what type of joint is the symphasis pubis?
what is the articular surface of the symphasis pubis?
the pubic bodies of each hip bone have a thin hyaline cartilage covering
the interpubic disc is strengthened anteriorly by several interlacing collagenous fibrous layers which interweave with fibres of ___ and ___ tendons of the _____
external oblique aponeuroses and medial tendons of the recti abdominus
what two points does the superior pubic ligament travel between?
from pubic tubercle to pubic tubercle and from crest to crest
attachment point for the arcuate pubic ligament
A1: interpubic disc
A2:inferior pubic rami
FD: Lateral and inferior
what is the primary function of the sacroiliac joint?
firmly unite the pelvic girlde to facilitate the transmission of weight bearing forces between the upper and lower extremities
What type of movement occurs between the ilium and sacrum?
structurally the sacroiliac joint is _ joints consisiting of a __ joint and a __ joint.
2 joints consisting of a SYNOVIAL PLANE joint and a FIBROSIS joint
what are the two articular surfaces of the sacroiliac joint?
ear shaped surface on the sacropelvic surface of the ilium and by a similar shaped surface on the alar (wing) of the sacrum
what are the articular surfaces of the sacroiliac joint covered with?
what two points does the fibrous portion of the sacroiliac joint run between?
exists between the iliac tuberosity and the upper dorsal surface of the sacrum
the two bones of the sacroiliac joint do not contact each other between the iliac tuberosity and the upper dorsal surface of the sacrum, consequently they form a ___ behind which the ___ projects beyond the ___
cleft behind which the ilium projects beyond the sacrum
what is the cleft of the sacroiliac joint filled with?
a dense mass of fibres called the interosseous sacro-iliac ligament
behind the cleft of the sacroiliac joint the fibres are known as the __
dorsal sacro-iliac ligament
what is the massive ligament located posteriorly, forming the chief bond of the SI joint and filling the irregular space posterosuperior to the joint?
interosseous sacro-iliac ligament
what covers the interosseous sacro-iliac ligament superficially?
dorsal sacroiliac ligament
the deeper part of the interosseous sacro-iliac ligament has superior and inferior bands passing from depression posterior to ___ and to ___
superior and inferior bands passing from depressions posterior to sacral auricular surface to iliac tuberosity
does the dorsal sacro-iliac ligament lie anterior or posterior to the interosseous SI ligament?
the dorsal SI ligament has several weak __ connecting ___ and __ sacral crests to the ___ and internal lip of the ___
has several weak FASICULI connecting INTERMEDIATE and LATERAL sacral crests to the PSIS and internal lip of the ILIAC CREST
often inferior fibres from __ and __ sacral segments ascend to ___ forming a separate long posterior sacroiliac ligament
inferior fibres from 3rd and 4th sacral segments ascend to PSIS forming a separate long posterior SI ligament
What is the Posterior SI Ligament continuous with laterally? Medially?
laterally: sacrotuberous ligament
medially: posterior lamina of the thoracolumbar fascia
Which ligament strengthens the ventral portion of the SI joint capsule and is most developed on the anterior inferior aspect of the joint?
anterior sacro-iliac ligament
what two points do the bands of the iliolumbar ligament run between?
the iliac crest and the transverse process of the 5th lumbar vertebrae, consist of 5 parts
what ligament prevents forward slippage of L5?
what ligament limits twisting, forward, back and lateral bending of L5?
Which points does the anterior portion of the iliolumbar ligament travel between?
A1: anterior inferior border of TP of L5
A2: medial body of L5
what two points does the superior portion of the iliolumbar ligament attach to?
A1: anterior and posterior fascia that surrounds QL
A2: anterior superior border of L5 TP
what points does the posterior aspect of the iliolumbar ligament attach to?
attached to the top of the posterior border of the TP and attached to the ilium behind QL
What points does the inferior aspect of the iliolumbar ligament attach to?
A1: lower border of the TP of L5
A2:SI ligament (anterior)
FD: Inferior and lateral
what two points does the vertical aspect of the iliolumbar ligament attach to?
the anterior and inferior border of L5 TP and descends vertically to the iliopectineal line
What are the medial and lateral attachments of the sacrospinous ligament? FD?
Medial attachment: lateral margin of the lower sacrum and coccyx
Lateral attachment: the spine of the ischium
FD: fibres run transversely laterally
what ligament does the sacrospinous ligament blend with?
the sacrotuberous ligament
list the proximal attachments for the sacrotuberous ligament
PSIS, PIIS, lower 1/2 of the dorsal surface of the sacrum, lower 1/2 of the lateral sacral crest, lateral margin of the coccyx and blends partially with the dorsal sacro-iliac ligaments
list the fibre direction and distal attachments for the sacrotuberous ligament
the fibres run down and laterally to attach distally to the medial margin of the ischial tuberosity
the posterior surface of the sacrotuberous ligament attaches to the lowest fibres of which muscle
lowest fibres of glute max
the lower part of the sacrotuberous ligament continues into what tendon?
lower part continues into biceps femoris tendon
what pierces the sacrotuberous ligament
inferior gluteal artery and perforating cutaneous nerve
What aspect of l5 – s1 tells you that it can handle lots of weight?
It’s width – remember structure dictates function
Why is the SI joint a weight transferal joint?
It’s a plane joint that relies on the forces of the muscles to hold it together – transfers the force to the coccyxfemoral joint where the thickest cartilage is, where the strongest ligaments and muscles are
If you have OA of the hip on only one side you need to consider…
the fact that it is likely disfunction that is causing the issue
What type of joint is the symphysis pubis weight bearing or weight transferal?
Why is the pelvis not a full bony structure
The joints allow movement, and important for pregnancy so the pelvic girdle can open
What two muscles support the symphysis pubis?
Aponeurosis of the external obliques
What creates force closure in the SI joints
What two movements must the SI joint allow for?
What is the bony configuration of the SI joint?
Essentially 2 blocks that fit together – the wedge shape of the sacrum helps to provide stability and it narrows inferiorly
What is one of the most common muscle imbalances you will see?
Glutes and Hamstrings
What will pain do to muscle in the area?
Turn them off – pain inhibition
How do you test the integrity of the SI joint?
Gapping Splaying Keep in mind when you are gapping and splaying the SI joint that it is so strong there realistically will be little to no movement – if there is there is a big problem
The orientation of the dorsal SI ligament is..
If there is tension on the sacrotuberous ligament it will place tension on the __ ligament
Dorsal SI ligament
How do you test the anterior SI ligament?
Is this test functional?
What is this test called, other than gapping or splaying?
Pushing out on the ASIS’s – again realistically should not move at all – so think is this test functional? No, its called a pain provocation test
How many bands does the iliolumbar ligament have?
5 running off of the TP of L4 and L5 – some authors say just L5
What are the directions of the 5 bands of the iliolumbar ligament?
What movement does the iliolumbar ligament prevent?
What is another function/purpose of the iliolumbar ligament
Side bending in L4 and L5
Stabilizes the vertebrae (L4-L5) on the innominate bone
If you have disfunction of L4-L5 what also may be in disfunction?
The innominate bone – clinical relevance: patient could present with a innominate bone disfunction but cause could be traces back to L4 or L5 stuck in a side bent position placing tension on the iliolumbar ligament and thus placing tension on the innominate
The iliolumbar ligament will also help prevent ___ from sliding anteriorly (Extremely significant)
What is the significance of the sacrospinous ligament with regard to foramen?
Converts the greater/lesser sciatic notch into foramen
What does the sacrotuberous blend with superiorly?
Posterior (dorsal) sacroiliac ligament, also goes into the posterior lamina of the thoracolumbar fascia – significant because it disperses the force (force attenuation) so the force is not focal on any one area
What does the sacrotuberous blend with inferiorly?
Ischial tuberosity – same attachment point as bicep femoris, so remember you are getting a transfer of forces all the way down the leg
What other muscles does the sacrotuberous ligament merge with?