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.
Complications of Female Incontinence Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Osteitis pubis is a self-limiting nonbacterial inflammation of the periosteum overlying the symphysis pubis that is associated with, but not unique to, incontinence surgery. This condition has also been associated with pelvic trauma, childbirth, and prolonged running (5). While OP tends to be self-limiting, it can be quite distressing and incapacitating for up several months following surgery. The patient usually complains of pubic pain in the immediate postoperative period, exacerbated by walking, climbing steps, and standing, and demonstrates pubic bony tenderness, adductor spasm, and a wide-based gait (6). Laboratory evaluation usually demonstrates leukocytosis and an elevated erythrocyte sedimentation rate, and pelvic reontgenography may show a “moth-eaten” lytic lesion that evolves over several weeks. Treatment includes rest, anti-inflammatory medication, and physical therapy. Steroid injections into the pubic symphysis may also be helpful (7).
Fascial Slings
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Figure 72.4 A tonsil-tip clAmp or double-heAded needle is pAssed from the AbdominAl incision, through the rectus fAsciA, And into the vAginAl incision on either side of the urethrA. CAre is tAken to stAy just behind the posterior Aspect of the pubic symphysis. The index finger of the nonpAssing hAnd guides the clAmp from below. (reproduced from blAivAs JG And ChAikin D, PubovAginAl fAsciAl sling for the treAtment of All types of stress Urinary incontinence: surgicAl treAtment And long-term outcome, in CArdozo L And stAskin D, eds., Textbook of FemAle Urology And Urogynecology, InformA, London, u.K., 2006. With permission.) Tie loosely with no tension
Perinatal pubic symphysis separation combined with pubic fracture: a case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2022
Liang Deng, Liang-Yu Xiong, Ji-Huan Zeng, Qiang Xiao, Yuan-Huan Xiong
In terms of the treatment, for pubic symphysis separation with separation distance ≤ 40 mm, conservative treatment can be performed with a pelvic correction belt. The elasticity of the pelvic correction belt can fix the crotch, tighten the separated pelvis, protect the pubis, and relieve the pain of pubic. Hence, the mechanical distribution of pelvis, back and buttock can be further improved, and the pubic symphysis can be recovered and maintained in the normal anatomical position (Culligan et al. 2002). For the parturient with a separation distance > 40 mm or combined with the persistent pain and pelvic instability, the active surgical intervention may be a sensible choice. With regard to this, the common surgical methods include external fixation and internal fixation, in which the internal fixation is the preferred method (Sujana et al. 2017). The internal fixation mainly includes the screws and steel plates fixation, which can provide sufficient mechanical stability and effective compression resistance and anti-rotation ability. In recent years, the minimally invasive surgeries represented by percutaneous cannulated screws have obtained remarkable results, which can effectively reduce the surgical trauma, shorten the operation time, and further contribute to the rapid postoperative recovery (Saeed et al. 2015). In this case, we have applied the conventional open reduction and internal fixation, and fixed with screws and steel plates. After one year of follow-up, the screws and steel plates were still fixed firmly and the separation distance of pubic symphysis was also effectively controlled.
Long-standing groin pain in an elite athlete: usefulness of ultrasound in differential diagnosis and patient education – a case report
Published in European Journal of Physiotherapy, 2018
Kingsley S. R. Dhinakar, Anjanette Cantoria Lacaste
Groin pain is common in sporting activities that involve kicking, quick sprinting, change of direction and cutting swiftly as in hockey, soccer and basketball. Athletic pubalgia (AP) is a commonly used term that is broadly defined as pain in the groin and pubic region. However, groin pain in athletes was the preferred umbrella term (using specific defined clinical entity) ahead of other such as athletic pubalgia, athletic groin pain, sports groin pain, athlete’s groin because it is clearly descriptive based on the Doha agreement meeting on terminology and definitions in groin pain in athletes 2015 [1]. Groin pain can occur in both male and female athletes but it is more prone to male. Campanelli [2] suggests that males are at an increased risk of groin pain as females have a wider and larger subpubic angle and stronger rectus abdominis attachments at the symphysis pubis. The larger and wider pelvis biomechanically dissipates forces away from the pubic symphysis and groin region, thus reducing the incidence in females. There is no dearth of literature describing groin pain and its various causes, however, largely this condition is poorly defined and poorly understood due to unclear aetiopathology. This lack of understanding is further compounded due to the involvement of multiple structures posing a clinical challenge. Therefore, only using traditional methods (without using instrumental diagnosis) of examination and assessment may mislead the clinician and result in failed treatment. Garvey et al. [3] and Balconi [4] suggest the following causes for groin pain as shown in Table 1.
Telerehabilitation for pelvic girdle dysfunction in pregnancy during COVID-19 pandemic crisis: A case report
Published in Physiotherapy Theory and Practice, 2022
The patient presented with a reduced active range of motion of hip abduction and external rotation on the left side with an inability to maintain hip abduction on the left side due to pain. The symptoms were aggravated when the patient performed a sit-to-stand activity but not vice versa. While performing a sit-to-stand activity, the patient had pain at the left side sacroiliac joint and pubic symphysis. While doing bed transitions, she complained of pain at the pubic symphysis. Based on the observed impairments and functional limitations, the author concluded that the patient presented with a pubic symphysis dysfunction along with left sacroiliac joint (SI joint) dysfunction likely a posterior innominate on the left side.
Related Knowledge Centers
- Bladder
- Fibrocartilage
- Hyaline Cartilage
- Synovial Membrane
- Clitoris
- Blood Vessel
- Cartilaginous Joint
- Pubis
- Suspensory Ligament of Penis
- Amphiarthrosis