Anterior and Posterior Bony Pelvis Anatomy

00:01 So, again here is an image, you could also look at the iliac crest heights. So, with your patient supine you're going to kind of place your hands above the iliac crest on both sides and see if you note any sort of asymmetry in the iliac crest heights. Again, the anterior superior iliac spines could be located as you follow the crest anteriorly and then usually I like to hook my thumbs underneath it and then compare both sides because the ASIS could actually be fairly long in some patients and so you could be at the top of one side or at the bottom of the other and have an asymmetry that isn't really there. So, I try to hook underneath the ASIS on both sides to compare to see if there is asymmetry. The AIIS is another landmark. Now this is a little bit harder to find.

00:50 It is about an inch inferior and may be an inch medial to the ASIS. What you could try to do is to look for a little bit of a tubercle, it is deep and then you could ask the patient to flex their hip and engage their quadricep because you know that the rectus femoris attaches there. You also could check the superior pubic rami, just check for levels due to the proximity of this region to the patient’s genitals. It's really important to ask the patient for permission first and make sure that you approach the region gently and then get your contact really firm and appropriate when you are trying to diagnose the levels of the superior pubic ramus. So, again looking at the pubic tubercle levels and then looking at the medial malleoli level. So we could check for any sort of asymmetry of the pelvis by checking the leg lengths. So, you have to assume that the leg lengths are equal and that the pelvic asymmetry is what's causing the leg length discrepancy. So, when I'm treating a patient’s pelvis I will check their malleoli and if there is an asymmetry there I usually would treat the pelvis first and after treating the pelvis if that asymmetry at the level of the malleoli does not resolve, then I would double check and make sure that they don't have some sort of leg length discrepancy that is causing that asymmetry. Posteriorly, you want to assess the PSIS. That is the knob that you could see sometimes as a fascial connection to the skin and so assessing the PSIS levels on both sides is important. Similar to the ASIS I have to get underneath the PSIS levels on my patients and usually I have them lying on their stomach so that they are relaxed so I could get a better sense of where the level of the PSIS is bilaterally.

02:43 You also want to compare additional landmarks that you could see including the iliac crest, the sacral sulci, the PSIS we mentioned. Sometimes you could see asymmetries in the gluteal folds, the greater trochanter, the ischial tuberosities and the medial malleoli. Because when the entire pelvis is off, some of these landmarks will also be off too.