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MSK: LQ > lab 4: SIJ examination and interventions > Flashcards

lab 4: SIJ examination and interventions Flashcards

1
Q

what is the order of examination

A
  • pt hx
  • systems review
    -observation
  • UQ/ LQ scanning exam
    -AROM ,PROM , flexibility
  • muscle performance
  • joint play
  • palpation
    -special test
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2
Q

if during observations ur patient says that have pain with sitting to standing or vise versa .. pian with transitional movements then what would we suspect

A

SIJ dysfunction

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3
Q

if a pt has a flatten spine what is possible, what is short adn weak

A

Possible stenosis, lateral shift, disc herniation
Short hamstrings, weak hip flexors

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4
Q

if a pt has excessive lordosis what is possible and what is short and weak

A
  • Possible pelvic crossed syndrome
  • Short ES and hip flexors, core and hip ext weak
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5
Q

if a pt has swayback what does that mean

A
  • Thoracic kyphosis + posterior
    pelvic tilt
  • Hips hyperextended
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6
Q

what signs would suspect a lumbar disc pathology

A
  • (+) pain w/ coughing and sneezing (bc increase pressure in interthecal)
  • Sx ↓ w/ walking (bc extension makes it feel better)
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7
Q

what are the signs that are present that would make us think lumbar spine joint pathology

A
  • (-) pain w/ coughing and sneezing (bc its not invovled within in SC)
  • (+) pain w/ extension or flexion
  • (+) pain w/ PA joint glides (arthokinematic things reproduces symptoms)
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8
Q

what signs are presents that would make use things hip joint

A
  • (+) Trendelenberg sign
  • (+) pain or ↓ ability to squat
  • (+) sign of buttock test
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9
Q

what 4 things could proceed us to do a full SIJ exam if they are positive

A
  • • Fortin’s sign
    • 1o SI joint stress tests: gapping or
    compression
    • TTP at post SI ligaments
    • Pain/weakness w/ SLS
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10
Q

what is Fortin’s Sign

A

patient localizes pain w 1 finger over PSIS

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11
Q

what are considered the primary SI joint stress test and that are considered the best psychomotor test

A

Gapping (distraction) test and compression test (painful side up)

both are provocation test bc the SI is a circle

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12
Q

what are the secondary SI joint stress tests (4)

A

-sacral thrust test (SIJ PA glide)
-Gaenslen’s test
-FABER/Patricks test
-thigh thrust test

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13
Q

what is the sacral thrust test

A

-patient in prone and u apply significant anterior force at S3 multiple times

  • (+): reproduction of concordant symptoms over SI and/or postieor SI ligaments
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14
Q

what is the Gaenslen’s test

A

Pt is positioned like the thomas test and then the PT apples an extension force on bottom leg and flexion force on top leg

purpose is to anterior rotate 1 ilium and postieor rotate the other one

leg being tested is the bottom leg

  • (+)= reproduction of concordant pain at SIJ or pubic symphysis
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15
Q

what is the FABER/ Patricks test

A

put patient in flexion, abduction and ER

screen for lumbar , SIJ and hip path

if no symptoms then add over pressure

(+)= reproduction of concordant pain over postieor pelvis/ buttocks *SIJ dysfunction

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16
Q

what is the thigh thrust test

A
  • pt on back and therapist put hand under sacrum to stabilize it and then puts pt into 90° of HF and then push down thru the femur to cause a posterior translation on the innomiante on the sacrum

(+)= reproduction of concordant pain in SIJ

17
Q

what is the (+) SI joint dysfunction clinical prediction rules

A
  1. Compression
  2. Distraction
  3. Sacral thrust
  4. Gaeslen test
  5. Thigh thrust

** IF 3 OR MORE OUT OF THE 5 TEST ARE (+) THEN WE THINK SIJ DYSFUCTION

18
Q

what is the (-) SI joint dysfunction clinical prediction rules

A
  1. Compression
  2. Distraction
  3. Gaeslen test
  4. FABER
  5. Thigh thrust

IF 3 OR LESS OUT OF THE 5 TEST ARE (+) THEN WE THINK NO SIJ DYSFUNCTION

19
Q

what stress test do u do for pubic symphysis pain

A

pubic stress (superior inferior) test for anterior pain

20
Q

what is the sign of buttock test , what does it indicate and how do u do it

A

use if u are looking for NON MSK things

indicated serious pathology like neoplasm , fx, infection , septic arthritis

produced
- do passive SLR = (+) for pain
- retunr leg to neutral
- passively flex hip w knee flexed to take out the sciatic nerve and it is (+) if increase pain w no change in ROM then we think something serious

21
Q

what are the 4 MOBILITY/FUNCTIONAL test for special test for SIJ dysfunction

A
  • seated flexion test
    -standing flexion test
    -supine to long sit (long sitting test)
    -gillet’s (stork) test
22
Q

what is the seated flexion test

A

pt is positioned in sitting and PT feels for PSIS and intructs pt to lean foward > PSIS SHOULD move equal distance in SUperior direction

• (+) test = PSIS do not move equal distances w/ affected side moving more than unaffected side

23
Q

what can the seated flexion test but used to rule out

A

LE dysfunction such as LLD or hamstring tightness when compared to standing test

24
Q

when would u do the mobility/fucnitonal special test for SIJ

A
  • (+) CPR
  • hypo mobility
  • papaltion problems
25
Q

what is the long sitting test used to determine and how do u do it

A

-• Used to determine direction of innominate rotation

  • pt is in supine adn they do a double limb bridge to reset pelvis and then PT palpates superior surfaces of both medial mall. and then intructs pt to sit up and then PT reassess medial mall

+) test = malleoli do not move equal distances
• Longer limb = posterior innominate on respective side
• Shorter limb – anterior innominate on respective sid

26
Q

what is the standing flexion test

A
  • pt is standing and PT palpates PSIS and ask pt to bend foward > PSIS should move equal in distance

+) test = PSIS do not move equal distances w/ affected side moving more than unaffected side

looking for hypomobilty.aberrant movement

27
Q

what is the gillet’s (stork) test

A

pt is standing , PT puts thumb on one PSIS (on side that is lifting up) and base of sacrum on the same side and then have pt stand on 1 leg and flex the other hip to 90°

PSIS should move inferiorly to sacrum

leg that is being tested is the one that is moving into flexion

• (+) test = PSIS does not move inferiorly when compared to sacrum OR causes concordant SI joint pain

28
Q

what special test do u do if u have insuffient form closure

A

active SLR (used to hypermobility)

form is passive
do this if they have mobility but no stability

29
Q

describe the active ALR for insufficient form closure

A

part 1: pt is supine w both legs extended , PT tells pt to lift 1 leg off table

+) test = reproduces concordant pelvic/SI joint pain OR compensatory pattern(s) observed

part 2: if part 1 is (+) then the same test is repeated w PT applying compression force thru pelvic

+) test = if pt able to perform ASLR test w/ less pain OR fewer compensatory patterns when compressive force was applied… SIJ belt would help this pt

30
Q

describe the active SLR for insufficient force closure

A

if part 1 is (+) then the test is repeated w PT telling the pt to contract core mm before lifting leg (can add pressure to opp shoulder to increase mm contraction)

+) test = if pt able to perform ASLR test w/ less pain OR fewer compensatory patterns when core mm. activated…. stabilization would help this patient

31
Q

what are the outcome measures used from SIJ

A
  • Modified Oswestry Disability
    Index
  • Roland-Morris Back Pain Disability Questionnaire
  • Fear Avoidance Behavior Questionnaire (FABQ)
  • Patient Specific Functional Scale (PSFS)
32
Q

how do u do sidelying SI gapping

A
  • pt lays in sidelying w affected side up w hi[s flexed to 90°
  • PT standing behind pt , table at check
  • PT grasps table side UP and pulls across pts boyd
  • PT then stabilizes top side PSIS w other hand
  • PT takes up slack but pulling table side arm towards PT and pushing top side PSIS away from PT then do quick thrust
33
Q

explain what long axis traction (prone) : 2 person technique is

A
  • pt lays prone w LE extended and feet off table
  • PT grabs affected LE just above the andkle w both hands and lift LE up and out (affected hip in ext, slight abd and IR)
  • other person stabilizes the sacrum
    _ PT takes up slack by distracting leg adn then quick pull
34
Q

if u are dong a prone joint mob to restore anterior innominates rotation what direction are u mobilizing in

A

mobilize affected joint into anterior rotation (PA glide)

35
Q

SI belt is used as a ___ technique

A

stabilization

MSK: LQ (22 decks)

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