Innominates

Question 1

3 bones of innominate? 3 joints?

Answer 1

ilium, ischium, pubis- fusion begins around age 16

• involves three major joints: SI, pubic symphysis, acetabulum
• the arrangment creates a compressive lateral force and friction to withstand the vertical load

Question 2

three types of movements

Answer 2

1-2 are physiologoic motions

1. Rotation: anterior and posterior
2. Flaring: lateral and medial
   3: non-physiological motion shearing: superior/inferior

Question 3

If Standing flexions test positive on right…. what are findings for right anteriorly rotated innominate

Answer 3

ASIS: inferior on right
PSIS: superior on right
Pubic tubercle: inferior on right

Question 4

S/I innominate shears

Answer 4

• non-physiologic motions- painful and indicative of compensated ligaments - looks as though one innominate is posterior or inferior on the SI joint

Question 5

innominate flares

Answer 5

• Lateral position change: ASIS medial or lateral compared to usual position- may be though of as rotation of an innominate along a vertical axis

Question 6

pubic symphysis shears

Answer 6

• can be superior, inferior or compressed- generally seen with saddle injuries or other trauma

Question 7

• happens with extension of hip
• standing flexion test positive-
  ASIS moves inferiorly (caudad)- PSIS moves superiorly (cephalad)-
  etiology: tight quads, leg length discrepancy- Patient may c/o hamstring tightness, spasm or even sciatica

Answer 7

anterior rotation of innominate

Question 8

• happens with flexion of the hip
  + standing flexion test
• ASIS superior (cephalad)- PSIS inferior (caudad)- superior pubes-ipsilateral-
  Patient may c/o: inguinal/groin pain due to rectus femoris dysfunction, medial knee pain due to sartorius dysfunction

Answer 8

posterior rotation

Question 9

Standing flexion + on right
ASIS: superior right
PSIS: inferior right
Pubic tubercle: superior right

Answer 9

right posteriorly rotated innominate

Question 10

+ standing flexion test ipsilateral
- ASIS medial- PSIS lateral
- patient c/o pelvic or sacroiliac joint pain- tender sacroiliac ligaments and inguinal ligaments,
tender point on pubic symphysis.

Answer 10

Medial flare: Innominate Inflare

Question 11

+ standing flexion test ipsilateral
- ASIS lateral- PSIS medial
- patient c/o pelvic or sacroiliac pain
tender sacroiliac ligaments and inguinal ligaments

Answer 11

Lateral flare: Innominate outflare

Question 12

(+) Standing Flex test-ipsilateral
ASIS superior, PSIS superior, Pubic tubercle superior
Patient may c/o pelvic pain
Palpatory findings: Tissue texture changes and tenderness at ipsilateral SI and pubes

Answer 12

superior innominate shear: “upslip”

Question 13

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS inferior, PSIS inferior, Pubic tubercle inferior
Patient may c/o pelvic pain.
Palpatory findings: Tissue texture changes and tenderness at ipsilateral SIJ and pubes.

Answer 13

Inferior innominate shear: “downslip”

Question 14

(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle superior
Patient may c/o pelvic pain or pubic arch pain
Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes- often happen with saddle injuries or mountain biking

Answer 14

superior pubic shear

Question 15

(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle inferior
Patient may c/o pelvic pain or pubic arch painHypertonic adductors
Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes

Answer 15

inferior pubic shear

Question 16

(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle level, but very tender
Patient may c/o pelvic pain or pubic arch pain (runners, extreme athletes…)
Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes

Answer 16

compressed pubic symphysis

Question 17

what axis does anterior/posterior rotation occur around?

Answer 17

inferior transverse aka iliosacral axis

Question 18

anterior rotation happens with….posterior rotation happens with…..

Answer 18

• anterior happens with extension of hip- posterior happens with flexion of hip

Question 19

what flare happens when walking?

Answer 19

Inflaring happens with extension of the hip, or anterior innominate rotation

Outflaring happens with flexion of the hip, or posterior innominate rotation

Question 20

when do bones of inomms fully fuse?

Answer 20

teenage years

Question 21

ddx of pelvis?

Answer 21

perform standing flexion test
reset patients hips
perform pelvic compression test (side meeting restriction first is dysfunctional)
- assess ASIS, pubic symphysis, PSIS

order of tx:

1. area of greatest restriction
2. pubic bone dys.
3. innominate shears, flares, then rotations

Question 22

what can cause false positive in standing flexion test?

Answer 22

ipsilateral quadratus lumborum: pulls inom up

contralateral hamstrings: holds opposite innominate down

Question 23

MET for inferior innominate shear?

Answer 23

ddx: right inferior innom. shear
physician is on dysf. side, patient is in supine position
with hand contact pubic symphasis - laterally distract the right innom from SI joint then push anteriorly while having patient inhale and exhale

Question 24

MET for superior innom. shear?

Answer 24

stand at foot of table, contact the patients dysfunctional leg,
hold ankle. abduct and flex or extend leg until SI joint is decompressed and tension is relaxed
internally rotate leg to close-pack the femoral heead into the acetabulum,
apply traction to leg by slowly leaning back
instruct patient to pull their hip cephalad and to take 3-4 deep breaths
have patient relax, then repeat

Question 25

MET for anteriorly rotate innominates

Answer 25

• physician is on dysfunction side, patient is in supine
  place patients knee against shoulder, flex hip to feather edge thus moving the innom. posterior
• have pt. push knee into your shoulder
• repeat

Question 26

MET for posteriorly rotated innoms.

Answer 26

stand on dysfunctional side, patient is supine, place hip against table to prevent pt. from rolling off. have them drape their dysfunctional leg off of table. contact contralateral ASIS to stabilize. extend patients leg, have them lift their leg toward your hand

Question 27

MET for innom. outflares

Answer 27

stand on dysf side, patient is supine
flex pateitns knee, contact patients contralateral ASIS with your cephalad hand.
push knee medially (inducting hip adduction) and instruct patient to push knee laterally

Question 28

MET for innom. inflares

Answer 28

flex knee to 90 degrees, contact opposite ASIS for stabilization, pull knee laterally (inducing hip abduction) and instruct patient to push knee medially

Question 29

MET for superior pubic shear

Answer 29

same as tx for posteriorly rotated innoms (take leg into extension off the side of the table)

Question 30

MET for inferior pubic shear

Answer 30

have pt. in supine, place patient knee against chest flexed - have patient push knee inferiorly (same as for anteriorly rotated inomms)