Final Review Flashcards
What are the 3 joint complexes that make up the pelvis?
1)sacroiliac (diathrosis, true synovial joint with joint cavity, synovial fluid and joint capsule). 2) Pubic Symphsis- fibrocartilagonous joint, amphiathrosis.
What is the SI joint shape morphology?
L-shape: upper half articulates at level of S1 and lower half articulates at the level of S2-3
Sacral Segment is lined with what type of cartilage?
Hyaline Cartilage
What surface is thicker?
Sacral Surface is thicker than the iliac surface
Describe the general shape of the sacrum
central groove that gives in a concave shape, it is wedge shaped superior to inferior and S shaped anterior to posterior
Describe the iliac surface
PSIS to PIIS, it is made of fibrocartilage (yellow colour) with a central convex ridge and has rough bony surfaces posteriorly and superiorly for ligamentous attachements.
Describe the pelvis at birth
joints are underdeveloped, smooth, flat and can glide in any direction. stability is provided by ligaments and it begins to develop during walking
Describe the pelvis during teen years
roughened surfaces, development of grooves/ridges. more pronounced in males than females. track bound movement developes (tram and rail)
Describe the pelvis in 3rd and 4th decades of life
articular change in the surface anatomy are well established, joint surfaces become more irregular, enlargement of iliac tuberosity/depression, beginning of joint surface erosions and possible DJD on the iliac surface which is more common in males.
Describe the pelvis in the 5th/6th decade of life
Joint surfaces become more irregular, each individual joint is unique in its topography to varying degrees (more pronounced in males), possible DJD develops on the sacral surface and continuing on iliac surface (more in males) possible development of joint adhesions, osteophytes and fusion (esp in males)
Describe the pelvis in the 7th decade and beyond
interarticular adhesions, high prevalence of bony anklylosis, Gender dependant (more in males) and age dependance in males (more in males over 80 years old. Fusion occurs mainly in the superior part of the joint
What are the Intrinsic SI ligaments?
Intrinsic SI ligaments bind sacrum to ilium.
Define the Anterior and posterior SI ligaments
1) Posterior SI ligaments include the interosseous (major stablizer) and dorsal ligaments (smaller, non-critical, limits nutation, runs from PSIS to iliac tuberosity)
2) Anterior SI ligaments: thin, thickening of the anterior joint capsule and it is weaker than the dorsal SI ligaments
3) Joint capsule is well developed anteriorly not posteriorly
What are the two Extrinsic ligaments
Sacrotuberous: Sacrum to Isch. Tube and limits posterior movement of sacral apex
Sacrospinous: Sacrum to Coccyx to Isch Spine, limits posterior moment of the sacral apex
What is the Symphysis Pubis
Amphiarthrosis joint with an interpubic fibrocartilaginous disc
Do muscles directly cross the SI joint
NO
What muscles load the SI joint?
Erector Spinae, QL, PSOAS, ILLIACUS, Piriformis, Gluteals.
What are some key static features of the pelvis?
1) Keystone effect: sacrum forms the keystone of the arch, inferior displacement is resister by this shape ligaments prevent AP displacement
2) Self locking mechanism: promotes stability and form closure due to wedging and form closure is aided by the thoracolumbar fascia and ligaments
Why is the SI a good shock absorber
it transmits forces between lower and axial skeleton. it glides/pivots during locomotion and decreases stress to the lumbar spine and opposing SI joint.
Describe SI kinematics
Unclear, amount of movement is debated and generally thought to be very small. Movability decreases with age, range is greater in females. Predominent ROM is around X-axis
What is thought to be the axis of rotation for the SI joint
posterior to the iliac tuberosity with some coupled motions with joint seperation
What is the most influencial model of locomotion
Illi’s: reciprocal motion between ilium and sacrum. flexion of hip and ilium is accompanied by ipsilateral anterior inferior movement of the sacral base and likewise extension of the hip and ilium is accompanied by ipsilateral posterior superior movement of the sacral base.
Motion is gyroscopic (oblique and horizontal figure 8)
Correlation to Gillet’s test!
Sacral base nutation (AI movement) creates what
LS extension and SI Flexion
Sacral counter nutation (PS movement) creates what
LS extension and SI Extension
SI movement is based on what the ____ does
Ilium
Pubic symphysis kinematics
gliding/shearing compression and seperation, rotation in the saggital plane with flexion/extension of the SI joint and it may play a role in the SI dysfunctions
What is the pideau’s test
PSIS and sacral apex should seperate when flexion happens. Can be done seated/standing
What is gillet’s test
evaluate the upper /lower portion of the joint, knee bent, raise up flexion, contacts move together, extention contacts move apart.
Define allydonia
pain produced by normal painless stimuli
Leg length evaluations can describe inequalities that are
anatomical or functional.
If you bend the knees to 90 degrees it does what
1) isolate the tibia/fibula length 2) if discrepency persists–>tib/fib inequality 3) if inequality is gone then its functional LLI or femoral inequality
Side posture: Lumbar segmental motion palpation can be done for flextion/extention, lateral flexion and rotation. What are they
flexion/extension: heel of hand/SP contact
rotation: hypothenar-mamillary resisted, spinous pull resisted, spinous push pull counter-resisted
LF: icshial push and double leg lift (long lever)
Side posture: SI joint motion palpation can be done by _________
one or two handed contacts for flexion and extension
Sitting: lumbar motion palpation can be done by
PA scan checking for pain/stiffness, Sectional/Segmental motion palpation and end play.
Sitting: SI motion palpation:
PA glide–>if motion is induced it is most likely extension
Sacral Shear/Illiac Shear
Sacral Push==> lean back and the sacrum should counternutate
Leg flare: PSIS movement M to L
Piedau’s test: SI joint extends and the sacrum counternutates.
What are some supine evaluations for the SI joint
leg length: same as prone, allis test (knee bent, checking for femoral or tib/fib inequalities or LLI). sit up test: most helpful. if leg length remains the same -->anatomical LLI if lengths change: functional LLI...remember that the short leg becomes long on the PI side!!!!!
What are the two ways to evaluate the low back
Neurological testing and orthopedic testing
What are the components of neurological testing,
1) nerve root compression/irritation a)sensory (pin prick), b) motor (muscle testing) c) reflex (DTR, superficial reflexes) d) radicular pain (pain from nerve root compression or irritation, sharp shooting pain)
2) Sclerotogenous pain: referred pain from deep somatic structures, deep, dull achy, hard to localize, diffuse, differently refferal areas than radicular
What is the straight leg raise?
patient raises their leg when supine (on their own). this stretches their sciatic nerve and spinal nerve roots primarily L5,S1,S2.
What are the degrees that indicate particular types of pain when doing the SLR
If symptoms shown between 0-35 degrees: extradural sciatic involvement. if between 35-70: radicular pain into extremities, in this range the sciatic nerve root tenses over the intervertebral disc causing futher irritation to a sensitve nerve root. IVD lesion/ nerve root compression
75-90: pain in the lumbars. lumbar pain suspected,
dull posterior thigh pain indicates tight hamstrings.
What is the Braggards test
patient is supine, raises leg to point of SLP and DR dorsiflexes the foot passively which increases sciatic nerve tension and is used as a confirmatory test for SLR. Radicular pain in the 35-70 degree range indicates IVD lesion, nerve root compression
What is the Bowstring test
patient is supine, bend leg and tuck between forearm and body, apply pressure on the popliteal fossa, increasing tension on the sciatic nerve. used as a confirmation test for the SLR. Lumbar or radicular pain and nerve root compression suspected