Gluteal pain was reproduced with palpation of the
sacrotuberous ligaments bilaterally, and digital pressure over the L4 and L5 vertebral segments during prone examination.
The pubic symphysis, bilateral sacroiliac joints and ligaments, bilateral hip joints, bilateral
sacrotuberous ligaments, and bilateral sacrospinous ligaments were intact.
A recently described alternative open technique consists of a transgluteal approach, which allows access to the pudendal nerve between the sacrospinous and the
sacrotuberous ligaments (Fig.
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.
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.
In our practice, we most often find the nerve entrapped between the sacrospinous and sacrotuberous ligaments, which form a sort of "V" in the pelvis.
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 sacrospinous and sacrotuberous ligaments of the pelvic floor also play a role in resisting external rotation and VS forces.
The stability of the pelvic ring is determined by the integrity of the posterior weightbearing sacroiliac complex, which includes the sacroiliac (posterior and anterior), sacrospinous, and sacrotuberous ligaments.
The sides are created by the right and left pubic arch and the sacrotuberous ligaments (Figure 2).
Posteriorly the ischiorectal fossae extends below the lower edge of gluteus maximus as far as the sacrotuberous ligament (Figure 4).
The following are areas in which the PN can become entrapped leading to injury and symptoms of pudendal neuralgia: the zone at the ischial spine, the zone between the sacrospinous and
sacrotuberous ligaments, the falciform process (formed by the dense fanning out bands of the medial portion of the
sacrotuberous ligament as it attaches to the ischial tuberosity), the zone between the levator ani and obturator internus muscle, within the pudendal canal and lastly compression from the piriformis muscle (Figure 1).
