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OMM > Innominate Mechanisms and Diagnosis > Flashcards

Innominate Mechanisms and Diagnosis Flashcards

1
Q

Sacroiliac Dysfunction Presentation

A
  • Highly variable
  • Groin pain, hip pain
  • Pain below iliac crest
  • Medial buttock pain
  • Lateral sacral pain
  • Referred pain can be to groin, butt, or posterior thigh
  • Usually unilateral
  • There is often assoc. hamstring tightness
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2
Q

Joints of the pelvis

A
  • 2 sacroiliac joints
  • Symphysis pubis
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3
Q

What kind of joint are sacroiliac joints

A
  • Diarthrodial (synovial) joint
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4
Q

Physiologic motion of Innominate

A
  • Rotation
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5
Q

3 true sacroiliac ligaments

A
  • Anterior SI ligaments
  • Interosseous SI ligaments
  • Posterior SI ligaments
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6
Q

3 accessory pelvic ligaments

A
  • Sacrotuberous
  • Sacrospinous
  • Iliolumbar
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7
Q

Sacrotuberous ligament anatomy

A
  • Attaches from inferior medial border of sacrum to ischial tuberosity and posterior sciatic notch
  • Blends w/ other sacral ligaments
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8
Q

Sacrospinous ligament anatomy

A
  • Attach to ischial spines
  • Divide the space into greater and lessor sciatic foramen
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9
Q

Iliolumbar ligament anatomy

A
  • Attaches from anterior iliac crest to transverse processes of L4, L5
  • Lower fibers attach to anterior sacral base, blending w/ ant SI lig
  • Prone to irritation by lumbosacral instability
  • Iliac crest and transverse processes of L4-5 can be tender, especially the area b/w the two
  • Referred pain to groin via ilioinguinal nerve
  • Need to assess ligaments as well as bony structures
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10
Q

Levator ani group

A

Make up pelvic diaphragm

  • Pubococcygeus
  • Puborectalis
  • Iliococcygeus
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11
Q

Primary intrinsic pelvic muscles

A
  • Levator ani group
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12
Q

Secondary pelvic muscles

A
  • Rectus abdominis
  • Internal and external oblique
  • Transverse abdominis
  • Quadratus lumborum
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13
Q

Pelvis lower extremity muscles (Anterior and medial compartments)

A

Anterior and medial compartments

  • Iliacus
  • Sartorius
  • Rectus femoris
  • Gracilis
  • Adductor group
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14
Q

Pelvis lower extremity muscles (Lateral compartment)

A
  • Tensor fascia lata-ITB
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15
Q

Pelvis lower extremity muscles (Posterior compartment)

A
  • Glutei maximus, medius and minimus
  • Obturator externus and internus
  • Superior and inferior gemeli
  • Biceps femoris
  • Semimembranosus
  • Semitendinosus
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16
Q

Muscles with fasical coverings continuous w/ the posterior SI ligament?

A
  • Piriformis
  • Biceps femoris Inflammation of the SIJ could affect piriformis and biceps femoris through reactive muscle spasm
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17
Q

What muscle ligament blends w/ posterior iliosacral ligaments over the lower half of the SIJ?

A
  • Gluteus maximus
18
Q

Innominante motion

A
  • Can be functionally considered as part of the lower extremities
  • Rotate anteriorly and posteriorly about the inferior transverse axis of the sacrum = inferior limb SIJ at level of S3
  • Induced by hip motion such as during gait - Or by muscular forces from above or below
19
Q

Motion of Pubes

A
  • Cartilagenous joint w/ fibrous disc
  • Allows for twisting/ rotational mvmt of the innominate about a transverse axis
  • Ipsilateral rotation inferiorly w/ anterior rotation of ilium
  • Can be sheared superiorly or inferiorly
  • Can be sheared anteriorly or posteriorly; rare
  • Can be gapped or compressed; rare
20
Q

Motion of Walking Cycle: Right Heel Strike

A
  • Quads activate and start anterior right innominate rotation
  • Weight bearing increases anterior rotation about the inferior transverse sacral axis (S3)
  • Sacrum rotates about alternate oblique axes
  • Shear forces are taking place at pubes
21
Q

Motion of Walking Cycle: Right Toe-off

A
  • Hamstrings activate and start posterior right innominate rotation
  • Shift in weight bearing facilitates posterior rotation about the inferior transverse sacral axis (S3)
  • Sacrum rotates about alternate oblique axes
  • Shear forces are taking place at pubes
22
Q

Physiologic Innominate Dysfunction

A
  • Muscles, connective tissue, and joints remain in positions that are normally a part of physiologic motion
  • These dysfunctional because they have not returned to neutral
  • These consist of anterior or posterior rotations
23
Q

Non-Physiologic Innominate Dysfunction

A
  • Often induced by trauma
  • Findings are not consitent w/ physiologic motion
  • These include innominate and pubis shears

*may occur together or independently

24
Q

Diagnosis of Innominate Dysfunction

A
  • Motion restriction and asymmetry of the sacroiliac joint and pubic symphysis

*this can manifest at SI joint

*innominates anteriorly

*Pubic symphysis

*internal/ external rotation asymmetry of the lower extremities

  • Tissue texture change and tenderness are also clues

*iliolumbar ligament

*sacral sulcus

*anterior lumbar tenderpoints (AL1-5)

*other anterior tenderpoints

25
Q

Lateralization test checks for

A
  • Motion of the SIJ
26
Q

PSIS position vs. Ipsilateral ASIS during pevlic exam

A
  • PSIS postion will be opposite of the ASIS on the same side
27
Q

Standing vs. Seated Flexion Test

A
  • Standing flexion test tells if theres anything wrong w/ the SIJ and which side
  • Seated tells you whether its a sacral or innominate problem

*pos. test = sacral problem

*neg. test = iliac (innominate) problem

28
Q

Sacroilieac vs. Iliosacral problem

A
  • Sacroilieac = problem w/ sacrum
  • Iliosacral = problem w/ ileum
29
Q

Posterior Innominate Dysfunction Anatomical Signs

A
  • Entire innominate appears rotated posterior relative to other side of hip
  • Standing forward flexion test is pos. on that side

*PSIS rises on the side of SIJ restriction

  • Supine

*ASIS is superior (and posterior)

*Apparent short lower extremity

  • Prone

*PSIS inferior

  • Standing

*PSIS is inferior

30
Q

Posterior Innominate Dysfunction Symptoms

A
  • Tight Sacrotuberous ligament on same side
  • Inguinal groin pain/ tenderness due to rectus femoris dysfunction
  • Medial knee pain due to sartorious dysfunction
31
Q

Anterior Innominate Rotation Signs

A
  • Entire innominate appears rotated anterior relative to other side of hip
  • Standing forward flexion test is pos. on that side
  • Supine

*ASIS is anterior and inferior

*Pos. ASIS compression test ipsilaterally

*Apparently long lower extremity

  • Prone

*PSIS superior

*SIJ restricted

  • Standing

*PSIS is superior

32
Q

Anterior Innominate Rotation Symptoms

A
  • Iliolumbar ligament tenderness same side
  • Tissue texture changes at the ipsilateral ILA (inferior lateral angle) of the sacrum
33
Q

Superior Innominate Shear Signs

A

Dysfunctional side has

  • Superior ASIS
  • Superior PSIS
  • Superior pubic ramus?
  • Pos. ASIS compression test
  • Pos. standing flexion test
  • Often there are tissue texture changes at ipsilateral SIJ and/or isilateral pubes
  • More common than inferior shears
34
Q

Inferior Innominate Shear Signs

A

Dysfunctional side has

  • Inferior ASIS
  • Inerior PSIS
  • Inferior pubic ramus
  • Pos. ASIS compression test
  • Pos. standing flexion test
  • Often there are tissue texture changes at ipsilateral SIJ and/or ipsilateral pubes
35
Q

Shear Dysfunctions

A
  • Non-physiological
  • Occur in directions not normally assoc. w/ sacroiliac motion
  • Should be treated before physiologic dysfunctions
36
Q

Innominate Flare Dysfunctions

A
  • Involves a positional change w/ the ASIS becoming more medial or lateral to its usual position
  • Visualize rotation of the innominate about a vertical axis
37
Q

Innominate Outflare Dysfunction Sign

A
  • ASIS more lateral on dysfunctional side

*muscles lax on side of outflare

*SIJ compressed

38
Q

Innominate Inflare Dysfunction Signs

A
  • ASIS more medial on dysfunctional side
  • Muscles are taut on side of inflare (medial flare)
  • SIJ is relatively separated
39
Q

Vertical Pubic Shears

A
  • Isolated vertical pubic shears may or may not actually exist
  • Ther emay be a component of rotation or subluxation that is difficult to diagnose
  • Sometimes the ASISs and PSISs appear displaced w/ one superior and the other inferior
  • Named for side of dysfunction
  • Often superior pubic shear is assoc. w/ a posterior or superior (up-slipped) ilium and opposite w/ inferior pubic shear
40
Q

Pubic Shears

A
  • Anterior pubic shears are uncommon and usually assoc. w/ trauma
  • One side of the symphysis is anterior to the other
41
Q

Pubic Symphysis Dysfunction Signs

A
  • Check for L5 counterstrain tenderpoint
  • Compression dysfunction = bulge
  • Seperation dysfunction = divet or gapping

OMM (6 decks)

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