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Interventions II > Final - Clinical conditions of the pelvis > Flashcards

Final - Clinical conditions of the pelvis Flashcards

1
Q

3 causes of pelvic dysfunction

A
  • Direct trauma
  • Indirect Trauma: traumatic force that is transferred to the pelvis via related bony structures
  • Pregnancy/Menses: ligamentous laxity and anterior weight gain
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2
Q

Causes of sacroiliac sprain

A
  • direct or indirect trauma

- fall on the ischial tuberosity, bumping down stairs, awkward twist and reach, pregnancy

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3
Q

Signs and symptoms of sacroiliac sprain

A
  • may have had pain for a relatively long period of time
  • localized pain over SIJ
  • pain may be referred, typically to groin and posterior thigh, and less often to leg; pain can be in lower abdomen
  • May radiate over lateral aspect of greater trochanter and down the front of the thigh
  • increased pain with lying on affected side
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4
Q

Treatment for SIJ Sprain

A
  • acute phase: rest, positional instruction, pain relief, normalize pelvic mobility, mobilizations for pain
  • sub acute and beyond: add stability exercises and progress functional activities
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5
Q

Cause of SIJ hypermobility

A

repetitive minor trauma, one legged standing, sexual intercourse, pregnancy, childbirth

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6
Q

signs and symptoms of sacroiliac hypermobility

A
  • dull ache (may worsen w/ posterior rotation)
  • may have anterior hip pain
  • pain or difficulty wit asymmetric activities
  • sit to stand and walking may increase symptoms
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7
Q

Clinical Findings of sacroiliac hypermobility

A
  • asymmetric mobility of the iliosacral and/or sacroiliac; asymmetric pelvic landmarks
  • dysfunction which may or may not change
  • tenderness
  • soft tissue swelling
  • increased muscle tone (glutes, piriformis, lumbar paraspinals)
  • trunk weakness
  • possible flexibility deficit
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8
Q

Sacroiliac Hypermobility Treatment

A
  • muscle energy techniques
  • education on modified activity: avoiding positions that exacerbate the symptoms (acute)
  • SI belt
  • strengthening of weak structures/ core stabilization
  • lengthen/stretch tight structures
  • neuromuscular re-education
  • positional instruction
  • patient education
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9
Q

Cause of sacroiliac hypomobility

A
  • part of the normal aging process

- may be due to overuse with positions that stress the SIJ causing accelerated degeneration of the joint

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10
Q

signs and symptoms of sacroiliac hypomobility

A
  • pain is typically felt on one side of the low back or buttocks
  • can radiate down the leg –> typically above the knee but can go down to ankle/foot at times
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11
Q

treatment for sacroiliac hypomobility

A

manipulation

mobilization

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12
Q

what causes sacroiliac displacement

A
  • excessive hypermobility leading to actual joint surface displacement
  • severe force to joint
  • possible rupture of pubic symphysis
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13
Q

signs and symptoms of sacroiliac displacement

A
  • pelvic dysfunction which may change

- positive SI tests with pain

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14
Q

Treatment for sacroiliac displacement

A
  • manipulation to reduce the lesion
  • SI belt
  • patient education on positioning
  • stabilization/ strengthening exercises
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15
Q

Causes of degenerative changes to the SIJ

A

OA

  • age >45
  • female > male
  • certain hereditary conditions such as defective cartilage and joint deformity
  • joint injuries caused by sports, work-related activities, accidents
  • obesity
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16
Q

signs and symptoms of degenerative changes of SIJ

A
  • Swelling/tenderness at SIJ
  • intermittent pain- usually better with movement
  • loss of flexibility
  • C/o stiffness
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17
Q

treatment for degenerative changes of SIJ

A
  • pain control
  • therapeutic exercises for stability and flexibility
  • weight control
  • cortisone injections
  • extreme cases = surgery
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18
Q

What is Ankylosing Spondylosis?

A
  • Disruption of the ligamentous-osseous junction that results in reactive bone formation as part of the repair process
  • progressive ossification leads to fused SI then spine
19
Q

what is the most common systemic condition that affects the SIJ?

A

ankylosing spondylosis

20
Q

What are the symptoms of ankylosing spondylosis?

A
  • may complain of insidious onset

- SIJ and lower lumbar pain, aching, morning stiffness that may last more than one hour

21
Q

What is the role of PT in Ankylosing Spondylosis?

A
  • Postural instruction and strengthening to minimize development of increased t/s kyphosis
  • Breathing exercises
22
Q

What is Reiter’s Syndrome?

A
  • AKA reactive arthritis

- Arthritis occurs as a reaction to an infection that started elsewhere in the body

23
Q

Where does infection that leads to Reiter’s Syndrome typically begin?

A

Genitourinary tract

spreads and embeds itself in SI

24
Q

Signs and symptoms of Reiter’s Syndrome

A
  • Swelling, redness, heat, and pain at SIJ
25
Q

Treatment for Reiter’s Syndrome

A

short periods of bed rest, NSAIDs, cortisone injections, antibiotics

26
Q

PT’s role in Reiter’s Syndrome

A

strengthening/ stability exercises and mobility exercises to improve joint functions

27
Q

What is Rheumatoid Spondylitis?

A

AKA: Ankylosing Spondylitis

  • disease of the connective tissue that results in the inflammation of the joints in the spine
  • hereditary
  • Men > women; 20-40yo
  • can lead to complete obliteration of SIJ
28
Q

What are the signs and symptoms of rheumatoid spondylitis?

A

may have periods with no pain/stiffness alternating with period of mild to moderate pain/stiffness, typically in the back

29
Q

Medical treatment of Rheumatoid Spondylitis

A

NSAIDs and sometimes corticosteroids

30
Q

PT role of Rheumatoid spondylitis

A

help with breathing, posture, and strength/mobility exercises

31
Q

What is Rheumatoid Arthritis?

A

an autoimmune disease that causes chronic inflammation of the joints and tissues around the joints

32
Q

signs and symptoms of RA

A
  • inflamed joints usually swollen and often feel warm and “boggy” when touched
  • pain often symmetrically but can be worse on one side
  • Stiffness in the morning which lasts up to an hour
33
Q

Medical treatment of RA

A
  • NSAIDs, corticosteroids, disease-modifying anti-rheumatic drugs
34
Q

PT role in RA

A

aimed at protecting joints and preserving movements

35
Q

Apophysis Fractures - Iliac crest

A
  • sudden, severe pain over iliac crest, pain with abdominal muscle contraction
  • MOI: sudden severe abdominal muscle contraction with a twist; may have a h/o steroids of other performance enhancing drugs
36
Q

Apophysitis Fractures - Ischial Tuberosity

A
  • hamstring contraction with pelvis fixed in flexion and knee extension
  • pain, tender, antalgic gait with sitting
37
Q

Traumatic Fractures of SIJ

A
  • due to fall from high surface, MVA
38
Q

medical management of SI traumatic fractures

A
  • if stable, protected WB and rest
  • if unstable, external fixator or ORIF
  • PT during and after healing process
39
Q

Osteitis Pubis MOI

A

repetitive/excessive stress to pubic symphysis (shear forces)
H/o urologic surgery, soccer, race walker, runner, kicker

40
Q

Signs and symptoms of Osteitis Pubis

A

gradual pubic pain, pivoting movements increase pain, stretching aggravates symptoms and may c/o “clicking”

41
Q

Treatment of Osteitis Pubis

A

rest/anti-inflammatory medication

42
Q

treatment sequence to address dysfunctions:

A
  1. correct upslip/downslip
  2. balance the pubes
  3. lumbar spine dysfunctions
  4. sacroilial or iliosacral lesions
  5. leg restrictors of the pelvis (stretch LE)
  6. iliopsoas dysfunction
  7. once normalized, re-train the muscles, maintain flexibility, address core stability, dynamic trunk strength, pt education/HEP
43
Q

What are METs?

A

A manual technique that involves the voluntary contraction of a nation’s muscle in a precisely controlled direction, at varying levels of intensity, against a distinctly executed counterforce applied by the operator

Interventions II (8 decks)

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