(1) The sacrospinous and
sacrotuberous ligaments divide the sciatic notch into the greater and lesser sciatic foramina.
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.
Ligaments (anterior, posterior, interosseal sacroiliac ligament, sacrospinous ligament, and sacrotuberous ligament) were left 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. Along with these three are the sacroiliac (SI) ligaments, which also help to stabilize the spine.
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 main concern with this approach since it was originally described by Professor Roger Robert in Nantes, France, has been the required transection of the sacrotuberous ligament and the possible impact on stability of the sacroiliac joint.
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 sides are created by the right and left pubic arch and the
sacrotuberous ligaments (Figure 2).
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).
