Posterior Abdominal Wall/lumbosacral plexus/Pelvice Floor

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Omidancer1
ID:
134989
Filename:
Posterior Abdominal Wall/lumbosacral plexus/Pelvice Floor
Updated:
2012-02-27 02:14:13
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Posterior Abdominal Wall lumbosacral plexus Pelvice Floor
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Posterior Abdominal Wall/lumbosacral plexus/Pelvice Floor
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  1. Psoas Major
    • Superior Attachment: TPs of lumbar vertabrae; sides of bodies of T12-L5 vertebrae and intervening IV discs
    • Inferior Attachment: Lesser trochanter of femur via iliopsoas tendon
    • Innervation: anterior rami of L1, L2, L3
    • Main Actions: Acting inferiorly with the iliacus, it flexes the thigh; acting superiorly it flexes the vertebral column laterally and anteriorly tilts pelvis; it is used to balance the trunk; when sitting it acts inferiorly with iliacus to flex trunk
  2. Psoas Minor
    • Superior Attachment: Sides of T12-L1 vertebrae and IV discs
    • Inferior Attachment: Pectineal line, iliopectineal eminence via iliopectineal arch
    • Innervation: anterior rami of L1, L2
    • Main Actions: Flexes and stabilises hip joint; tilts pelvis posteriorly
  3. Iliacus
    • Superior Attachment: Superior two thirds of iliac fossa, ala of sacrum, and anterior sacroiliac ligaments
    • Interior Attachment: Lesser trochanter of femur and shaft inferior to it and to iliopsoas tendon
    • Innervation: Femoral nerve (L2-L3)
    • Main Actions: Flexes thigh and stabilises hip joint; acts with psoas major
  4. Quadratus Lumborum
    • Superior Attachment: Medial half of inferior border of 12th ribs and tips of lumbar TPs
    • Inferior Attachment: Iliolumbar ligament and internal lip of iliac crest
    • Innervation: Anterior branches of T12 and L1-L4
    • Main Actions: Extends and laterally flexes vertebral column; fixes 12th rib during inspiration
    • Reverse Action: "hip hiker" muscle: pulls hip up toward vertebral column

    Can be palpated posteriorly
  5. Levator Ani
    • Proximal Attachment: Body of pubis; tendinous arch of obturator fascia; ischial spine
    • Distal Attachment: Sacrum, perineal body, anococcygeal ligament, walls of prostate or vagina, rectum, anal canal, and a little of the coccyx
    • Innervation: Nerve to levator ani (branches of S4), inferior anal (rectal) nerve, and coccygeal plexus
    • Main Actions: Forms most of the pelvic diaphragm the helps support pelvic viscera and resists increases in intra-abdominal pressure; elevates anus; stops urine flow
  6. Piriformis
    • Proximal Attachment: Pelvic surface of S2-S4 secments; superior margin of greater sciatic notch and sacrotuberous ligament
    • Distal Attachment: Superior surface of greater trochanter
    • Innervation: anterior rami of S1 and S2
    • Main Actions: Rotates thigh laterally; ABducts thigh; assists in holding head of femur in acetabulum
  7. Coccygeus
    • Proximal Attachment: Ischial spine
    • Distal Attachment: Inferior end of sacrum and coccyx
    • Innervation: Branches of S4 and S5 spinal nerves
    • Main Actions: Forms small part of pelvic diaphragm that supports pelvic viscera; flexes coccyx; elevates anus; stops urine flow
  8. Obturator Internus
    • Proximal Attachment: Pelvic surfaces of ilium and ischium; obturator membrane
    • Distal Attachment: Medial apsect of greater trochanter
    • Innervation: Nerve to obturator internus (L5, S1, S2)
    • Main Actions: Rotates thigh laterally; ABducts flexed thigh; assists in holding head of femur in acetabulum
  9. Pelvic Inlet
    • Imaginary plane from front of sacrum around pelvic brim to pubic symphysis
    • more open on female
    • heart shaped on males
  10. Pelvic Outlet
    From coccyx around ischial tuberosities
  11. Iliolumbar Ligament
    • Passes from the TPs of L5 to the posterior part of the inner lip of the iliac crest
    • Strengthens lumbosacral joint
  12. Greater sciatic foramen
    • Bounded by greater sciatic notch, sacrospinous ligament, and sacrotuberous ligament
    • Sciatic n., piriformis, superior and inferior gluteal aa., vv. and nn. pass through it
  13. Lesser Sciatic Foramen
    • Bounded by ischial spine and lesser sciatic notch, and sacrotuberous ligament
    • Tendon of obturator internus passes through it
  14. Sacrospinous ligament
    • Goes from ischial spine to lower portion of sacrum and upper coccyx
    • Forms inferior boundary of greater sciatic foramen
  15. Lumbar Plexus
    • Muscles Innervated: Anterior, medial, and lateral thigh
    • Cutaneous Innervation: Lower abdomen; anterior, medial, and lateral thigh; medial lower leg
  16. Sacral Plexus
    • Muscles Innervated: Gluteal, posterior thigh, below knee
    • Cutaneous Innervation: Gluteal, posterior thigh, below knee (except medial lower leg)
  17. Subcostal n. (T12)
    • Not part of lumbar plexus
    • Comes from just below 12th rib
    • Innervates skin over ASIS
  18. Nerves of Lumbar Plexus
    • Iliohypogastric (L1)
    • Ilioinguinal (L1)
    • Genitofemoral (L1-L2)
    • Lateral Femoral Cutaneous (L2-L3)
    • Femoral (L2-L4)
    • Obturator (L2-L4)
    • Lumbosacral trunk (L4-L5)

    • Mnemonic: In Indiana Girls Like Fat Old Losers
    • L1, L1, L1-L2, L2-L3, L2-L4, L2-L4, L4-L5
  19. Iliohypogastric (L1)
    Innervates: Internal oblique, transverse abdominus, external oblique, rectus abdominus; Skin over hypogastric region and over iliac crests
  20. Ilioinguinal (L1)
    Innervates: Internal oblique, tranverse abdominus, external oblique, rectus abdominus; Skin of external genitalia
  21. Genitofemoral n. (L1-L2)
    Innervations: cremaster muscles (males); skin of superior medial thigh and external genitalia
  22. Lateral Femoral Cutaneous (L2-L3)
    • Innervates: skin on lateral thigh
    • pierces skin just medial to ASIS
  23. Femoral n. (L2-L4)
    • Innervates: muscles of anterior thigh: hip flexors (quadriceps), knee extensors (sartorious)
    • Anterior femoral cutaneous branch: innervates skin of anterior thigh
    • Saphenous branch: medial leg
  24. Obturator (L2-L4)
    Innervates: ADductors, skin of medial thigh
  25. Lumbosacral trunk (L4-L5)
    Comes off lumbar plexus and down to sacral plexus
  26. Superior gluteal a.
    • Branch of the internal iliac a.
    • Supplies: Gluteus maximus, gluteus minimus, gluteus medius, TFL
    • Exits through greater sciatic notch above piriformis
  27. Inferior gluteal a.
    • Branch of the internal iliac a.
    • Supplies: Gluteus maximus, obturator internus, quadratus femoris, superior hamstrings
    • Exits through greater sciatic notch below piriformis

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