Innominate Dx And Tx Flashcards
1
Q
3 bones that make up the innominate
A
Ilium
Ischium
Pubis
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
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)
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)
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
6
Q
OTHER considerations for the pelvis
A
- *unequal hamstring length: standing flexion may be falsely positive/negative
- must treat hamstrings and then reassess
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
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
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*
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*
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
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
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
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
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
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
