Sacrotuberous ligament

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Sacrotuberous ligament
Greater sciatic foramen.png
Articulations of pelvis, anterior view, with greater sciatic foramen (labeled in red) and its boundaries.
Gray320.png
Articulations of pelvis. Posterior view.
Details
From sacrum
To tuberosity of the ischium
Identifiers
Latin ligamentum sacrotuberale
TA98 A03.6.03.005
TA2 1850
FMA 21479
Anatomical terminology

The sacrotuberous ligament (great or posterior sacrosciatic ligament) is situated at the lower and back part of the pelvis. It is flat, and triangular in form; narrower in the middle than at the ends.

Contents

Structure

It runs from the sacrum (the lower transverse sacral tubercles, the inferior margins sacrum and the upper coccyx [1] ) to the tuberosity of the ischium. It is a remnant of part of biceps femoris muscle. The sacrotuberous ligament is attached by its broad base to the posterior superior iliac spine, the posterior sacroiliac ligaments (with which it is partly blended), to the lower transverse sacral tubercles and the lateral margins of the lower sacrum and upper coccyx. Its oblique fibres descend laterally, converging to form a thick, narrow band that widens again below and is attached to the medial margin of the ischial tuberosity. It then spreads along the ischial ramus as the falciform process, whose concave edge blends with the fascial sheath of the internal pudendal vessels and pudendal nerve. The lowest fibres of gluteus maximus are attached to the posterior surface of the ligament; superficial fibres of the lower part of the ligament continue into the tendon of biceps femoris. The ligament is pierced by the coccygeal branches of the inferior gluteal artery, the perforating cutaneous nerve and filaments of the coccygeal plexus. [2]

Variation

The membranous falciform process of the sacrotuberous ligament was found to be absent in 13% of cadavers. When present it extends towards the ischioanal fossa travelling along the ischial ramus and fusing with the obturator fascia.

The lower border of the ligament was found to be directly continuous with the tendon of origin of the long head of the biceps femoris in approximately 50% of subjects. [3] biceps femoris could therefore act to stabilise the sacroiliac joint via the sacrotuberous ligament.

Function

The sacrotuberous ligament contains the coccygeal branch of the inferior gluteal artery.

Clinical significance

If the pudendal nerve becomes entrapped between this ligament and the sacrospinous ligament causing perineal pain, the sacrotuberous ligament is surgically severed to relieve the pain.

Additional images

Related Research Articles

<span class="mw-page-title-main">Coccyx</span> Bone of the pelvis

The coccyx, commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates since Nacholapithecus, the coccyx is the remnant of a vestigial tail. In animals with bony tails, it is known as tailhead or dock, in bird anatomy as tailfan. It comprises three to five separate or fused coccygeal vertebrae below the sacrum, attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between the sacrum and the coccyx.

<span class="mw-page-title-main">Sacrum</span> Triangular-shaped bone at the bottom of the spine

The sacrum, in human anatomy, is a large, triangular bone at the base of the spine that forms by the fusing of the sacral vertebrae (S1–S5) between ages 18 and 30.

<span class="mw-page-title-main">Gluteus maximus</span> Largest and most superficial of the three gluteal muscles

The gluteus maximus is the main extensor muscle of the hip in humans. It is the largest and outermost of the three gluteal muscles and makes up a large part of the shape and appearance of each side of the hips. It is the single largest muscle in the human body. Its thick fleshy mass, in a quadrilateral shape, forms the prominence of the buttocks. The other gluteal muscles are the medius and minimus, and sometimes informally these are collectively referred to as the glutes.

<span class="mw-page-title-main">Piriformis muscle</span> One of six small hip muscles in the lateral rotator group

The piriformis muscle is a flat, pyramidally-shaped muscle in the gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group.

The biceps femoris is a muscle of the thigh located to the posterior, or back. As its name implies, it consists of two heads; the long head is considered part of the hamstring muscle group, while the short head is sometimes excluded from this characterization, as it only causes knee flexion and is activated by a separate nerve.

<span class="mw-page-title-main">Adductor magnus muscle</span> Muscle in the thigh

The adductor magnus is a large triangular muscle, situated on the medial side of the thigh.

The semimembranosus muscle is the most medial of the three hamstring muscles in the thigh. It is so named because it has a flat tendon of origin. It lies posteromedially in the thigh, deep to the semitendinosus muscle. It extends the hip joint and flexes the knee joint.

<span class="mw-page-title-main">Posterior cutaneous nerve of thigh</span> Sensory nerve that supplies the back of the thigh, leg, buttock, and perineum

The posterior cutaneous nerve of the thigh is a sensory nerve of the thigh. It is a branch of the sacral plexus. It supplies the skin of the posterior surface of the thigh, leg, buttock, and also the perineum.

<span class="mw-page-title-main">Sacrospinous ligament</span>

The sacrospinous ligament is a thin, triangular ligament in the human pelvis. The base of the ligament is attached to the outer edge of the sacrum and coccyx, and the tip of the ligament attaches to the spine of the ischium, a bony protuberance on the human pelvis. Its fibres are intermingled with the sacrotuberous ligament.

<span class="mw-page-title-main">Fascia lata</span> Deep fascia of the thigh

The fascia lata is the deep fascia of the thigh. It encloses the thigh muscles and forms the outer limit of the fascial compartments of thigh, which are internally separated by the medial intermuscular septum and the lateral intermuscular septum. The fascia lata is thickened at its lateral side where it forms the iliotibial tract, a structure that runs to the tibia and serves as a site of muscle attachment.

<span class="mw-page-title-main">Inferior gluteal artery</span>

The inferior gluteal artery is a terminal branch of the anterior trunk of the internal iliac artery. It exits the pelvis through the greater sciatic foramen. It is distributed chiefly to the buttock and the back of the thigh.

<span class="mw-page-title-main">Inferior rectal artery</span>

The inferior rectal artery is an artery that supplies blood to the lower third of the anal canal below the pectinate line.

<span class="mw-page-title-main">Internal pudendal veins</span> Set of veins in the pelvis enclosed by pudendal canal

The internal pudendal veins are a set of veins in the pelvis. They are the venae comitantes of the internal pudendal artery. Internal pudendal veins are enclosed by pudendal canal, with internal pudendal artery and pudendal nerve.

<span class="mw-page-title-main">Lesser sciatic foramen</span> Opening between pelvis and thigh in human anatomy

The lesser sciatic foramen is an opening between the pelvis and the back of the thigh. The foramen is formed by the sacrotuberous ligament which runs between the sacrum and the ischial tuberosity and the sacrospinous ligament which runs between the sacrum and the ischial spine.

<span class="mw-page-title-main">Ischial tuberosity</span> Bones used to sit

The ischial tuberosity, also known colloquially as the sit bones or sitz bones, or as a pair the sitting bones, is a large posterior bony protruberance on the superior ramus of the ischium. It marks the lateral boundary of the pelvic outlet.

<span class="mw-page-title-main">Anal triangle</span> Posterior part of the perineum

The anal triangle is the posterior part of the perineum. It contains the anal canal.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

<span class="mw-page-title-main">Hip bone</span> Bone of the pelvis

The hip bone is a large flat bone, constricted in the center and expanded above and below. In some vertebrates it is composed of three parts: the ilium, ischium, and the pubis.

<span class="mw-page-title-main">Pelvis</span> Lower torso of the human body

The pelvis is the lower part of the trunk, between the abdomen and the thighs, together with its embedded skeleton.

<span class="mw-page-title-main">Gemelli muscles</span> Two small muscular fasciculi, accessories to the tendon of the internal obturator muscle

The gemelli muscles are the inferior gemellus muscle and the superior gemellus muscle, two small accessory fasciculi to the tendon of the internal obturator muscle. The gemelli muscles belong to the lateral rotator group of six muscles of the hip that rotate the femur in the hip joint.

References

PD-icon.svgThis article incorporates text in the public domain from page 309 of the 20th edition of Gray's Anatomy (1918)

  1. Marios Loukas, Robert G Louis Jr, Barry Hallner, Ankmalika A Gupta and Dorothy White. (2006) "Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome" Surg Radiol Anat 28(2): 163–169
  2. Gray's anatomy, 40 edition.
  3. Vleeming, A., R. Stoeckart, et al. (1989). "The sacrotuberous ligament: a conceptual approach to its dynamic role in stabilizing the sacroiliac joint." Clinical Biomechanics 4(4): 200–203.