Pelvic Muscles& Sacral

Plexus
For
Medical Students
Anat 212
Prof. EL Hassan
Heidar

Important
Notice
These slides are only to
illustrate the lecture and are
not substitute for the
recommended textbooks.

Piriformis Muscle

1- Origin:
Arises from the front of the middle 3 sacral pieces.
Its tendon leaves the pelvis through the greater
sciatic foramen to the gluteal region.
2- Insertion: into the top of the greater trochanter.
Nerve supply:
By branches from the sacral plexus (L5, S1, 2).
3- Action:
Lateral rotation and abduction of the thigh.
4- Relations in the pelvis:
Anteriorly: rectum, sacral plexus, branches of the
internal iliac vessels.
Posteriorly: sacrum.

Piriformis Muscle

Obturator Internus Muscle

Origin: from:
Inner surface of the ilium just below the arcuate
line and obturator membrane.
Insertion:
The tendon comes out from the pelvic cavity
through the lesser sciatic foramen to be inserted
into the medial surface of the greater trochanter.
The tendon takes the insertion of the two gemelli.
Nerve supply: arises from sacral plexus (L5, S1,2).
Action:
Lateral rotator to the thigh and assist in the
abduction of the thigh.

Obturator Internus Muscle

1- Levator ani Muscle

Origin: from the back of body of pubis.

1- From the inner surface of ischial spine.

2- From the tendinous arch of the obturator fascia.
Insertion:
Inserted with those of the opposite side into the
perineal body.
The most posterior fibers:
Inserted into the side of coccyx and ano-coccygeal
body.
The intermediate fibers:
Fuse with those of the opposite side just behind the
recto-anal junction to form pubo-rectalis muscle.
Morphologically the muscle is divided into two parts
according to the origin into:
Pubococcygeus and iliococcygeus

Levator Ani Muscle

2- Levator Ani Muscle

Nerve supply:
Pelvic (upper) surface: from the 4th sacral nerve.
Perineal (lower) surface: from the inferior rectal branch of the
pudendal nerve.
Action:
Both muscles: act together to increase the intra-abdominal
pressure by raising the pelvic floor.
The pubo-rectalis part: acts as a sphincter to constrict the
rectum and reinforces the anal sphincter.
Relations:
- Pelvic (upper) surface:
In the male related to: urinary bladder, prostate, seminal vesicle
and rectum.
In the female related to: urinary bladder, vagina, broad ligament
and rectum.
- Perineal (lower) surface:
Forms the medial wall of the ischio-rectal fossa.

Levator Ani muscle

Coccygeus Muscle
Origin: from the tip of the
ischial spine.
Insertion: into the side of
the last piece of sacrum
and first piece of coccyx.
Nerve supply: from
the 4th and 5th sacral nerve.
It unite with its follow to
form with the levator ani
the pelvic floor, which
sometimes called pelvic diaphragm.

Pelvic Diaphragm

It forms a partition between the pelvis and perineum.

The pelvic diaphragm is formed by levator ani and
coccygeus of both sides at the floor of the pelvis and
pierced by, urethra, rectum in the male and added vagina
in the female.
The pelvic floor is covered by a layer of fascia called
parietal layer of the pelvic fascia
The pelvic fascia which cover the pelvic organs is called
visceral layer or endopelvic fascia, its loose on the
expansile organs and dense on the organ which does not
expand as prostate.
N.B.: The fascia which covers the viscera is loose to
allow for distension, of the organs, while the fascia
which covers the muscles is tough.

Pelvic Diaphragm

Nerves of the Pelvis

The nerves include the following:

sacral plexus and coccygeal plexus.
The obturator nerve.
Pelvic parts of the sympathetic trunks and,
parasympathetic nerve supplies the pelvic viscera.
1- Coccygeal Plexus:
It's formed by the lower part of the 4th sacral with 5th
sacral and coccygeal nerve.
It gives branches to the levator ani and coccygeus.
2- Pelvic part of the sympathetic trunks
The sympathetic trunk in the pelvis is directed as
continuation of the sympathetic trunks of the abdomen.
Each trunk: enter the pelvis then descends medial to
anterior sacral foramina and carries 4 sympathetic
ganglia.
Both trunks (right and left) ends in one ganglion called
ganglion impar lies in front of the coccyx.

Nerves Of The Pelvis

Sacral Plexus
It lies on the pelvic surface of the sacro-iliac joint and
piriformis, it's found between the muscles and its fascia.
It is formed by the anterior primary rami of L4, 5 and
S1,2,3,4.
The lower part of the 4th and 5th lumbar form the lumbosacral trunk which descends on; the medial side of the
psoas major, on the ala of the sacrum and on the
sacro-iliac joint to share in the formation of the sacral
plexus.
Relations of the Sacral Plexus to the Blood Vessels:
The superior gluteal vessels: pass between the lumbosacral trunk and first sacral nerve.
The inferior gluteal vessels: pass between the 1st and 2nd
sacral nerves.
The internal pudendal vessels: lies in front of the sacral
nerves.

Sacral Plexus

Relation Of Blood Vessels to The

Sacral Plexus

Branches Of Sacral Plexus

Branches:
A- From the roots to:
Piriformis (L5, S 1,2).
Levator ani (pelvic surface S4).
Coccygeus (S4,5).
B- From the plexus:
1-Superior gluteal nerve. (L4,5 ,S1)
2- Nerve to quadratus femoris.
3- Inferior gluteal nerve (L5, S1, 2)
4- Nerve to obturator internus.
5- Posterior cutaneous nerve of the thigh (S1,2,3).
Perineal branch of the 4th sacral nerve.
C- Two terminal branches of the plexus:
1- Sciatic nerve (L4,5 and S1,2,3): The largest one.
2- Pudendal nerve (S2,3,4): The smallest one.

Branches Of The Sacral Plexus

Thank
you