Li
All treatments, including routine physical therapies and RSWT, as well as follow-up, were conducted from May 2018 to May 2019, at the Department of Rehabilitation Medicine, Huashan Hospital of Fudan University, Shanghai. The assessment intervals during the treatment were 1.5, 3, 7 and 11 months after the first intervention. The outcome measurements showed significant improvement throughout the therapeutic period. Ultrasound examination suggested that the size of hyperechoic foci had shown a gradual decrease from 45 mm*25 mm to 18 mm*16 mm (Figure 1). CT scans also revealed the reduction of ossification mass at the ilium, ischium, femur cross-section, respectively. Three-dimensional reconstruction CT further proved that the volume of ossification mass decreased throughout the year after first RSWT intervention (Figure 2). The passive ROM of the hip joint was severely limited at the very early phase of NHO, which was gradually increased during the course of RSWT. The pain was mitigated as suggested by the reduction of VAS score from 8 to 1 after 1.5 months of the treatment which was maintained for another five months. The patient complained of no pain in the last session of the treatment. The sALP level declined from 184 IU/L to 126 IU/L after the first session of the treatment, and kept stable around five months, then further declined to 86 IU/L in the end (Table 1).
Frequency of ischiofemoral space discrepancy when comparing magnetic resonance images of distinct institutions for the same patient
Published in Baylor University Medical Center Proceedings, 2021
Munif Hatem, RobRoy L. Martin, Scott J. Nimmons, Hal David Martin
Impingement between the lesser trochanter and the ischium is a cause of hip pain and limitation in hip extension.1–5 The ischiofemoral space (IFS) is the distance between the lesser trochanter and the ischium, with values ≤17 mm traditionally indicating ischiofemoral impingement.6 Variation in hip flexion/extension, abduction/adduction, and internal/external rotation during the acquisition of imaging studies is a potential source of variation in IFS.7 Inaccuracy of the IFS measurement may result in radiographic misdiagnosis of ischiofemoral impingement, as well as insufficient or excessive osseous resection in patients surgically treated. This study compared the IFS measured in magnetic resonance imaging (MRI) studies performed in distinct health services for the same patient. The hypothesis is that variability in the IFS is a frequent finding.
Related Knowledge Centers
- Acetabulum
- Ischial Spine
- Obturator Internus Muscle
- Ischial Tuberosity
- Hip Bone
- Ilium
- Pubis
- Gemelli Muscles
- Lesser Sciatic Notch
- Hamstring