Innonimates

Question 1

Anatomy

Answer 1

Made up of :
 Ilium
Ischium
Pubis

Fusion begins around age 16

Involved in 3 major joints
SI
Pubic Symphysis
Acetabulum

Question 2

Self-Bracing Mechanism

Answer 2

Attained by form + force closure

Model that allows for efficient locomotion and weight transfer

Form closure via structural anatomy of wedge shaped sacrum

Force closure requires horizontal, compressive force and friction to withstand vertical load

Question 3

Dorm Closure

Answer 3

Structural anatomy of the wedge shaped sacrum

Internal structure of the sacroiliac joints

Question 4

Force Closure

Answer 4

Creates compressive lateral force and friction to withstand vertical load

Accomplished by:
Sacrotuberous and sacrospinous ligaments
Multifidus, Latissimus dorsi, Piriformis, Gluteus maximus, biceps femoris

Question 5

3 types of movements

Answer 5

Rotation
 Anterior
 Posterior

Flaring
 Lateral
 Medial

Shearing
 Superior
 Inferior

Rotation and flaring are physiologic and shearing is non-physiologic

Question 6

Innominate Diagnosis

Answer 6

Standing flexion test

Landmarks
Anterior superior illiac spine
Posterior superior iliac spine
(pubic rami)

Question 7

Standing flexion test

Answer 7

Give the lateralityof the somatic dysfunction

Positive test on the right = right innominate somatic dysfunction

Question 8

Anterior rotation happens with

Answer 8

extension of the hip

Question 9

Posterior rotation happens with

Answer 9

flexion of the hip

Question 10

Anteriorly Rotated Innominate

Diagnostic Criteria

Answer 10

(+) Standing Flex test-ipsilateral
ASIS inferior (caudad)
PSIS superior (cephalad)
Inferior pubes -ipsilateral

Question 11

Anteriorly Rotated Innominate

Etiology

Answer 11

Tight quads, leg length discrepancy

Question 12

Anteriorly Rotated Innominate

Patient may c/0

Answer 12

hamstring tightness, spasm or even sciatica on ipsilateral side.

Question 13

Posteriorly rotated Innominate

Diagnostic Criteria

Answer 13

(+) Standing Flex test-ipsilateral
ASIS superior (cephalad)
PSIS inferior (caudad)
Superior pubes-ipsilateral

Question 14

Posteriorly rotated Innominate

patient may c/o

Answer 14

inguinal/groin pain (due to rectus femoris dysfunction)

Medial knee pain (due to sartorius dysfunction)

Question 15

Innominate Flare

Answer 15

Lateral positional change
ASIS medial or lateral compared to its usual position
May be thought of as rotation of an innominate along a vertical axis

Question 16

Medial Flare

Answer 16

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS medial
PSIS lateral

Patient may c/o pelvic or sacroiliac joint pain.

Tender sacroiliac ligaments and inguinal ligaments (on either side), tender pubic symphysis
Treatment: ME

Question 17

Lateral Flare

Answer 17

Diagnostic Criteria on Side of Restriction:
 ASIS lateral
PSIS medial
(+) Standing Flex test-ipsilateral

Patient may c/o pelvic or sacroiliac pain.

Tender sacroiliac ligaments and inguinal ligaments (on either side)
Treatment: ME

Question 18

Innonimate Shear

Answer 18

Traumatic positional change

Apparent vertical transmission of the entire innominate within the S-I joint, either superiorly or inferiorly

Question 19

Superior innonimate Shear

Answer 19

Diagnostic Criteria on Side of Restriction:
    (+) 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

Question 20

Inferior innonimate Shear

Answer 20

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.

Question 21

Pubic SD

Answer 21

Three diagnoses
 Superior
Inferior
Compressed

Generally seen with saddle injuries or other trauma

Question 22

Superior Pubic Shear

Answer 22

Diagnostic Criteria on Side of Restriction:
(+) 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

Question 23

Inferior Pubic Shear

Answer 23

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle inferior

Patient may c/o pelvic pain or pubic arch pain
Hypertonic adductors

Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes

Question 24

Compressed pubic symphysis

Answer 24

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-equivocal
ASIS and PSIS level
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