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Advanced MSK > Anatomy and Biomechanics of SIJ > Flashcards

Anatomy and Biomechanics of SIJ Flashcards

1
Q

SIJ functions

A

load transmission- downward from head, trunk and upper limbs and lower limbs
upward from ground reaction forces
shock absorption - protect impact forces from reaching lumbar spine
childbirth - temporary increase joint laxity/movement. lower sacrum rotates posteriorly
increase pelvic outlet

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2
Q

load transfer across pelvis

A

pelvic ring
sacrum = keystone
downward = direction of BW force from trunk to femurs
upward = direction of force from femurs to trunk

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3
Q

joint features of SIJ

A

Diarthrodial joint
Synovial fluid
Articular surfaces covered with hyaline cartilage – Sacral > iliac
Normally asymmetrical!
At birth – surfaces flat
Puberty – roughened & irregular (M>F)
Fibrous capsule – reinforced by ligaments
Innervation from L2 – S4

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4
Q

Ligaments of SIJ

A

Interosseous sacroiliac ligament
iliolumbar ligament
sacrospinal ligament
sacrotuberal ligament
anterior sacroiliac ligament
anterior sacrococcygeal ligament
anterior longitudinal ligament

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5
Q

list the primary stabilising ligaments

A

Anterior sacroiliac ligament
Interosseous ligament
Short & long dorsal ligaments

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6
Q

list the secondary stabilising ligaments

A

Sacrotuberous ligament
Sacrospinous ligament

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7
Q

list the structures that become activated and stretched during pelvic nutation

A

stretched ligaments - interosseous, sacrospinous, sacrotuberous
active muscle - rectus abdominis, multifidi and erector spinae, bicep femoris

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8
Q

form closure

A

a stable situation where joint surfaces are closely fitting and no extra forces are required to maintain stability.
Shape of articular surface
Friction coefficient of articular cartilage
Integrity of joint ligaments

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9
Q

purpose of assessing active SLR

A

testing lumbo-pelvic structures ability to transfer load
core muscle control

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10
Q

muscles responsible for muscle control during active SLR

A

Transversus Abd (Richardson et al 2002)
Multifidus
Biceps femoris: continuous with Sacrotuberous ligt
Oblique slings: load transference during rotational activities
Gluteus maximus: contraction  Sacrotuberous ligt tension
Contralateral Latissimus dorsi

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11
Q

Sacrak nutation

A

anterior sacral-on-iliac rotation
OR
posterior ilium-on-sacrum rotation
OR
both
Trunk forward bending

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12
Q

sacral counternutation

A

posterior sacral-on-iliac rotation
OR
anterior ilium-on-sacrum rotation
OR
both
Trunk bending back

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13
Q

describe biomechanics of trunk flexion

A

Sacrum nutates - 60°
Interosseous ligts / Sacrotuberous ligt taut
Articular ridges resist
Occ counternutates EOR
Bilateral anterior innominate rotn (on femora)

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14
Q

describe biomechanics of trunk extension

A

Sacrum counternutates?
Long dorsal ligament taut
Pelvis relatively more unstable in counternutation
Bilateral posterior innominate rotn (on femora)

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15
Q

describe biomechanics of hip flexion

A

Posterior innominate rotn = sacral nutation

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16
Q

describe the biomechanics of hip extension

A

Anterior innominate rotn = sacrum counternutates

17
Q

possible traumatic/degenerative causes of SIJ pain

A

Pelvic #
Arthrosis – often contralateral to hip OA
Osteitis condensans ilii
Ligamentous / Muscular sprain

18
Q

possible inflammatory causes of SIJ pain

A

AS
Psoriatic arthritis

19
Q

mechanical causes of SIJ pain/dysfunction

A

Hypermobility
Hypomobility
Combination of both

20
Q

pelvic asymmetrical causes of SIJ pain/dysfunction

A

sacral torsion/rotation
innominate upslip/downslip
innominate rotation ant. or post.

21
Q

metabolic causes of SIJ pain/dysfunction

A

Osteoporosis
Paget’s Disease

22
Q

other causes of SIJ pain/dysfunction

A

Infections
Tumours
Deep Gluteal Syndrome (aka Piriformis Syndrome)
Referral from Lumbar Spine / Viscera
pregnancy

23
Q

describe pelvic girdle pain

A

Pain experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the SIJ. The pain may radiate in the posterior thigh and can also occur in conjunction with/or separately in the symphysis

24
Q

possible cause of pelvic girdle pain

A

Transient osteoporosis
Diastastis rectus abdominis (DRA)
PF dysfunction
Hip dysfunction
Femoral Head AVN
Lumbar dysfunction

25
Q

subjective findings of pelvic girdle pain

A

Often unilateral pain
Usually younger person involved in sport e.g.
dance, running, tennis
OR
Pregnancy / childbirth related
Pain aggravated by loading:
Stairs: step up
Sit  stand
Prolonged standing
Turning in bed
Getting in & out of bed
Gait (WB phase)

26
Q

describe form closure

A

a stable situation where joint surfaces are closely fitting and no extra forces are required to maintain stability.

27
Q

what contributes to form closure

A

Shape of articular surface
Friction coefficient of articular cartilage
Integrity of joint ligaments

28
Q

risk factors of antepartum

A

Prior h/o pregnancy, MSK dysfunction
Higher BMI
Smoking
Work dissatisfaction
Lack of belief of improvement of PGP

29
Q

aim of physical exam of SIJ/Pelvis

A

Is SIJ or PS the source of nociception?
PSIS / buttock is very common referral area for lumbar / hip problems
are SIJ moving normally
Is pelvis symmetrical

30
Q

pelvic girdle pain assessment

A

ODI
Pelvic girdle questionnaire
Fear-Avoidance Beliefs Questionnaire
Pain Catastrophizing Scale
pain provocation ax
faber’s test
gaenslens test
functional load - SLS, STS, turning in bed
mobility ax
ASLR
Endurance test - trunk flex, ext
dynamometry - hip ADD, hip EXT
diastasis recti abdominis - > 2 fingers

31
Q

what does active straight leg raise

A

Lumbo-pelvic structures ability to transfer load
Core muscle control

32
Q

management strategy for antepartum pelvic girdle pain

A

Exercise – consider
Low risk & minimal adverse events
SIJ belt – consider it but conflicting evidence
MT – emerging but weak evidence

33
Q

management strategy for postpartum pelvic girdle pain

A

Education – biomechanical & BPS, load pain minimisation
Eg. Turning in bed?
Exercise – ↑ ms performance, ↓ pain & disability
All types  stabilisation (TrA, back extensors & PF  force closure focus), strengthening incl. hip add/abd
Often with SIJ belt
Strong evidence MT in conjunction with cointerventions  ST ↓ pain & disability
Strong evidence MT is no better than stabilization exs for LT improvement (>6/12)

34
Q

diagnostic criteria for pelvic girdle pain

A

can be diagnosed by
pain provocation tests (P4 *, Faber *, Gaenslen’s test and modified Trendelenburg’s test * / march test) +
pain palpation tests (long dorsal ligament test * and palpation of the symphysis *)
functional test - ASLR

Advanced MSK (18 decks)

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