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Background: Injuries of the proximal attachment of the hamstring muscles are common. The present study aimed to investigate the relationship of the proximal attachment of the hamstring muscles with neighboring structures comprehensively. Methods: A total of 97 hemipelvis from 66 cryopreserved specimens were evaluated via ultrasound, anatomical and histological samples. Results: The proximal attachment of the hamstring muscles presents a hyperechogenic line surrounding the origin of the semimembranosus and the long head of the biceps femoris muscles, as well as another hyperechogenic line covering the sciatic nerve. The anatomical and histological study confirms the ultrasound results and shows different layers forming the sacrotuberous ligament. Furthermore, it shows that the proximal attachment of the semimembranosus muscle has a more proximal origin than the rest of the hamstring muscles. Moreover, this muscle shares fibers with the long head of the biceps femoris muscle and expands to the adductor magnus muscle. The histological analysis also shows the dense connective tissue of the retinaculum covering the long head of the biceps femoris and semimembranosus muscles, as well as the expansion covering the sciatic nerve. Conclusions: These anatomical relationships could explain injuries at the origin of the hamstring muscles. [ABSTRACT FROM AUTHOR]

Ossification of the sacrotuberous ligament is a rare occurrence in soft tissue, with only 15 cases reported in the past few decades. We reported two cases of bilateral ossification in sacrotuberous ligaments and provided a concise review of the literature on this pathology. Clinical data, radiographic outcomes, and diagnostic and treatment details were obtained. This study aimed to summarize this disease's characteristics and investigate its pathogenesis through a review of literature from the last thirty years. This condition is often incidentally confirmed in elderly males via imagiological examination or gross anatomy and presents a low morbidity rate. Its pathogenesis may be related to stress concentration, excessive intake of element ions, injury repair, and improper operative technique. The majority of patients may not exhibit any clinical symptoms or signs and typically do not require medical interventions. It may be complicated with pudendal nerve entrapment syndrome. The long‐term effects of surgical resection and the most effective treatment approach remain areas for further research.

Ossification of the sacrotuberous ligament is a rare occurrence in soft tissue, with only 15 cases reported in the past few decades. We reported two cases of bilateral ossification in sacrotuberous ligaments and provided a concise review of the literature on this pathology. Clinical data, radiographic outcomes, and diagnostic and treatment details were obtained. This study aimed to summarize this disease's characteristics and investigate its pathogenesis through a review of literature from the last thirty years. This condition is often incidentally confirmed in elderly males via imagiological examination or gross anatomy and presents a low morbidity rate. Its pathogenesis may be related to stress concentration, excessive intake of element ions, injury repair, and improper operative technique. The majority of patients may not exhibit any clinical symptoms or signs and typically do not require medical interventions. It may be complicated with pudendal nerve entrapment syndrome. The long‐term effects of surgical resection and the most effective treatment approach remain areas for further research. [ABSTRACT FROM AUTHOR]

Deep gluteal syndrome is a clinical condition in which discomfort may arise due to the pathoanatomy of the subgluteal space. We conducted an anatomical exploration to categorize the relationship of the piriformis muscle, sciatic nerve (SN), and pudendal nerve (PN) to the ischial spine (IS) and sacrospinous ligament. We analyzed 22 cadavers. The piriformis muscle, SN, and PN were exposed through either a transgluteal approach or a gluteal flap. The relationship of the neural structures to the IS, sacrospinous ligament, and ischial bone as they exit the greater sciatic foramen was observed, and the exit zones were classified as zone A, medial to the IS (entirely on sacrospinous ligament); zone B, on the IS; and zone C, lateral to the IS (entirely on ischial bone). The SN was observed either in zone B or zone C in all specimens. The PN was found to be in either zone A or zone B in 97.6% of specimens. The most common combinations were SN in zone B and PN in zone A (type I), and SN in zone C and PN in zone B (type II). The results from this study show clear anatomical differences in the SN-PN relationship, which may play a role in pain seen in deep gluteal syndrome. Moreover, classification of the SN-IS and PN-IS relationships described in this article will help describe different pathologies affecting the deep gluteal area. [ABSTRACT FROM AUTHOR]

Objective: The efficacy of sciatic nerve decompression via transgluteal approach for entrapment of the sciatic nerve at the greater sciatic notch, called piriformis syndrome, and factors affecting the surgical outcome were analyzed. Methods: The outcome of pain reduction was analyzed in 81 patients with sciatic nerve entrapment who underwent decompression through a transgluteal approach. The patients were followed up for at least 6 months. The degree of pain reduction was analyzed using a numerical rating scale-11 (NRS-11) score and percent pain relief before and after last follow-up following surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. In addition, demographic characteristics, anatomical variations, and variations in surgical technique involving sacrotuberous ligamentectomy were analyzed as factors that affect the surgical outcome. Results: At a follow-up of 17.5±12.5 months, sciatic nerve decompression was successful in 50 of 81 patients (61.7%), and the pain relief rate was 43.9±34.17. Subjective improvement based on a 10-point Likert scale was 4.90±3.43. Among the factors that affect the surgical outcome, only additional division of the sacrotuberous ligament during piriformis muscle resection played a significant role. The success rate was higher in the scarotuberous ligementectomy group (79.4%) than in the non-resection group (42.6%), resulting in statistically significant difference based on average NRS-11 score, percent pain relief, and subjective improvement (p<0.05, independent t-test). Conclusion: Sciatic nerve decompression is effective in pain relief in chronic sciatica due to sciatic nerve entrapment at the greater sciatic notch. Its effect was further enhanced by circumferential dissection of the sciatic nerve based on the compartment formed by the piriformis muscle and the sacrotuberous ligament in the greater sciatic notch. [ABSTRACT FROM AUTHOR]

Key Clinical Message: To underscore the importance of evaluating the entrapment of the posterior femoral cutaneous nerve (PFCN) in patients exhibiting symptoms in the posterior thigh region. A 42‐year‐old male dentist, initially diagnosed with a semitendinosus muscle tear and persistent pain and tingling in the posterior thigh, sought treatment at our outpatient clinic. Despite unsuccessful physiotherapy, a comprehensive evaluation revealed an unusual entrapment of the PFCN between the sacrotuberous ligament and the semitendinosus muscle stump. The patient was subjected to a series of specialized therapeutic interventions, including soft tissue release, kinesiology taping, and lifestyle modifications. The patient's symptoms, including pain and tingling, were completely resolved, enabling him to sit on a stool for extended periods without discomfort. This case presentation emphasizes the need for physical therapists to consider the possibility of PFCN entrapment in patients experiencing pain and tingling in the posterior thigh. These symptoms can be easily mistaken for conditions such as sciatica or a hamstring muscle tear. [ABSTRACT FROM AUTHOR]

Purpose: The pudendal nerve is an anatomical structure arising from the ventral branches of the spinal roots S2–S4. Its complex course may be affected by surrounding structures. This may result in irritation or entrapment of the nerve with subsequent clinical symptoms. Aim of this study is to review the anatomy of the pudendal nerve and to provide detailed photographic documentation of the areas with most frequent clinical impact which are essential for surgical approach. Methods: Major medical databases were searched to identify all anatomical studies investigating pudendal nerve and its variability, and possible clinical outcome of these variants. Extracted data consisted of morphometric parameters, arrangement of the pudendal nerve at the level of roots, formation of pudendal nerve, position according to sacrospinal and sacrotuberal ligaments and its terminal branches. One female cadaver hemipelvis was dissected with common variability of separate course of inferior rectal nerve. During dissection photodocumentation was made to record course of pudendal nerve with focus on areas with recorded pathologies and areas exposed to iatrogenic damage during surgical procedures. Results: Narrative review was done to provide background for photodocumentation. Unique photos of course of the pudendal nerve was made in areas with great clinical significance. Conclusion: Knowledge of anatomical variations and course of the pudendal nerve is important for examinations and surgical interventions. Surgically exposed areas may become a site for iatrogenic damage of pudendal nerve; therefore, unique picture was made to clarify topographic relations. [ABSTRACT FROM AUTHOR]

Background: Injuries of the proximal attachment of the hamstring muscles are common. The present study aimed to investigate the relationship of the proximal attachment of the hamstring muscles with neighboring structures comprehensively. Methods: A total of 97 hemipelvis from 66 cryopreserved specimens were evaluated via ultrasound, anatomical and histological samples. Results: The proximal attachment of the hamstring muscles presents a hyperechogenic line surrounding the origin of the semimembranosus and the long head of the biceps femoris muscles, as well as another hyperechogenic line covering the sciatic nerve. The anatomical and histological study confirms the ultrasound results and shows different layers forming the sacrotuberous ligament. Furthermore, it shows that the proximal attachment of the semimembranosus muscle has a more proximal origin than the rest of the hamstring muscles. Moreover, this muscle shares fibers with the long head of the biceps femoris muscle and expands to the adductor magnus muscle. The histological analysis also shows the dense connective tissue of the retinaculum covering the long head of the biceps femoris and semimembranosus muscles, as well as the expansion covering the sciatic nerve. Conclusions: These anatomical relationships could explain injuries at the origin of the hamstring muscles.

Key Clinical Message To underscore the importance of evaluating the entrapment of the posterior femoral cutaneous nerve (PFCN) in patients exhibiting symptoms in the posterior thigh region. A 42‐year‐old male dentist, initially diagnosed with a semitendinosus muscle tear and persistent pain and tingling in the posterior thigh, sought treatment at our outpatient clinic. Despite unsuccessful physiotherapy, a comprehensive evaluation revealed an unusual entrapment of the PFCN between the sacrotuberous ligament and the semitendinosus muscle stump. The patient was subjected to a series of specialized therapeutic interventions, including soft tissue release, kinesiology taping, and lifestyle modifications. The patient's symptoms, including pain and tingling, were completely resolved, enabling him to sit on a stool for extended periods without discomfort. This case presentation emphasizes the need for physical therapists to consider the possibility of PFCN entrapment in patients experiencing pain and tingling in the posterior thigh. These symptoms can be easily mistaken for conditions such as sciatica or a hamstring muscle tear.

This study aimed to elucidate the origin, course, and distribution of the branches of the posterior femoral cutaneous nerve, considering the segmental and dorsoventral compositions of the sacral plexus, including the pudendal nerve. The buttocks and thighs of five cadavers were analyzed bilaterally. The branches emerged from the sacral plexus, which was divided dorsally to ventrally into the superior gluteal, inferior gluteal, common peroneal, tibial, and pudendal nerves. It descended lateral to the ischial tuberosity and comprised the thigh, gluteal, and perineal branches. As for the thigh and gluteal branches, the dorsoventral order of those originating from the sacral plexus corresponded to the lateromedial order of their distribution. However, the dorsoventral boundary was displaced at the inferior margin of the gluteus maximus between the thigh and gluteal branches. The perineal branch originated from the ventral branch of the nerve roots. In addition, the pudendal nerve branches, which ran medially to the ischial tuberosity, were distributed in the medial part of the inferior gluteal region. These branches should be distinguished from the gluteal branches; the former should be classified as the medial inferior cluneal nerves and the latter as the lateral ones. Finally, the medial part of the inferior gluteal region was distributed by branches of the dorsal sacral rami, which may correspond to the medial cluneal nerves. Thus, the composition of the posterior femoral cutaneous nerve is considered necessary when considering the dorsoventral relationships of the sacral plexus and boundaries of the dorsal and ventral rami. [ABSTRACT FROM AUTHOR]

Introduction: Most sacroiliac joint (SIJ) disorders are conservatively treated; however, patients with severe pain occasionally require SIJ arthrodesis after failure of continuous conservative management for more than 6 months. We investigated the incidences of preoperative tenderness in the sacrotuberous ligament (STL) and postoperative lower-buttock pain originating from the STL to determine the best way to manage these symptoms to achieve good outcomes. Methods: We retrospectively investigated 33 patients (14 men and 19 women) with a mean age of 47.7 years (range: 25-79 years) who underwent SIJ arthrodesis for severe pain confirmed using diagnostic SIJ injections between April 2009 and December 2019. We investigated the pain improvement at or around the posterior superior iliac spine (PSIS) pre- and postoperatively using the visual analogue scale (VAS) values, incidence of tenderness of the STL before surgery, rate of the persisting STL tenderness, incidence of new-onset STL pain, and treatment options for STL pain postoperatively. Results: The mean VAS value at or around the PSIS was significantly relieved postoperatively from 85.6 to 31.5 mm (P

Background: The perforating cutaneous nerve/perforating nerve of the sacrotuberous ligament is rarely observed. It usually arises from the posterior division of the sacral plexus or the pudendal nerve and perforates the sacrotuberous ligament. The anatomy of this nerve and its variants is poorly described in the literature, but there are data indicating its role in pudendal neuralgia. Materials and methods: Herein, we present an anatomical study of six formal-in-fixed cadavers with descriptions of the topography of spinal nerves S2-S4, the pudendal bundle, the perforating cutaneous nerve and the sacrotuberous ligament. Results: We found three perforating cutaneous nerves and described each of them in detail, with measurements of length and width, and point of perforation of the sacrotuberous ligament. Conclusions: We distinguished three types of perforating cutaneous nerve on the basis of our findings and previous publications; two of the three types were observed in our study. [ABSTRACT FROM AUTHOR]

Introduction: Up to 84% of people experience low back pain during their lifetime. It is therefore a major social problem and a challenge for physiotherapy. Disruption of muscle tone in the hip and lower spine is one of the primary causes of pain and degenerative changes. Results: One of the key structures in this area, besides the sacrotuberous ligament, is the piriformis muscle, along with the nerves and arteries that run in its area. Which, in turn, may be the cause of abnormalities in the tension and function of other anatomical structures, such as the iliopsoas muscle, the sciatic and obturator nerves or the femoral artery. Conclusion: An in-depth anatomical analysis of the structural relationships between the muscles, vessels and nerves in this area will allow us to better understand the causes of these complaints and develop more effective physiotherapy. [ABSTRACT FROM AUTHOR]

Objective: The efficacy of sciatic nerve decompression via transgluteal approach for entrapment of the sciatic nerve at the greater sciatic notch, called piriformis syndrome, and factors affecting the surgical outcome were analyzed., Methods: The outcome of pain reduction was analyzed in 81 patients with sciatic nerve entrapment who underwent decompression through a transgluteal approach. The patients were followed up for at least 6 months. The degree of pain reduction was analyzed using a numerical rating scale-11 (NRS-11) score and percent pain relief before and after last follow-up following surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. In addition, demographic characteristics, anatomical variations, and variations in surgical technique involving sacrotuberous ligamentectomy were analyzed as factors that affect the surgical outcome., Results: At a follow-up of 17.5±12.5 months, sciatic nerve decompression was successful in 50 of 81 patients (61.7%), and the pain relief rate was 43.9±34.17. Subjective improvement based on a 10-point Likert scale was 4.90±3.43. Among the factors that affect the surgical outcome, only additional division of the sacrotuberous ligament during piriformis muscle resection played a significant role. The success rate was higher in the scarotuberous ligementectomy group (79.4%) than in the non-resection group (42.6%), resulting in statistically significant difference based on average NRS-11 score, percent pain relief, and subjective improvement (p<0.05, independent t-test)., Conclusion: Sciatic nerve decompression is effective in pain relief in chronic sciatica due to sciatic nerve entrapment at the greater sciatic notch. Its effect was further enhanced by circumferential dissection of the sciatic nerve based on the compartment formed by the piriformis muscle and the sacrotuberous ligament in the greater sciatic notch.

Tumors of the greater sciatic foramen remain difficult to treat. They often have both intrapelvic and extrapelvic components that may limit visualization and make safe resection of the tumor difficult. Therefore the goal of the present anatomic study was to quantitate how much additional surgical working space could be gained by transection of the sacrospinous and sacrotuberous ligaments. Sixteen sides from 9 fresh-frozen Caucasian cadaveric torsos underwent transgluteal dissection and exposure of the greater sciatic foramen and associated liagments. With the piriformis in place, the vertical and horizontal diameters of the greater sciatic foramen were measured. Next, the sacrotuberous and sacrospinous ligaments were cut at their ischial attachments. The vertical diameter of the now confluent greater and lesser sciatic foramina (V 2) was measured. The mean vertical diameter of the greater sciatic foramen (V 1) was 54.8 ± 9.7 mm. The horizontal diameter of the greater sciatic foramen had a mean of 44.3 ± 6.1 mm with a range of 30–52 mm. After transection of the sacrotuberous and sacrospinous ligaments, the vertical distance of the greater and lesser sciatic foramina (V 2) had a mean of 74.8 ± 6.8 mm with a range of 60.1–90 mm. The mean ratio of V 2 to V 1 was 1.40. The vertical length of the greater sciatic foramen increased, on average, 40% after resection of the sacrotuberous and sacrospinous ligaments. The results of this study support an alternative technique for resecting large intrapelvic tumors via a transgluteal approach. [ABSTRACT FROM AUTHOR]

CASE REPORT A 9-year-old female Maltese crossbred dog was evaluated for a 6-week history of intermittent neurogenic pain of the left hindlimb. Six years prior to presentation, the dog had sustained left iliac and ischial fractures and a right femoral fracture following a motor vehicle accident. These fractures had been surgically stabilised at a previous referral facility using plates and screws applied to the left ilium and right femur. In working up the left hindlimb lameness and pain, magnetic resonance imaging (MRI) revealed a significantly enlarged sciatic nerve segment caudal to the left coxofemoral joint cranial to the malunited left ischium. Surgical exploration revealed an enlarged sciatic nerve segment that was trapped in a constricted area caudal to the trochanter and bound caudolaterally by the displaced ischiatic tuberosity. Proximal sacrotuberous ligament transection and subsequent transposition onto the greater trochanter of the femur was performed to create a fascial sling deep to the sciatic bundle to prevent the lateralised nerve slipping back into the space between the femur and ischium. Follow-up assessments revealed a progressive decrease in the size of the swollen segment of the sciatic nerve. The dog showed significant improvement postoperatively and regained normal comfort levels and limb function. CONCLUSION Sacrotuberous ligament transposition was a simple and effective way to suspend an entrapped sciatic nerve as a late complication of unreduced ischial fractures. [ABSTRACT FROM AUTHOR]

Knowledge of the vascular supply associated with the sacrotuberous ligament is incomplete, and at most attributed to a single coccygeal branch. Our aim was to investigate the sacrotuberous ligament vasculature with a focus on its origin and distribution. We dissected 21 hemipelvises (10 male and 11 female). The gluteus maximus was reflected medially, and a special emphasis was placed on the dissection of the vascular and neuronal structures. All specimens exhibited several (1-4) coccygeal arteries branching from the inferior gluteal artery penetrating the sacrotuberous ligament along its length. Seven specimens demonstrated the superior gluteal artery supplying sacral branches to the proximal superior border of the sacrotuberous ligament. Our study highlights several branches from a variety of origins as the supply to sacrotuberous ligament unlike previous reports stating only one vessel. Our results implicate surgical procedures in and around the area of the gluteal region such as decompressive procedures of the pudendal nerve, as it travels between the sacrotuberous and sacrospinous ligaments. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the intrinsic preload of the sacrotuberous ligament. Preload measurements and anatomical experiments were performed on 20 specimens from 10 human cadavers and assessed to consider the thesis of the ligamentous tension band system as a possible load distribution. The result was an unexpectedly high preload force with an overall average of 118 N ± 74 N. Age has been significantly different between females and males in the cohort (median 94 vs. 77 years). Nevertheless, there is preliminary evidence of the sex-dependent sacrotuberous ligament preload force with an average value of approximately 65 N for the 10 female cadaver specimens and 172 N for the 10 male cadaver specimens. The assessment of further influencing factors and their statistical evaluation also showed a dependence of the sacrotuberous ligament preload force on body height, age and elastin content. Thus, the sacrotuberous ligament is more preloaded in the cadaver than previously assumed in the literature. Therefore, and contrary to most assumptions, it could possibly also be more preloaded in a living person in an upright position under a muscular load. This leads to the hypothesis that pelvic stability is more dependent on ligamentous preload than previously thought. These considerations should be taken more into account in numerical simulations of sacroiliac joint function. [Display omitted] • The sacrotuberous ligament is significantly preloaded. • The preload of the sacrotuberous ligament is sex-dependent. • Height, age, and elastin content have a significant influence on the sacrotuberous ligament preload. [ABSTRACT FROM AUTHOR]

Introduction: In this study we aimed to determine whether high-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches. We also attempted to identify the best approach for visualizing these structures. Methods: Normal anatomy of the pudendal nerve was evaluated in 3 cadavers and 20 healthy volunteers proximally at the level of the ischial spine and distally with low-frequency (2-5-MH Z) and high-frequency (12-7-MH Z and 17-5-MH Z) transducers. Two musculoskeletal radiologists performed the examinations and evaluations. Volunteers were placed in 3 different positions, which allowed different approaches (posterior, medial, and anterior transperineal). A 0-3 scale was used to assess nerve visibility. Results: Visualization of the pudendal nerve at the ischial spine was best when using a medial approach ( P < 0.004); the terminal branches were seen best with the anterior approach ( P < 0.002). Conclusion: High-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches. Muscle Nerve 47:403-408, 2013 [ABSTRACT FROM AUTHOR]

Background An objective of our work was to clarify variations in pudendal nerve formation, as well as their possible impact on the clinical picture. Method Bilateral pudendal nerve course and formation was studied on 20 adult cadavers. An anterior approach was used in 15 subjects, and both posterior and anterior approaches were used in five subjects. Results The prefixed type plexus formation was observed in eight cases (40%). In these cases, S1 and S2 roots contributed to the formation of the pudendal nerve. In the postfixed type, the S3 root was dominant in two cases (66.7%), and less the S4 root in one case (23.3%), albeit to a lesser degree. Most commonly, the S2 root participated in its formation in 17 cases (85%). The inferior rectal nerve penetrating the sacrospinous ligament was seen in one case, arising from the pudendal nerve before entering the pudendal canal in four cases. The dorsal nerve of the penis arose from the S1 root in two cases (10%). We observed it branching before entering the pudendal canal in 15 cases (75%), and it had divided in the pudendal canal in the other cases. For the posterior access, the pudendal nerve was localized 13.1 ± 0.72 cm medial to the greater trochanter, 8.1 ± 0.72 cm above the ischial tuberosity, at a depth of 6.4 ± 0.32 cm. Conclusions This description may be useful when carrying out a pudendal nerve block and during surgical procedures carried out in this anatomical region. [ABSTRACT FROM AUTHOR]

Summary: Little is known about the morphometric properties of the sacrotuberous ligament (ST) and the sacrospinous ligament (SS). The influence of ligaments on pelvic stability and the extent of reconstruction in case of instability are controversially discussed. The ST and the SS of 55 human subjects fixed in alcohol solution and of four fresh cadavers were measured. Both ligaments were defined as geometric figures. The ST was a contorted bifrustum, while the SS was a contorted frustum, both with elliptic planes. In all cases investigated, the ST and the SS fibres were twisted. For men, the ST and the SS had a mean length of 64 and 38mm. For women, lengths of 70 and 46mm were measured in the ST and the SS. The ST length, height and cross-sectional area showed gender-specific differences at statistically significant level. The ST and the SS volumes correlated closely, regardless of gender or side. Measurements of fresh ligaments of four unfixed cadavers showed similar results. The data obtained were then used to generate computer-based three-dimensional models of both ligaments, using the Catia® software. Conclusively, the virtually generated ST and SS are suitable models to be included in pelvic fracture simulation, using the finite element method. [Copyright &y& Elsevier]

Pudendal canal syndrome (PCS) is induced by the compression or the stretching of the pudendal nerve within Alcock’s canal. Considering the difficulty and possible complications involved in exposing the pudendal canal and nerve by either transperineal, transgluteal or transischiorectal approaches, an intra-abdominal laparoscopic pudendal canal decompression (ILPCD) was employed. For this technique, 30 male adult human cadavers were examined. Measurements revealed an adequate working space in 16 (80%) of the 20 cadavers, while in four specimens the ischiococcygeus muscle was too large to be mobilized sufficiently. The mean working space was 24 mm with a range of 18 to 31 mm. It was considered that a working space of less than 20 mm would not be sufficient for manipulation of the instruments. With regards to pudendal nerve compression, it was observed that 7 (35%) of the 20 cadavers exhibited anatomic signs of PCS. In five (25%) specimens, the compression was observed between the sacrospinous and sacrotuberous ligaments, while the other two (10%) exhibited a broader compression, by the falciform portion of the sacrotuberous ligament. Under the guidance of a laparoscope, the peritoneum was cut laterally to the bladder, and fascia pelvis was identified. The latter was split and the internal iliac vein was traced to the opening of the pudendal canal allowing clear visualization of its contents. Subsequently, either the sacrospinous or sacrotuberous ligament was cut. Considering that none of the surgical procedures currently used are known to completely improve all the symptoms of PCS, ILPCD could theoretically reduce stretching of the pudendal nerve. [ABSTRACT FROM AUTHOR]

In view of the paucity of literature, this study was undertaken to reappraise the gross anatomy of the sacrotuberous ligament (STL), with the objective of providing an accurate anatomical basis for clinical conditions involving the STL. We studied the gross anatomy of the STL in 50 formalin fixed cadavers (100 sides) during the period of 2004–2005. All specimens exhibited an STL with a ligamentous part and (87%) of specimens exhibited a membranous (falciform) segment, which extended towards the ischioanal fossa. The variations of the falciform extensions were classified into three types. In Type I (69%), the falciform process extended towards and along the ischial ramus to terminate at the obturator fascia. In Type II (108%), the falciform process extended along the ischial ramus, fused with the obturator fascia and continued towards the ischioanal fossa. In addition, the medial border of the falciform process descended to fuse with the anococcygeal ligament, forming a continuous membrane. Lastly, in Type III (13%), the falciform process of the STL was absent. The above mentioned data could have an important implication to the understanding of the relationship between the pudendal nerve and the sacrotuberous ligament and their relevance to pudendal nerve entrapment syndrome. [ABSTRACT FROM AUTHOR]

It has been reported that via its attachment to the sacrotuberous ligament, the long head of the biceps femoris muscle is capable of influencing the motion or stability of the sacroiliac joint. However explanations of this mechanism focus primarily on these two structures and do not address the potential influence of surrounding tissues. A review of the anatomical literature was therefore undertaken to determine what muscles and ligaments are commonly associated with the sacrotuberous ligament. The morphology of this ligament in situ is presented and discussed so that readers may appreciate the clinical anatomy of this structure. [ABSTRACT FROM AUTHOR]

Introduction: Most sacroiliac joint (SIJ) disorders are conservatively treated; however, patients with severe pain occasionally require SIJ arthrodesis after failure of continuous conservative management for more than 6 months. We investigated the incidences of preoperative tenderness in the sacrotuberous ligament (STL) and postoperative lower-buttock pain originating from the STL to determine the best way to manage these symptoms to achieve good outcomes., Methods: We retrospectively investigated 33 patients (14 men and 19 women) with a mean age of 47.7 years (range: 25-79 years) who underwent SIJ arthrodesis for severe pain confirmed using diagnostic SIJ injections between April 2009 and December 2019. We investigated the pain improvement at or around the posterior superior iliac spine (PSIS) pre- and postoperatively using the visual analogue scale (VAS) values, incidence of tenderness of the STL before surgery, rate of the persisting STL tenderness, incidence of new-onset STL pain, and treatment options for STL pain postoperatively., Results: The mean VAS value at or around the PSIS was significantly relieved postoperatively from 85.6 to 31.5 mm ( P <0.001). Preoperative tenderness of the STL was identified in 21 of 33 patients (63.6%). The STL tenderness resolved after surgery in 12 of these 21 patients (57.1%); however, it persisted in nine patients (42.9%), all of whom were women. Of the 12 patients who did not have preoperative STL tenderness, 4 (33.3%) developed lower-buttock pain and had STL tenderness. In total, 9 (27.3%) of the 33 patients whose progress could be followed up after SIJ arthrodesis had pain originating from the STL; the STL pain in 8 of the 9 patients was relieved after the STL injections and physical therapy., Conclusions: The STL pain can occur pre- and postoperatively, and management of both persisting and new-onset STL pain after SIJ arthrodesis should be considered to achieve better outcomes., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest., (Copyright © 2022 The Japanese Society for Spine Surgery and Related Research.)

Summary We report bilateral muscular and neurovascular anomalies of the gluteal region in a cadaver. On the right side, the gluteus maximus muscle had two parts, one of which was fibrous and the other muscular. In addition, there were duplicated piriformis muscles and high division of the sciatic nerve. The common peroneal nerve passed between the two parts of the piriformis muscle, and the tibial nerve emerged from under the lower piriformis muscle (infrapiriform foramen). At the same time the internal pudendal vessels and pudendal nerve passed over the sacrotuberous ligament on the left side. The double piriformis muscles and high division of the nerve are known as an anomaly which is believed to cause a nerve compression syndrome called the syndrome of the piriformis muscle. To the best of our knowledge anomalies of the gluteus maximus muscle and pudendal structures have not yet been reported. This complex anomaly should be kept in mind in connection with intramuscular injections of the gluteal region, the piriformis syndrome, and the surgery of this region. [ABSTRACT FROM AUTHOR]

In a collection of 101 anatomical preparations of the human pelvis, ossification of the sacrotuberous ligament was found in 8 cases. In 7 of these, the ossification showed a characteristic intraligamentous morphology, with a broad-based origin at the ischial tuberosity and tapering off craniomedially. The length varied between 1.1 and 7.2 cm. The surface of the bone formations appeared fasciculated, except in one case which had a wax-like flowing bone formation lying upon the sacrotuberous ligament. Careful anatomical and radiological examination of the spine, the ulnae, the calcanei and the iliac crests in these 8 cases, revealed in only one case any findings (spurs at the olecranon) that could be attributed to extraspinal manifestations of diffuse idiopathic skeletal hyperostosis (DISH). Indeed, in no case were the most widely accepted diagnostic criteria of DISH, the spinal alterations, seen. We therefore suggest that ossification of the sacrotuberous ligament is an autonomous finding and not a good indicator of the presence of spinal DISH. [ABSTRACT FROM AUTHOR]

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