Innominates Flashcards
What are innominates?
Hip bones
What are the important bony landmarks?
Iliac crests ASIS Pubic tubercles Medial Malleoli PSIS
What are the pelvic ligaments that stabilize the pelvis?
Iliolumbar
Sacroiliac - anterior and posterior
Sacrospinous
Sacrotuberous
What does muscle tension do for the pelvis and what can it lead to?
Stabilizes pelvis but can also lead to pain and somatic dysfunction
Form closure
SI joint stabilized by gravity and shape of joint (sacrum and innominate bones)
Force closure
SI joint stabilized by joint compression by muscles, ligaments, thoracolumbar fascia (all non-bone things)
Form closure and Force closure are important for?
Stable foundation for trunk and to transmit force with gait
SI joint pain is _____ % of chronic low back pain
15-25%
What are the 3 innominate motions?
Innominate rotation
Innominate and pubic shear
Innominate flare
When testing for innominate dysfunction what are you comparing bony landmarks to?
The contralateral side!
If an innominate rotates anterior, describe the locations of the ASIS and PSIS
ASIS = inferior PSIS = superior
If an innominate rotates posterior, describe the locations of the ASIS and PSIS
ASIS = superior PSIS = inferior
At what stage in walking is the innominate rotated posteriorly?
Heel strike
At what stage in walking is the innominate rotated anteriorly?
Toe off
What motions of the innominates are generally pathologic and cause pain?
Shear and flare
Innominate shear
ENTIRE innominate is superior or inferior
Pubic shear
ONLY PUBIC TUBERCLES are superior or inferior
Innominate flare
ASIS is more medial or lateral compared to opposite side - measure relative to umbilicus
Innominate inflare
ASIS more medial
Innominate outflare
ASIS more lateral
What are the 3 sacral motions?
Flexion (nutation)
Extension
Oblique axis rotation
The sacrum flexes and extends around what axis?
Transverse axis
Sacral nutation
Flexion
When the sacrum flexes around the transverse axis, what tips forward?
Sacral base
The sacrum rotates around what axis?
Oblique
What is an oblique axis?
Vertical axis slightly tilted
How is the sacral oblique axis named?
For which sacral base (R/L top corner) it passes through
Ex. Left oblique axis with right rotation. What is the sacral movement?
Top right sacral base rotates posteriorly
4 steps to assessing innominates for somatic dysfunction
- Screen innominates for somatic dysfunction (TART)
- Lateralization tests
- Palpate bony landmarks
- Diagnose innominate somatic dysfunction
How do you screen innominate for somatic dysfunction (step 1)?
Have them stand, and you sit behind them and assess for posterior spine/innominates TART - find one side that is worse
What are the lateralization tests (step 2)?
ASIS compression test
Standing flexion test
ASIS compression test
Posteromedial compression of both ASIS
- find which side is more resistant to compression
Standing flexion test
Have patient stand and you monitor both PSIS’s with your thumbs. Have patient bend over and see which PSIS moves SUPERIORLY
For the lateralization tests, the dysfunctional sides move how?
ASIS compression test - harder end feel
Standing flexion test - PSIS moves superior
What are the bony landmarks to palpate (step 3)?
Iliac crests ASIS Pubic tubercles Medial malleoli PSIS
Anterior rotated innominate
Iliac crests and pubic tubercles = EVEN
ASIS and medial malleolus = INFERIOR
PSIS = SUPERIOR
Posterior rotated innominate
Iliac crests and pubic tubercles = EVEN
ASIS and medial malleolus = SUPERIOR
PSIS = INFERIOR
Superior innominate shear
ALL boney landmarks are SUPERIOR
Inferior innominate shear
ALL boney landmarks are INFERIOR
Innominate inflare
ASIS more medial
Innominate outflare
ASIS more lateral
Superior/Inferior pubic shear
Pubic tubercle ONLY is either superior or inferior compared to other side
What should you do before you begin the ASIS compression test?
Reset the hips!
- Have patient push hips toward sky and then back down
