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OS II > Innominates _ES > Flashcards

Innominates _ES Flashcards

1
Q

What is the role of the pelvis?

A
  • body support
  • locomotion
  • maintains stability - distributes the effects of mass, gravity, and mechanical forces from above and below
  • at base of vertebral column, yet still long way from the ground
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2
Q

The weight of the upper body is directed through the ___ and ____ downward and the resistance to forces from below forma balance at the pelvis

A

spine

axial skeleton

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3
Q

What creates a great potential for SD?

A

injury, postural and muscle imbalances directed from above or below towards the pelvis

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4
Q

What influences LE circulation and drainage?

A

pelvic diaphragm and inguinal area

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5
Q

What are the main functions of the pelvis?

A
  • biomechanical function and balance: foundation for body support and locomotion
  • reproduction (genital structures)
  • elimination (GI and urologic)
  • vascular and lymphatic functions for the region
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6
Q

What are the bones of the inominate?

A

ilium, pubis, and ischium

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7
Q

How many ossification centers are in the acetabulum?

A

3

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8
Q

What are major pelvic ligaments?

  • anterior
  • posterior
A

anterior

  • sacropinous
  • iliolumbar
  • anterior sacroiliac l
  • inguinal l

posterior

  • sacrotuberous
  • posterior sacroiliac l
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9
Q

What is the sacrospinous l?

A

sacrum to spine of ischium

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10
Q

What is iliolumbar l?

A

from ilia to 5th lumbar vertebra

  • stabilization of L5 (possibly L4)
  • stabilizes anterior motion of the lower lumbar spine
  • restricts anterior and rotary motion of L5
  • blends with the upper part of the anterior SI l
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11
Q

What is anterior sacroiliac l?

A

covers much of SI joint

  • connects the 3rd sacral segment to the lateral side of the pre-auricular sulcus
  • thicker than the posterior SI ligaments to prevent the sacrum from “popping” out anteriorly
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12
Q

What is inguinal l?

A

ASIS to superior pubic rami

  • consists of thick bands which extend from the ASIS to the pubic tubercle
  • forms the floor of the inguinal canal through which an indirect inguinal hernia may develop
  • give origin to the internal oblique and transversus abdominis m
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13
Q

What is sacrotuberous l?

A

sacrum to ischial tuberosity

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14
Q

What is posterior sacroiliac l?

A

covers much of SI joint

  • inferior fibers from the 3rd and 4th sacral segments, ascend to the PSIS and posterior end to the internal lip of the iliac crest
  • blends with STL and thoracolumbar fascia
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15
Q

What is the interosseous sacroiliac l?

A

major bond between the bones, filling the irregular space posterosuperior to the joint
-covered posteriorly by the posterior sacroiliac l

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16
Q

What is the pubic symphysis?

A
  • lies anteriorly btwn the adjacent surfaces of the pubic bones
  • each of the joint’s surfaces is covered by hyaline cartilage and is linked across the midline to adjacent surfaces by fibrocartilage
  • joint surrounded by interwoven layers of collagen fibers and the two major ligaments: superior pubic ligmaent and inferior pubic ligament
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17
Q

Describe the forces of the pubic symphysis

A

extremely strong posterior ligaments

articulation at SI joint

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18
Q

Describe the innominate biomechanics of the heel strike

  • innominate rotation
  • muscles
A
  • right leg glides forward and this is aided by the right innominate rotating posteriorly
  • contralateral innominate rotates anteriorly
  • iliopsoas and quadriceps femoris were contracted to flex the LE at the hip
  • iliopsoas contraction and motion of the swing phase act upon the innominate to cause posterior rotation
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19
Q

Describe innominate biomechanics of toe off

  • rotation
  • muscles
A
  • body does a controlled fall forward with the left leg gliding forwards and anterior rotation of the innominate is mainly a passive process
  • contralateral innominate rotates posteriorly, mainly an active process
  • iliopsoas relaxation allows anterior rotation of the innominate with gluteus maximus and hamstring contraction to extend the LE at the hip
  • ipsilateral e spinae and quadratus lumborum contraction aids anterior innominate rotation
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20
Q

5 major hip/pelvis muscle groups

A
  • flexors - 2 at hip, 2 act at hip and knee
  • external rotators -6
  • adductors - 3 plus 2 minor
  • abductors -3
  • extensors - 4
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21
Q

hip flexors

A

major

  • iliacus
  • psoas

minor

  • rectus femoris
  • sartorius
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22
Q

iliacus

A

hip flexor major

from ala of ilia (iliac fossa) to lesser trochanter fo the femur

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23
Q

psoas (major and minor)

A

major hip flexor

from the 5 lumbar vertebrae to the lesser trochanter of the femur

24
Q

rectus femoris

A

minor hip flexor

AIIS to patella

25
Q

sartorius

A

minor hip flexor

ASIS to medial tibia

26
Q

Dysfunction of what muscles may cause an anterior rotation of the innominate and/or inferior shear at the pubes?

A

rectus femoris, iliacus, or the ipsilateral adductor group

27
Q

Hip extensors

A
  • gluteus maximus

- hamstrings: biceps femoris, semitendonosis, semimembranosis

28
Q

gluteus maximus

A

hip extensor

posterior iliac fossa to posterosuperior aspect of greater trochanter and femur

29
Q

semimembranosis

A

hip extensor - hamstring

ischial tuberosity to medial tibia

30
Q

semitendinosis

A

hip extensor - hamstring

ischial tuberosity to medial tibia

31
Q

biceps femoris

A

hip extensor -hamstring

ischial tuberosity and STL to lateral fibula and tibial plateau

32
Q

hamstring tension may cause a ____ rotation of the innominate and affect pelvic mechanics

A

posterior

33
Q

hip adductors

A

major

  • ad magnus
  • ad brevis
  • ad longus

minor

  • gracilis
  • pectineus
34
Q

major adductors

  • what muscles
  • O
  • I
A

brevis, magnus, and longus (superior to inferior)
O: body and inferior ramus of pubis
I (brevis and magnus): pectineal line and proximal part of linea aspera of the femur
I (longus): superomedial surface of the distal femur

35
Q

pectineus

A

minor hip adductor
O: pectineal line on the pubic bone
I: pectineal line on the femur

36
Q

gracilis

A

minor hip adductor
O: inferior ramus of the pubis
I: the medial aspect of the proximal femur and tibial plateau

37
Q

hip abductors

A

gluteus medius
gluteus minimus
tensor fascia lata

38
Q

gluteus medius

A

hip abductor

posterior ischial fossa to superior greater trochanter

39
Q

gluteus minimus

A

hip abductor

posterior ischial fossa to superior greater trochanter

40
Q

tensor fascia lata

  • muscle group
  • O/I
A

hip abductor
O: from anterior part of external lip of the iliac crest, the lateral surface of the ASIS and the notch inferior to the ASIS
I: upon the iliotibial band, which eventually inserts into the lateral condyle of the tibia

41
Q

trendelenburg sign

A
  • used to determine whether the pt has adequate hip abductor strength, particularly of the gluetus medius.
  • pt instructed to stand on both feet and slowly raise one foot off the ground without additional support
  • if the pt has adequate abductor strength then the both hips should remain level or slightly elevated to the standing side
  • should maintain an upright posture w/o lateral tilt

-drop of pelvis when lifting leg opposite to weak gluteus medius

42
Q

hip external rotators

A

piriformis
obturator - externus and internus
gemelli - superior and inferior
quadratus femoris

43
Q

piriformis

  • muscle group
  • I/O
  • abnormal contraction
A
  • hip external rotator when hip is extended and abductor when hip is flexed
  • from anterior sacrum to sup greater trochanter
  • abnormal contraction may cause sciatica (sciatic N pierces piriformis in 10-12% of population)
  • *the only hip rotator that connects directly to the sacrum**
44
Q

gemelli superior and inferior

A

hip external rotator

from ischial spine to greater trochanter

45
Q

obturator internus and externus

A

hip external rotator

from obturator membrane to the greater trochanter

46
Q

quadratus femoris

A

hip external rotator

from ischial tuberosity to greater trochanter

47
Q

secondary muscle attachments

A
  • rectus abdominis
  • transversus abdominis
  • internal and external oblique
  • quadratus lumborum
48
Q

dysfunction of the quadratus lumborum may produce symptoms similar to a groin pull or hernia by irritating the _____ and ____ nerves as they pass just anterior to this muscle

A

ilioinguinal and iliohypogastric L1

49
Q

What separates the greater sciatic foramen and lesser sciatic foramen?

A

sacrospinous ligament

50
Q

What can be seen in the gravitational line?

A
  • auditory meatus
  • acromion process
  • greater trochanter
  • body of L3
  • anterior 1/3 of sacrum
  • lateral condyle of knees
  • lateral malleolus
51
Q

What are some problems of the pelvis?

A
  • anterior/posterior innominate rotation
  • superior/inferior innominate shear
  • out-flare or in-flare
  • pubic bone shear
  • pubic bone abduction/distraction
  • pubic bone adduction/compression
52
Q

What palpatory landmarks are used for innominate SD?

A
  • iliac crests
  • ASIS
  • pubic tubercles
  • medial malleoli heights (least reliable)
  • PSIS
  • ischial tuberosities - only used in diagnosis for small hemipelvis (one side of pelvis is congentially smaller than the other)
53
Q

What is the order of finding SD diagnosis?

A

lateralization

  • standing flexion
  • ASIS compression

palpation of landmarks

  • iliac crest
  • ASIS
  • pubic tubercles
  • PSIS
  • medial malleoli
  • possible ischial tuberosity
54
Q

What is the standing flexion test?

A
  • pt standing, physician behind pt with eyes at level of patient’s PSIS
  • contact the inferior aspect of the PSIS bilaterally
  • ask pt to bend forward with hands towards toes, knees straight
  • let thumbs follow the motion of the PSIS

+ test = one PSIS moves farther superiorly
indicates SI joint dysfunction on the side that elevates first

55
Q

What is the ASIS compression test?

A
  • pt supine
  • physician stands with dominant eye closest to the patient’s body
  • contact the ASIS bilaterally, induce a force through aSIS toward the table (posterior and medially) alternating between right and left hands

+ test = “hard end-feel” or “restriction of motion” on one side
indicates SI joint dysfunction on the side of restricted motion

OS II (4 decks)

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