5. Manipulative Conditions Of The Pelvis Flashcards
How is the diagnosis of SI syndrome made?
There is no gold standard test. Diagnosis made after exclusion of other pathology
What are the three theories of pathophysiology of SI syndrome?
- joint subluxation due to response to adjustment
- joint dysfunction with abnormal mobility (prominent theory)
- chronic low grade inflammation (conflicting study evidence)
What are the etiologies of SI syndrome?
- acute trauma
- repetitive stress injury
- static overstrain
- post-traumatic complications of sprains or strains
- osteoarthrosis
- gender
The SI joint is more susceptible to axial compression and torsion that the lumbar motion segments. What are some activities that can cause this?
- forward bending, twisting and lifting
- fall on the buttocks
- unexpected step, or a step from a miscalculated height
- uncoordinated movement, minor trivial event
What is the most common cause of SI syndrome?
Repetitive stress injury
What are examples of repetitive stress injuries that can cause SI syndrome?
- repetitive lifting and twisting (nurses, package handlers)
- athletic training (figure skaters)
What is an example of static overstrain leading to SI syndrome?
Postural from prolonged slouching while sitting or from a bad chair
A high percentage of older males have DJD but it doesn’t necessarily
correlate with symptoms or dysfunction. When does DJD/osteoarthrosis correlate with joint dysfunction?
In cases of premature degeneration and DJD ins spinal facets
How does pregnancy play a role in the etiology of SI syndrome?
Ligamentous laxity and large belly in the 3rd trimester causes increased lumbar lordosis, anterior pelvic tilt which causes increased stress to the SI joints
How does childbirth play a role in the etiology of SI syndrome?
Stress of birth process to SI joints may lead to postpartum laxity, etc. with corresponding stress to joints
What is the estimated prevalence of SI syndrome in adults?
Estimates range from 23% to 50-70% from various studies with limited objective diagnostic criteria
What is the estimated prevalence of SI syndrome in children?
Studies indicate that it is not uncommon (23% had LBP and 28% had hypomobile SI joints) and most common in 12-17 years olds
Si syndrome is a clinical diagnosis and is not established by the presence or absence of any singular symptom or finding. Some of the symptoms and physical findings that may be present include:
- Deep aching pain of SI, usually unilateral, with episodes of sharp pain
- referred pain to buttock and possibly all the way to dorsum of foot
- hypersthesia in buttock or leg
- aggravating factors are activities that increase the focus of weight in the joint
- alleviating factors including rest, NSAIDS, stretching, ice and massage
The pain pattern of SI syndrome can help differentiate from other low back syndromes. How would facet syndrome referred pain be different?
The lumbar pain is often bilateral and is accompanied by scleratogenous pain referral to hip, buttock and sometimes leg (above knee)
What is the referred (scleratogenous) pain of SI syndrome.
common referral to buttocks, posterior
thigh, groin
occasionally to lateral calf, ankle and/or
dorsum of foot
The pain pattern of SI syndrome can help differentiate from other low back syndromes. How would disc herniation referred pain be different?
Disc herniations would present with lumbar pain and referred (radicular pain into the buttock and leg, often extending into the calf and foot
What activities typically aggravate SI syndrome?
Anything that increases focus of weight in the joint
Ex: sitting to standing, climbing stairs, etc.
Also activities that cause extreme motion to SI or sustained postures, such as prolonged sitting
What are activities/treatments that alleviate SI syndrome pain?
mild walking rest (variable) direct pressure/massage stretching ice heat anti-inflammatory agents, analgesics
What are some postural findings that could be present with SI syndrome?
- normal to antalgic posture
- unleveling of crests, PSIS’s, gluteal folds or contours
- lumbar scoliosis
What are some possible gait findings with SI syndrome?
- normal to protective gait that may include decreased stance phase on affected side to reduce painful weight bearing
What are some possible GROM findings for SI syndrome?
- normal to painful and restricted GROM
- altered lumbopelvic rhythm
What are some possible bony static palpatory findings in SI syndrome?
- Tenderness over the sacral sulcus, PSIS
- asymmetry of PSIS’s, iliac crest, depth of sacral base
- leg length inequality
- PI ilium
- AS ilium
Why can a PI ilium cause medial knee pain?
The PI ilium will pull on sartorial due to flexed position which irritates the insertion
A PI ilium would result in a functional ____ (short/long) leg that _____ (shortens/lengthens) during the sit up test.
Short, lengthen
An AS ilium would result in a functional ____ (short/long) leg that _____ (shortens/lengthens) during the sit up test.
Long, shortens
What are the soft tissue static palpations that can be found with SI syndrome?
Tenderness over the SI joint and periarticular soft tissue
Si syndrome could present with _____ during joint play
Pain on springing
Segmental motion in SI syndrome may be:
Painful, restricted or aberrant in flexion or extension
In SI syndrome, when doing percussion, what might be a finding?
Pain over involved joint which might differentiate an inflamed or infected SI joint
What orthopedic tests can be used to evaluated SI syndrome?
- SI stretch test or HIbbs test to evaluate pain with traction
- iliac compression test, thigh thrust or sacral trust to evaluate pain with compression and/or shearing
What kind of muscle testing can be done in the evaluation of SI syndrome?
There are no muscles crossing the joint. However, imbalance or injury to hip flexors, extensors or rotators may initiate, exacerbate, predispose or complicate this condition.
Because there are different etiological theories of SI syndrome, there are also different treatment approaches. The school of thought that SI dysfunction results from SI joint restriction and/or ilium/sacrum malposition has what treatment options?
- manipulation
- mobilization
- exercises
- orthotics
- leg length inequality treatment
Because there are different etiological theories of SI syndrome, there are also different treatment approaches. The school of thought that SI dysfunction results from instability/hypermobility has what treatment options?
- belts
- exercises (stabilization)
- proliferant injections
- fusion
Because there are different etiological theories of SI syndrome, there are also different treatment approaches. The school of thought that SI discomfort caused mainly by inflammation in the joint has what treatment options?
- ice
- oral or injected anti-inflammatory medications
- PT modalities
- rest
