Exam 1 - Pelvis and hip 1 Flashcards
describe the sacroiliac joint
synovial, non axial
very stable joint with irregular articular surfaces
fibrous capsule reinforced by ligaments in multiple directions
describe the pubic symphysis
midline of body
rigth and left pubic ones joined with fibrocartilage disc and ligs
amphiarthrodial joint
what is an amphiarthrodial joint
not synovial joint
more stable
what are the attachments of the superior pubic ligament
what is its function
attaches the pubic tubercles on each side
strengthens the joint superiorly and anteriorly
what are the attachments of the inferior pubic ligaments
what is its function
attaches between the 2 inferior pubic rami
strengthen the joint inferiorly
what is the function of the SI joint
designed for stability and has very little mobility
what is the incidence of SI joint dysfunction
20% during pregnancy
13% not pregnant with LBP
what are the risk factors for SI joint dysfunction
laxity and hormonal changes
during pregnancy - previous LBP/pelvic trauma
none located if not pregnant
what is the etilogy of SI joint dysfunction
peri-partum
immature skeletons d/t lack of bony irregularity and congruency
trauma
autoimmune diseases (AS)
what are the symptoms of SI joint dysfunction
localized to SIJ
gluteal region and lateral hip
possibly pubic symphysis P!
often like hypermobility/instability
why is SI joint dysfunction symptoms often like hypermobility/instability symptoms
too much movement in the SI joint
joint gets loosened and gets off position and gets stuck again
what are the signs of SI joint dysfunction
A/PROM: no consistent pattern with just SI dysfunction with
RST: impaired local mm, weak anti-gravity hip mm
ST: >/= 3 (+) of SI provocation tests
what is the evidence for palpation for position for SI joint dysfunction
poor studies
considered a special test
t/f
movements in the SIJ are so minute that external determination by manual methods is virtually impossible
true
what motion test for SIJ is most useful but is still considered unreliable
march or gillet test
t/f
research consensus that motion and palpation SIJ tests are unreliable and invalid
true
what special test would you predict to be (+) for SIJ dysfunction
ASLR (+) for impaired local mm
t/f
imaging is diagnostic for SIJ dysfunction
false
imaging is not diagnostic
what is the gold standard for diagnosing SIJ dysfunction
SI block
what is the PT rx for SIJ dysfunction
POLICED
STM/muscle energy/acupuncture for P!/ muscle guarding
pelvic belt
JM
MET
education
what is the outcome for manipulation of SIJ dysfunction
improved symptoms and clinical test findings
did not alter positions per RSA imaging
likely a positive soft tissue and muscle influence per manipulation
what is the focus of MET for SIJ dysfunction
primary focus is stabilization
local mm and lumbar hypermobility/instability MET
what is the focus of pt education for SIJ dysfunction
reduce fear
early mobilization without provocation
reassurance of good prognosis
what is the MD rx for SIJ dysfunction
intra-articular SIJ injections for AS, not recommended without AS
P!/anti-inflammatory meds - mixed short-term benefit
no evidence for prolotherapy or fusion
what is the prognosis of SIJ dysfunction
rapidly declines during first 3 months after pregnancy
“serious P!” during pregnancy left 21% with symptoms 2 years later
what is femoral acetabular impingement
abnormal hip joint morphology or bony shape and arrangement
symptomatic contact between proximal femur and acetabulum
what is the prevalence of femoral acetabular impingement
males > females
higher with vigorous or end range activities (dance)
what are the risk factors for femoral acetabular impingement
genetics and gender: abnormal bony morphology, higher risk for sibling
vigorous loading in athletics
use of excessive motion
pediatric hip conditions
abnormal hip/pelvis kinematics
describe the abnormal hip/pelvis kinematics that can lead to femoral acetabular impingement
anterior pelvic tilt
limited posterior tilt that may also limit the coupled hip ER
excessive hip adduction
limited hip IR but is more likely d/t bony abutment than capsular tightness
what is the etiology of femoral acetabular impingement
largely unknown
more often: abnormal hip mechanics, vigorous athletic loading, combo
less often: slipped capital femoral epiphysis, femoral neck fx/malunion, legg-calve-perthes disease
describe the cam femoral acetabular impingement
less spherical femoral head
head contacts anterosuperior acetabulum/12:00
more common in males
37% presence in general population without P!
55% presence in athletes without P!
describe the pincer femoral acetabular impingement
deeper acetabulum or anterior osteophyte
neck primarily contact anterior but may also contact posterior labrum (countercoup phenomenon)
most common in middle-aged athletic females
what type of femoral acetabular impingement is most common
both cam and pincer
what structures are involved with femoral acetabular impingement
with/out age-related changes/labral tears
labrum
t/f
articular cartilage damage and labral damage are very common with femoral acetabular impingement
true
83% with articular cartilage damage
93% with labral damage
the labrum is primarily made up of what type of collagen
type 1 collagen
up to __% of labrum changes are insidious or gradual
75%
what patients should be considered with mechanical groin pain without alternative radiological diagnosis related to labrum tears
active individuals
_% of athletes with groin pain have labrum tears related to femoral acetabular impingement
20%
labral tears related to femoral acetabular impingement affect __% of pts with hip and groin pain
55%
