Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OMM > L22-23: Sacrum I-II > Flashcards

L22-23: Sacrum I-II Flashcards

1
Q

Three steps to diagnosing sacrum

A
  1. ) History/SeFT:
    - history of possible sacral SD such as LBP, hip pain, sciatica, upper back pain, neck pain, HAs, bowel or bladder dysfunction
    - pos SeFT: determines side of iliosacral SD and/or pubic SD
  2. ) Two landmarks: determine side of deep sulcus and side of inferior/posterior ILA
  3. ) A test: Sphinx test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

For COMLEX purposes, what does positive SeFT indicate?

A
  • SeFT is positive on the opposite side of axis for torsions

- Or SeFT is positive on the same side of flexed or extended sacral SD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Categories of sacral diagnoses

A
  1. ) Torsions

2. ) Flexions/extensions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How sacral torsions are named?

A

First name = direction of rotation
Last name = direction of oblique axis

  1. ) Forward torsions (same first and last name): eg. Left on left, right on right
  2. ) Backward torsions (opposite first and last names): eg. Right on left, left on right
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How sacral flexions/extensions are named?

A
  • First name: left or right
  • Last name: (unilateral sacral) flexion or extension
  • Flexion or extension if deep sulcus and post/inf ILA on same side
  • If Sphinx test positive = extension
  • If Sphinx test negative = flexion
  • Name the flexion for the side of deep sulcus
  • Name the extension for the side of the shallow sulcus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

To diagnose sacral torsion, what are the placements of the two landmarks?

A
  • Deep sulcus and inferior/post ILA on opposite sides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

To diagnose flexed/extended sacrum, what are the placements of the two landmarks?

A
  • Deep sulcus and inferior/post ILA on same sides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Step 3 in diagnosing sacral SD is the Sphinx test. What does this test differentiate? Explain results of test

A
  • Differentiates bw a forward or backward torsion
  • Differentiates bw a unilateral flexion or extension
  • Positive Sphinx test: ILAs become less symmetric (more asymmetric). Indicates sacral base backwards/posterior. Indicates backwards sacral torsion or unilateral sacral extension
  • Negative Sphinx test: ILAs become more symmetric. Indicates sacral base is forward/anterior. Indicates forward sacral torsion or unilateral sacral flexion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the possible motions of the sacrum?

A
  1. ) Flexion / extension on a transverse axis (horizontal line through sacrum): base moves anteriorly (apex posteriorly) or base moves posteriorly (apex anteriorly)
  2. ) Rotation on an oblique axis (from sup area of SI joint to contralateral inf area of SI joint): anterior aspect of sacrum faces right or left
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

To what structure on the sacrum are sacral motions named on?

A
  • Sacral base
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When the L-spine flexes, what happens to the sacrum?

A
  • Sacrum extends
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When L5 rotates to the left, what happens to the sacrum?

A
  • Rotates to the right
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ILA is posterior/inferior on left, deep sulcus on right. Sphinx test is positive. What is the diagnosis? Name the diagnosis? Is there a sacral tenderpoint associated with this? Sacral drag direction of ease? Spring test positive or negative?

A
  • Opposite ILA to deep sulcus indicates torsion
  • Positive sphinx test: backward torsion or unilateral sacral extension
  • Diagnosis = backward sacral torsion
  • Name of diagnosis = left on right backward sacral torsion (meaning = rotated left on right oblique axis)
  • S2 tenderpoint
  • Caudad sacral drag
  • Positive spring test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ILA is posterior/inferior on left, deep sulcus on right. Sphinx test is negative. What is the diagnosis? Name the diagnosis? Is there a sacral tenderpoint associated with this? Sacral drag direction of ease? Spring test positive or negative?

A
  • Opposite ILA to deep sulcus indicates torsion
  • Negative sphinx test: forward torsion or unilateral sacral flexion
  • Diagnosis = forward sacral torsion
  • Name of diagnosis = left on left forward sacral torsion (meaning = rotated left on left oblique axis)
  • No tenderpoint
  • Cephalad sacral drag
  • Negative spring test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ILA is posterior/inferior on right, deep sulcus on left. Sphinx test is negative. What is the diagnosis? Name the diagnosis? Is there a sacral tenderpoint associated with this? Sacral drag direction of ease? Spring test positive or negative?

A
  • Opposite ILA to deep sulcus indicates torsion
  • Negative sphinx test: forward torsion or unilateral sacral flexion
  • Diagnosis = forward sacral torsion
  • Name of diagnosis = right on right forward sacral torsion (meaning = rotated left on left oblique axis)
  • No tenderpoint
  • Cephalad sacral drag
  • Negative spring test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ILA is posterior/inferior on right, deep sulcus on left. Sphinx test is positive. What is the diagnosis? Name the diagnosis? Is there a sacral tenderpoint associated with this? Sacral drag direction of ease? Spring test positive or negative?

A
  • Opposite ILA to deep sulcus indicates torsion
  • Positive sphinx test: backward torsion or unilateral sacral extension
  • Diagnosis = backward sacral torsion
  • Name of diagnosis = right on left backward sacral torsion (meaning = rotated left on right oblique axis)
  • S2 tenderpoint
  • Caudad sacral drag
  • Positive spring test
17
Q

ILA is posterior/inferior on the right, deep sulcus on right. Sphinx test is positive. What is the diagnosis? Name the diagnosis? Is there a sacral tenderpoint associated with this? Sacral drag direction of ease? Spring test positive or negative?

A
  • ILA and deep sulcus on same side indicates flexion or extension
  • Positive sphinx test = extension
  • Diagnosis = unilateral extension
  • Name of diagnosis = left unilateral extension * note since extension, named for shallow sulcus
  • No tenderpoint
  • Caudad sacral drag
  • Positive spring test
18
Q

ILA is posterior/inferior on the right, deep sulcus on right. Sphinx test is negative. What is the diagnosis? Name the diagnosis? Is there a sacral tenderpoint associated with this? Sacral drag direction of ease? Spring test positive or negative?

A
  • ILA and deep sulcus on same side indicates flexion or extension
  • Negative sphinx test = flexion
  • Diagnosis = unilateral flexion
  • Name of diagnosis = right unilateral flexion
  • S4 tenderpoint
  • Cephalad sacral drag
  • Negative spring test
19
Q

ILA is posterior/inferior on the right, deep sulcus on right. Sphinx test is positive. What is the diagnosis? Name the diagnosis? Is there a sacral tenderpoint associated with this? Sacral drag direction of ease? Spring test positive or negative?

A
  • ILA and deep sulcus on same side indicates flexion or extension
  • Positive sphinx test = extension
  • Diagnosis = unilateral extension
  • Name of diagnosis = left unilateral extension
  • No tenderpoint
  • Caudad sacral drag
  • Positive spring test
20
Q

Why is the Sphinx test negative on forward torsions?

A
  • Base is stuck forward therefore as Sphinx test is done, it comes backwards and makes ILAs more symmetric
21
Q

Why is the Sphinx test positive on backward torsions?

A
  • Base is stuck backward therefore as Sphinx test is done, it comes further backwards and makes ILAs more asymmetric
22
Q

Treatments for forward sacral torsions? Describe logic of treatment.

A

1.) IT spread
OR
Remember, sacrum is stuck in flexion and rotation, so we need to rotate it in the opposite direction and extend it. How? Use the L-spine. How? Do to the L-spine what is currently being done to the sacrum – flex it and rotate it in the same direction. How does this work? Remember, L-spine flexion causes sacral extension and L-spine rotation one way causes sacrum to rotate the other way. Treatment options as follow:
2.) Muscle energy: lateral sims – hugging table, legs off, push down on ankles and feel for motion at LS junction, muscle energy to barrier
3.) Muscle energy: mirror image (aka lateral recumbent) – opposite, pull ankle towards ceiling until motion felt at LS junction, muscle energy to barrier

23
Q

Treatments for backward sacral torsions? Describe logic of treatment.

A
  • Sacrum is stuck in extension and rotation, so we need to rotate it in the opposite direction and flex it. How? Use the L-spine. How? Do the L-spine what is currently being done to the sacrum – extend it and rotate it in the same direction. How does this work? Remember, L-spine extension causes sacral flexion and L-spine rotation one way causes sacrum to rotate the other way. Treatment options as follow:
    1. ) Muscle energy: lateral recumbent laying on deep sulcus side – pull shoulder out from pt causing them to rotate to side that sacrum is rotated while palpating LS junction, straight leg on table, have pt wrap arms around yours while your hand is on LS junction, move top leg off table until motion felt at LS junction, pt exhales, apply pressure on top knee until resistance, ask pt to keep hold breath (or continue to exhale) and push knee up towards ceiling, muscle energy to barrier
    2. ) Muscle energy: alternate technique, which is same as above except don’t have top leg entirely off, put foot in popliteal fossa of other leg
24
Q

Treatment for unilateral sacral flexion

A
  • This is rule of Is: inhale, internally rotate, ILA
  • Pt prone, palpate for SI joint and gap it by abducting and internally rotating hip, place hypothenar eminence on posterior inferior ILA, pt takes deep breath in while physician pushes ILA superiorly, pt holds breath while physician maintains pressure for 3 seconds, repeat to 4th barrier
    • Hand placements on side of deep sulcus
25
Q

Treatment for unilateral sacral extension

A
  • This is rule of Xs: exhale, externally rotate, extended L-spine
  • Pt prone, palpate for SI joint (on shallow sulcus), pts hip is abducted and externally rotated (so anterior SI joint aspect is gapped), physicians places hypothenar eminence on sacral base while other hand moves to ASIS on same side, pt gets into Sphinx position fully exhales while physician pushes hand that is over the base towards the table and caudally while also pulling laterally on ASIS, pt holds breath out while pushing ASIS towards table, pt inhales again (physician holds position), repeat to 4th barrier
  • After 4th barrier, physician must hold position until pt is completely prone
26
Q

Sacral tenderpoint treatments

A

1 left/right: push on opposite side ILA and apply skin drag obliquely towards the mid lateral thigh
2: push on apex of sacrum and apply skin drag caudally
3: perform either treatment 2 or 4
4: push on base of sacrum and apply skin drag towards the head
5 left/right: push on opposite side sacral sulcus and apply skin drag obliquely towards transverse process of T12

OMM (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions