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OS II Sacrum/Innominate > Innominate Dx And Tx > Flashcards

Innominate Dx And Tx Flashcards

1
Q

3 bones that make up the innominate

A

Ilium
Ischium
Pubis

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2
Q

Always have the patient…..

A
  • Reset the hips

- supine, bend knees, feet flat on table lift hips off table and then back down, extend knees back to flat supine

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3
Q

Trendelenburg Test

A
  • pt lifts 1 foot by bending at the knee and stands on other leg
  • doc behind pt w/eyes at level of pelvis
  • gluteus medius should contract on the weight bearing side to elevate the pelvis on the unsupported side
  • positive test= weak gluteus medius/superior gluteal n if the unsupported side drops (opposite side)
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4
Q

Thomas Test

A
  • pt supine pulls knees to chest and then lowers 1 leg on the table to test flexibility of hip flexors (iliopsoas)
  • positive test= inability to fully extend at hip
  • test for psoas tension (hip flexor contracture)
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5
Q

Ober Test

A
  • pt lateral recumbent with hips and knees flexed
  • passively abduct and extend upper leg OR let upper leg hang off the table
  • stabilize the hip OR pull back on the ASIS to prevent pelvis rotation
  • positive test= leg will not fully adduct OR cannot easily press down on the leg
  • test for IT band contracture
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6
Q

OTHER considerations for the pelvis

A
  • *unequal hamstring length: standing flexion may be falsely positive/negative
  • must treat hamstrings and then reassess
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7
Q

What is important about the pelvic/ASIS compression test

A
  • induce force through ASIS posterior medially looking for hard end feel
  • Does NOT discriminate between iliosacral and sacroilial motion!!
  • indicates SI joint dysfunction on side of restriced motion
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8
Q

What is imporatant about pubic tubercles?

A
  • note asymmetry or pain to palpation

* common site for dysfunction post delivery or after stepping down hard

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9
Q

If my patient had a Left anterior innominate rotation what would my findings be?

A
  • standing flexion/pelvic compression= POS on L
  • ASIS height= inferior on L
  • Malleoli= Long/inferior on L
  • PSIS height= superior on L
  • butt out*
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10
Q

If my patient had a Right posterior innominate rotation what would my findings be?

A
  • standing flexion/pelvic compression= POS on R
  • ASIS height= superior on R
  • Malleoli= Short/superior on R
  • PSIS height= inferior on R
  • tuck butt*
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11
Q

If my patient had a superior or inferior shear what would my findings be?

A
  • superior shear= all superior on side of dysfunction

- inferior shear= all inferior on side of dysfunction

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12
Q

If my patient had a inflare or outflare of the innominate what would my findings be?

A
  • Inflare= all heights equal, ASIS to midline distance shorter
  • Outflare= all heights equal, ASIS to midline distance longer
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13
Q

What is my patient had a superior or inferior pubic shear what would my findings be?

A
  • standing flexion/pelvic compression= POS on side dysfunction
  • pubic bone/tubercle= superior or inferior on side dysfunction
  • other landmarks= equal OR have innominate shear
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14
Q

What if my patient had pubic compression (adduction) or pubic gapping (abduction)?

A
  • compression= B/L tenderness of each pubic rami and pubic symphysis
  • gapping= occurs often after childbirth, pelvic fractures or trauma to pelvis, very painful

*positve compression bilaterally, NEG standing flexion, everyhting else symmetrical

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15
Q

Treat a Left inflare of the innominate

A
  • pt supine doc standing on the right of the patient
  • flex hip/knee of L leg and place lateral to R knee
  • cephalad hand on asis on R and caudad hand on pt knee
  • hip is abducted/externally rotated until reach barrier
  • pt will adduct/internally rotate their hip by pushing into doc hand and doc provide equal counter force 3-5 sec
  • pt relax and new restrictive barrier engaged
  • perform until no new barriers
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16
Q

Treat a Right outflare of innominate

A
  • pt supine doc on pt left side
  • R hip/knee flexed and foot lateral to L knee
  • cephalad hand on R ASIS and caudad hand lateral to knee
  • pt is adducted/internally rotated until restrictive barrier reached
  • pt abduct/externally rotate the flexed hip doc provides equal counter force for 3-5 sec
  • pt relax and doc engage new restrictive barrier
  • perform until no new barriers met
17
Q

treat a Left superior innominate shear with ME and HVLA

A
  • pt supine with feet off table, doc at foot of table grasp above ankle and internally rotate/abduct pt L leg (protect hip keep close pack and allow LE to be a lever to work upon the innominate)
  • lean back to maintain axial traction and pt pull L hip toward L shoulder 3-5 sec
  • pt relax and doc engage new restrictive barrier until no new barriers are met
  • can also do with respiration maintaing force in inhale and increasing caudad force in exhale
  • HVLA= 2-3 breath cycles apply axial “leg tug” thrust to LE on exhale
18
Q

Treat a Right inferior innominate shear

A
  • pt lateral recumbant with R side up, doc behind pt
  • grasp ASIS and PSIS on dysfunctional side–> lateral distraction to gap SI joint, followed by cephalad force
  • pt inhale and exhale
  • maintain cephalad force during inhale, increase cephalad force on exhale
  • continue until no new barriers met
  • HVLA= after 2-3 cycles of respiration apply cephald force through the ASIS/PSIS contacts on exhale
19
Q

Treat a Right anterior innominate rotation with ME

A
  • supine:
  • doc on pt R side and flex pt hip.knee until reach restrictive barrier
  • pt push knee into doc hand while doc provide equal counterforce 3-5 sec
  • pt relax and doc flex pt into new restrictive barrier
  • continue until no new barriers *modification= pt fully extend knee and flex leg at hip
  • prone:
  • R innominate off table doc on R side
  • place hand on patient sacrum and pelvis to stabilize and have pt foot on thigh
  • flex hip and pt push foot into doc leg while doc provide equal counterforce 3-5 sec
  • pt relax and doc engage new barrier
  • perform until no new barrier met
20
Q

Treat a Left posterior innominate rotation with ME

A
  • supine:
  • pt lie near side of table to SI joint off table doc at L side
  • cephalad hand over R ASIS and caudad hand extend pt hip until reach restrictive barrier
  • pt push their leg toward ceiling doc provide equal counterforce 3-5 sec
  • pt relax doc engage new restrictive barrier until no new barriers met
  • prone:
  • doc at R side cephalad hand on L PSIS
  • caudad hand extend pt hip until restrict barrier reached
  • patient pull leg down to table and doc provide equal counter force 3-5 sec
  • pt relax and doc engage new barrier, continue until no new barriers
21
Q

Treat a pubic restriction (treatment done alternating fashion to treat both fixed compression and fixed gapping of pubic symphysis)

A
  • compression=
  • pt supine hips flexed to 45 knees flexed 90 feet fla ton table
  • doc abduct pts knees with forarms between knees
  • pt pull both knees medially (adduct) against doc while doc provide equal counterforce 3-5 sec, pt relax
  • gapping=
  • pt supine hips 45 knee 90 feet flat on table
  • knee closest to doc placed on abdomen while grasping lateral aspect of other knee wiht both hands
  • pt abduct knees doc provide equal counterforce 3-5 sec, pt relax
  • after 1 cycle of tx barrier is further engaged and repeat until no new barriers
  • HVLA= pt in frog leg posture and have pt inhale and exhale and apply thrust toward abduction at end of exhale
22
Q

Treat a Right anterior innominate rotation with HVLA

A
  • pt lateral recumbant R side up doc facing pt
  • pt hip/knees flexed until motion felt L5/S1 and pt top leg dropped off side table (foot should NOT reach floor)
  • doc place caudad forearm in line between pt PSIS and greater trochanter and cephalad hand on pt top shoulder
  • induce axial rotation by pushing shoulder posterior and rolling pelvis anterior until barrier engaged
  • pt inhale and exhale on exhale doc provide thrust in direction of shaft of femur inducing posterior rotation
23
Q

Treat a Right posterior innominate rotation with HVLA

A
  • pt lateral recumbent with L side up doc facing pt
  • cephald hand at L5/S1 caudad hand flex hips and knees until motion felt
  • pt straighten bottom leg and hook top in popliteal fossa
  • cephalad hand on pt elbow and forarm on pt shoulder
  • caduad hand on PSIS OR forearm on PSIS and posterior iliac crest
  • doc induce axial rotation by pushing top shoulder posterior and rolling pelvis anterior until barrier engaged
  • pt inhale and exhale and upon exhale doc provide thrust toward pts umbilicus inducing anterior rotation

OS II Sacrum/Innominate (2 decks)

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