Musculoskeletal System - Pelvis Development

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Stage20-23 limbs b.jpg


The Embryonic Pelvic Girdle (week 5)
Adult appendicular skeleton
Hip bone

The pelvis is a developmentally complex skeletal structure requiring the fusion of separate elements and articulation with both the axial skeleton and lower limb. Postnatally, the human upright posture has also placed highly species specific physical demands on this structure. Developmental dysplasia of the hip is also one of the 3 most common (along with cleft palate, cleft lip) skeletal abnormalities.

The skeletal pelvis consists of: the sacrum and coccyx (axial skeleton), and pelvic girdle formed by a pair of hip bones (appendicular skeleton). Before puberty, he pelvic girdle also consists of three unfused bones: the ilium, ischium, and pubis. In chicken, the entire pelvic girdle originates from the somatopleure mesoderm (somite levels 26 to 35) and the ilium, but not of the pubis and ischium, depends on somitic and ectodermal signals.[1]

The mesoderm forms nearly all the connective tissues of the musculoskeletal system. Each tissue (cartilage, bone, and muscle) goes through many different mechanisms of differentiation.

The musculoskeletal system consists of skeletal muscle, bone, and cartilage and is mainly mesoderm in origin with some neural crest contribution.

The intraembryonic mesoderm can be broken into paraxial, intermediate and lateral mesoderm relative to its midline position. During the 3rd week the paraxial mesoderm forms into "balls" of mesoderm paired either side of the neural groove, called somites.

Somites appear bilaterally as pairs at the same time and form earliest at the cranial (rostral,brain) end of the neural groove and add sequentially at the caudal end. This addition occurs so regularly that embryos are staged according to the number of somites that are present. Different regions of the somite differentiate into dermomyotome (dermal and muscle component) and sclerotome (forms vertebral column). An example of a specialized musculoskeletal structure can be seen in the development of the limbs.

Skeletal muscle forms by fusion of mononucleated myoblasts to form mutinucleated myotubes. Bone is formed through a lengthy process involving ossification of a cartilage formed from mesenchyme. Two main forms of ossification occur in different bones, intramembranous (eg skull) and endochondrial (eg limb long bones) ossification. Ossification continues postnatally, through puberty until mid 20s. Early ossification occurs at the ends of long bones.

The pelvis is also covered in some urogenital studies.[2][3][4][5] Musculoskeletal and limb abnormalities are also one of the largest groups of congenital abnormalities.

See also the Anatomical Record - Special Issue:The Human Pelvis: Anatomy, Development and Function (April 2017).[6]

Links: pelvis | shoulder | appendicular skeleton | axial skeleton

Historic Pelvis  

Thomson A. The sexual differences of the fetal pelvis. (1899) J Anat Physiol. 33(3): 359-380.

Ruth EB. A study of the development of the mammalian pelvis. (1932) Anat. Rec. 53(2): 208 -

Limb Links: limb | limb axis | appendicular skeleton | Limb Rotation Timetable | Upper limb ossification | Lower limb ossification | Mouse limb | SHH | FGF | BMP | WNT | limb abnormalities | ICD-11 limb anomalies | Category:Limb
Historic Limb Embryology  
1901 Limb Development | 1902 Limbs | 1905 Rabbit Limb Veins | 1906 Hand papillary ridges | 1906 Digit Abnormalities | 1908 Two Subclavian Arteries | 1910 Limb Muscles | 1910 Upper Limb Bursae | 1915 Femur Epiphysis | 1919 Lower Limb Arteries | 1922 Pig Limb Vasculature | 1924 Rare Malformations | 1932 Postnatal Foot Growth | 1948 Chick Wing | 1968 Knee Development | 1990 Upper Limb Innervation

Musculoskeletal Links: Introduction | mesoderm | somitogenesis | limb | cartilage | bone | bone timeline | bone marrow | shoulder | pelvis | axial skeleton | skull | joint | skeletal muscle | muscle timeline | tendon | diaphragm | Lecture - Musculoskeletal | Lecture Movie | musculoskeletal abnormalities | limb abnormalities | developmental hip dysplasia | cartilage histology | bone histology | Skeletal Muscle Histology | Category:Musculoskeletal
Historic Embryology - Musculoskeletal  
1853 Bone | 1885 Sphenoid | 1902 - Pubo-femoral Region | Spinal Column and Back | Body Segmentation | Cranium | Body Wall, Ribs, and Sternum | Limbs | 1901 - Limbs | 1902 - Arm Development | 1906 Human Embryo Ossification | 1906 Lower limb Nerves and Muscle | 1907 - Muscular System | Skeleton and Limbs | 1908 Vertebra | 1908 Cervical Vertebra | 1909 Mandible | 1910 - Skeleton and Connective Tissues | Muscular System | Coelom and Diaphragm | 1913 Clavicle | 1920 Clavicle | 1921 - External body form | Connective tissues and skeletal | Muscular | Diaphragm | 1929 Rat Somite | 1932 Pelvis | 1940 Synovial Joints | 1943 Human Embryonic, Fetal and Circumnatal Skeleton | 1947 Joints | 1949 Cartilage and Bone | 1957 Chondrification Hands and Feet | 1968 Knee

Some Recent Findings

  • Position of pelvis in the 3rd month of life predicts further motor development[7] "The aim of the study is to select elements of motor skills assessed at 3 months that provide the best predictive properties for motor development at 9 months. In all children a physiotherapeutic assessment of the quantitative and qualitative development at the age of 3 months was performed in the prone and supine positions, which was presented in previous papers as the quantitative and qualitative assessment sheet of motor development. The neurological examination at the age of 9 months was based on the Denver Development Screening Test II and the evaluation of reflexes, muscle tone (hypotony and hypertony), and symmetry. The particular elements of motor performance assessment were shown to have distinct predictive value for further motor development (as assessed at 9 months), and the pelvis position was the strongest predictive element. Irrespective of the symptomatic and anamnestic factors the inappropriate motor performance may already be detected in the 3rd month of life and is predictive for further motor development. The assessment of the motor performance should be performed in both supine and prone positions. The proper position of pelvis summarizes the proper positioning of the whole spine and ensures proper further motor development. To our knowledge, the presented motor development assessment sheet allows the earliest prediction of motor disturbances."
  • Anatomy, Development, and Function of the Human Pelvis[6] "The pelvis is an anatomically complex and functionally informative bone that contributes directly to both human locomotion and obstetrics. Because of the pelvis' important role in obstetrics, it is one of the most sexually dimorphic bony elements of the human body. The complex intersection of pelvic dimorphism, locomotion, and obstetrics has been reenergized by exciting new research, and many papers in this special issue of the pelvis help provide clarity on the relationship between pelvic form (especially female) and locomotor function. Compared to the pelvis of our ape relatives, the human pelvis is uniquely shaped; it is superoinferiorly short and stout, and mediolaterally wide-critical adaptations for bipedalism that are already present in some form very early in the history of the hominin lineage. In this issue, 13 original research papers address the anatomy, development, variation, and function of the modern human pelvis, with implications for understanding the selection pressures that shaped and continue to shape this bone. This rich collection of scholarship moves our understanding of the pelvis forward, while raising dozens of new questions that we hope will serve as inspiration for colleagues and students (both current and future) puzzled by this fascinatingly complex bone."
  • Cartilage formation in the pelvic skeleton during the embryonic and early-fetal period[8] "The pelvic skeleton is formed via endochondral ossification. However, it is not known how the normal cartilage is formed before ossification occurs. Furthermore, the overall timeline of cartilage formation and the morphology of the cartilage in the pelvis are unclear. In this study, cartilage formation in the pelvic skeletons of 25 human fetuses (crown-rump length [CRL] = 11.9-75.0 mm) was observed using phase-contrast computed tomography and 7T magnetic resonance imaging.
  • Review - Ontogeny of the Human Pelvis[9] "The human pelvis has evolved over time into a remarkable structure, optimised into an intricate architecture that transfers the entire load of the upper body into the lower limbs, while also facilitating bipedal movement. The pelvic girdle is composed of two hip bones, os coxae, themselves each formed from the gradual fusion of the ischium, ilium and pubis bones. Unlike the development of the classical long bones, a complex timeline of events must occur in order for the pelvis to arise from the embryonic limb buds. An initial blastemal structure forms from the mesenchyme, with chondrification of this mass leading to the first recognisable elements of the pelvis. Primary ossification centres initiate in utero, followed post-natally by secondary ossification at a range of locations, with these processes not complete until adulthood.
More recent papers  
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Search term: Pelvis Embryology | Pelvis Development

Older papers  
These papers originally appeared in the Some Recent Findings table, but as that list grew in length have now been shuffled down to this collapsible table.

See also the Discussion Page for other references listed by year and References on this current page.


  • The Developing Human: Clinically Oriented Embryology (8th Edition) by Keith L. Moore and T.V.N Persaud - Moore & Persaud Chapter 15 the skeletal system
  • Larsen’s Human Embryology by GC. Schoenwolf, SB. Bleyl, PR. Brauer and PH. Francis-West - Chapter 11 Limb Dev (bone not well covered in this textbook)
  • Before we Are Born (5th ed.) Moore and Persaud Chapter 16,17: p379-397, 399-405
  • Essentials of Human Embryology Larson Chapter 11 p207-228


The following timeline data comes from a recent CT and MRI study of late human embryos from the Kyoto Collection.[8]

Human Pelvis Development
Carnegie Stage Event
18 chondrification centres of the ilium, ischium, and pubis first appears. Located around the acetabulum and grew radially.
20 iliac crest formed while the iliac body's central part remained chondrified.
22 Sacroiliac joint forms.
22 Iliac body is discoid. The growth rate was greater in the ilium than in the sacrum-coccyx, pubis, and ischium.
23 Articulation of the pubic symphysis, connection of the articular column in the sacrum, and Y-shape connection of the three parts of the hip bones to the acetabulum.
Early Fetal connection of the ischium and pubic ramus.
Data from human CT and MRI study.[8]
   Links: pelvis | pelvis timeline | joint | limb | timeline

Muscle Development (Myogenesis)

  • Early myogenic progenitor cells in the dermomyotome can be initially identified by the transcription factor Pax3.
  • Subsequent myogenic program development then depends on the myogenic determination factors (Myf5, MyoD, and MRF4), both Myf5 and MyoD are expressed in the limbs.
  • Final differentiation of these cells into post-mitotic muscle fibers in the limb bud is regulated by another myogenic determination factor, Myogenin.

(Some of the above text modified from[10]

Links: Muscle Development

Limb Bone

Limb sox9 and Wnt6 expression[11]
Chicken- limb bud chondrogenesis

Bone formation within the limb occurs by endochondral ossification of a pre-existing cartilage template. Ossification then replaces the existing cartilage except in the regions of articulation, where cartilage remains on the surface of the bone within the joint. Therefore bone development in the limb is initially about cartilage development or chondrogenesis.

In addition, there are two quite separate aspects to this development.

  1. Pattern - where the specific regions will commence to form cartilage, which will be different for each cartilage element.
  2. Chondrogenesis - the differentiation of mesoderm to form cartilage, which will be essentially the same program for all cartilage templates.

A recent study has identified that the overlying limb surface ectoderm potentially inhibits limb early chondrogenesis through Wnt6 signaling.[11]

Links: Cartilage Development | Bone Development


Fibroblast Growth Factors

  • Fgf8 - morphogen gradient forms by a source-sink mechanism with freely diffusing molecules.[12]

T-box Transcription Factors


LB74 Structural developmental anomalies of pelvic girdle - LB74.0 Developmental dysplasia of hip

LB74.1 Congenital subluxation of hip | LB74.2 Unstable hip | LB74.3 Congenital coxa vara | LB74.4 Congenital coxa valga | LB74.5 Wide symphysis pubis | LB74.Y Other specified structural developmental anomalies of pelvic girdle | LB74.Z Structural developmental anomalies of pelvic girdle, unspecified

Developmental Dysplasia of the Hip

X-Ray Developmental Dysplasia of the Hip
Acetabular angle[13]
 ICD-11 LB74.0 Developmental dysplasia of hip
A condition caused by failure of the hip to correctly develop during the antenatal period. This condition is characterized by slippage of the hip from the socket. This condition may present with outward turning of the leg, reduced movement on one side of the body, shortness of one leg, uneven skin folds on thigh or buttocks, walking difficulties, or inward rounding of the lower back.

Developmental dysplasia of the hip ((DDH) or congenital hip dislocation is one of the 3 most common skeletal abnormalities and can range from unilateral or bilateral instability to complete dislocation at the femur acetabulum of the lower limb. See the recommendation statement for screening for developmental dysplasia of the hip.[14]

  • Instability: 1:60 at birth; 1:240 at 1 wk: Dislocation untreated; 1:700
  • congenital instability of hip, later dislocates by muscle pulls or gravity
  • familial predisposition female predominance
  • Growth of femoral head, acetabulum and innominate bone are delayed until the femoral head fits firmly into the acetabulum.

Barlow test

(Barlow maneuver) A clinical term to describe a physical examination of the newborn for Developmental dysplasia of the hip (DDH). The examiner adducts the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. A positive sign is the hip being dislocatable, if the hip can be popped out of socket with this test. This test is then combined with the Ortolani test (manoeuvre). The test is named after Thomas Barlow (1845 – 1945) a British royal physician.

Ortolani test

(Ortolani manoeuvre) A clinical term to describe a physical examination of the newborn for developmental dysplasia of the hip (DDH). This is a test for posterior dislocation of the hip. Using the examiner's thumb, abduct the infant's leg, while using the examiner's index finger to place anterior pressure on the greater trochanter. A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum, usually becomes negative after 2 months of age. This test is combined with the Barlow test (maneuver). Named after Marino Ortolani, the test developer in 1976.

Abduction Splints

There is variable evidence for the use of abduction splinting during onset of walking in children on the maturation of mild dysplastic hips.[13]


The skeletal shoulder consists of: the clavicle (collarbone), the scapula (shoulder blade), and the humerus. Development of his region occurs through both forms of ossification processes.

Links: shoulder


  1. Malashichev Y, Christ B & Pröls F. (2008). Avian pelvis originates from lateral plate mesoderm and its development requires signals from both ectoderm and paraxial mesoderm. Cell Tissue Res. , 331, 595-604. PMID: 18087724 DOI.
  2. Pillet J. Reconstruction des organes pelviens d’embryons humains de 12,5 et de 25 mm CR. (1967) Ass Anat 51: 819-827.
  3. Pillet J. Reconstruction du pelvis d’un embryon humain de 7.5 mm (Stade XVI de Streeter) CR. (1968) Ass Anat 52: 1013-1023.
  4. Pillet J (1969) Reconstruction des organes génito«-urinaires et des veines pelviennes d’un embryon de 12,5 mm (Stade XVII de Streeter) CR. Ass Anat 53 : 1817-1824.
  5. Pillet J. Reconstruction des organes pelviens d’un embryon de 5 mm (Stade XV de Streeter) CR. (1971) Ass Anat 54:705-715
  6. 6.0 6.1 DeSilva JM & Rosenberg KR. (2017). Anatomy, Development, and Function of the Human Pelvis. Anat Rec (Hoboken) , 300, 628-632. PMID: 28297176 DOI.
  7. Gajewska E, Sobieska M & Moczko J. (2018). Position of pelvis in the 3rd month of life predicts further motor development. Hum Mov Sci , 59, 37-45. PMID: 29602050 DOI.
  8. 8.0 8.1 8.2 Okumura M, Ishikawa A, Aoyama T, Yamada S, Uwabe C, Imai H, Matsuda T, Yoneyama A, Takeda T & Takakuwa T. (2017). Cartilage formation in the pelvic skeleton during the embryonic and early-fetal period. PLoS ONE , 12, e0173852. PMID: 28384153 DOI.
  9. Verbruggen SW & Nowlan NC. (2017). Ontogeny of the Human Pelvis. Anat Rec (Hoboken) , 300, 643-652. PMID: 28297183 DOI.
  10. Giordani J, Bajard L, Demignon J, Daubas P, Buckingham M & Maire P. (2007). Six proteins regulate the activation of Myf5 expression in embryonic mouse limbs. Proc. Natl. Acad. Sci. U.S.A. , 104, 11310-5. PMID: 17592144 DOI.
  11. 11.0 11.1 Geetha-Loganathan P, Nimmagadda S, Christ B, Huang R & Scaal M. (2010). Ectodermal Wnt6 is an early negative regulator of limb chondrogenesis in the chicken embryo. BMC Dev. Biol. , 10, 32. PMID: 20334703 DOI.
  12. Yu SR, Burkhardt M, Nowak M, Ries J, Petrásek Z, Scholpp S, Schwille P & Brand M. (2009). Fgf8 morphogen gradient forms by a source-sink mechanism with freely diffusing molecules. Nature , 461, 533-6. PMID: 19741606 DOI.
  13. 13.0 13.1 Windhagen H, Thorey F, Kronewid H, Pressel T, Herold D & Stukenborg-Colsman C. (2005). The effect of functional splinting on mild dysplastic hips after walking onset. BMC Pediatr , 5, 17. PMID: 15958160 DOI.
  14. US Preventive Services Task Force. (2006). Screening for developmental dysplasia of the hip: recommendation statement. Pediatrics , 117, 898-902. PMID: 16510673 DOI.


Anatomical Record - Special Issue:The Human Pelvis: Anatomy, Development and Function. April 2017 DeSilva JM & Rosenberg KR. (2017). Anatomy, Development, and Function of the Human Pelvis. Anat Rec (Hoboken) , 300, 628-632. PMID: 28297176 DOI.

Hill RE. (2007). How to make a zone of polarizing activity: insights into limb development via the abnormality preaxial polydactyly. Dev. Growth Differ. , 49, 439-48. PMID: 17661738 DOI.


Satoh A, Makanae A & Wada N. (2010). The apical ectodermal ridge (AER) can be re-induced by wounding, wnt-2b, and fgf-10 in the chicken limb bud. Dev. Biol. , 342, 157-68. PMID: 20347761 DOI.

Galli A, Robay D, Osterwalder M, Bao X, Bénazet JD, Tariq M, Paro R, Mackem S & Zeller R. (2010). Distinct roles of Hand2 in initiating polarity and posterior Shh expression during the onset of mouse limb bud development. PLoS Genet. , 6, e1000901. PMID: 20386744 DOI.

Stefanov EK, Ferrage JM, Parchim NF, Lee CE, Reginelli AD, Taché M & Anderson RA. (2009). Modification of the zone of polarizing activity signal by trypsin. Dev. Growth Differ. , 51, 123-33. PMID: 19207183 DOI.


Strayer MMJr. The embryology of the human hip joint. (1943) Yale J Biol. Med. 16(1): 13–26.6. PMCID: PMC2601352

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