Ischemic compression was applied to the
sacrotuberous and sacrospinous ligaments and the surrounding hip and pelvic musculature.
The iliolumbar ligament is one of three vertebral-pelvic ligaments responsible for stabilizing the lumbrosacral spine in the pelvis, along with the sacrospinous and
sacrotuberous ligaments.
(2) During cycling, repetitive impacts generate extreme perineal pressure leading to increased friction in the pudendal canal and compression from the surrounding muscular (levator ani, obtruator internus, and piriformis) and ligaments structures (sacrospinous and
sacrotuberous).
These injuries are rotationally unstable, there may also be some vertical displacement but this is limited by the
sacrotuberous and sacrospinous ligaments, which typically remain intact (1,2).
The nerve runs between the sacrospinous and
sacrotuberous ligaments, for instance, and entrapment between these two ligaments is probably the most common cause of pudendal neuralgia.
The long and short posterior sacroiliac ligaments, the interosseous ligaments within the sacroiliac joints and the
sacrotuberous ligaments all resist forces leading to vertical translation between the ilia and the sacrum.
The
sacrotuberous ligament fans out from the ischial tuberosity to the posterior superior iliac spine and the tuberosities of the sacrum; and the sacrospinous ligament, deep to the
sacrotuberous ligament, attaches from the posterolateral aspects of the S3-S5 sacral body segments to the ischial spine [36].
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.
The surgery itself involves sectioning the
sacrotuberous ligament into two parts to explore the proximal nerve, incising Alcock's canal, sectioning the sacrospinous ligament at the ischial spine, and then transposing the pudendal nerve.
A second site for entrapment of the pudendal nerve is under the
sacrotuberous ligament just before it enters into Alcock's canal.
It originates in the posterior gluteal line of the ilium, the iliac crest, and the aponeurosis of the erector spinae and on the dorsal surface of the lower portion of the sacrum and the lateral aspect of the coccyx, the
sacrotuberous ligament, and the fascia that covers the gluteus medius muscle.
The boundaries of the perineum are the pelvic floor superiorly, pubic symphysis anteriorly, coccyx posteriorly, ischial tuberosities laterally, ischiopubic rami anterolaterally,
sacrotuberous ligaments posterolaterally, and fascia and skin inferiorly.
