Lab Innominate Dx and Tx Flashcards
trendelenburg test
patient stands on one leg, if opposite hip drops, abductors on standing leg are dysfunctional
thomas test
patient supine
patient pulls knee to chest and lowers one leg to the table
+ test = inability to fully extend at hip
indicates psoas (hip flexor) tightness contractor
ober test
lateral recumbent with hips and knees flexed, stabilize hip
passively abduct and extend the upper leg and let it passively adduct
+ test - leg will not fully adduct or cannot easily press down the leg
indicates IT band contracture
structures to evaluate on the innominate
standing flexion test or ASIS compression test PSIS height ASIS height Iliac crest height medial malleoli height ASIS to midline Pubic tubercles
standing flexion test and ASIS test are used to
lateralize dysfunction to one side
before doing a supine innominate evaluation what should be performed
ask patient to reset hips by lifting them off table
name the dysfunction standing flexion test on the right PSIS superior on the right ASIS inferior on the right Malleoli long on the right iliac crests even
right anterior innominate rotation
name the dysfunction standing flexion on the left PSIS inferior on the left ASIS superior on the left malleoli short on the left iliac crests even
left posterior innominate rotation
name the dysfunction standing flexion on the right PSIS high on the right ASIS high on the right Malleoli short on the right iliac crest superior on the right
Superior right innominate shear
name the dysfunction standing flexion on the left PSIS high on the right ASIS high on the right malleoli short on the right iliac crest superior on the right
inferior right innominate shear
name the dysfunction
standing flexion on the right
ASIS to midline distance long on right
right outflare
name the dysfunction
standing flexion test on the left
ASIS to midline distance long on the right
left inflare
pubic dysfunctions
superior/inferior shear
compression subluxation
Anterior Innominate SD ME
Patient supine
Flex hip and leg and apply ME principles 3-5x
Reassess
Posterior Innominate SD MET
Patient prone
Extend leg at hip and have patient try to flex leg
Apply principles of ME 3-5x
Reassess
Superior innominate shear SD MET
Supine with feet off table
IR and abduct leg to gap SI joint (close packing of hip joint)
Have patient pull hip toward ipsilateral shoulder and apply principles of MET 3-5x
Reassess
Inferior innominate sheer MET
Supine with feet off table, dysfunctional foot resting on physicians leg
IR and abduct leg to gap SI joint and close pack the hip joint
Pt resists superior compression by physician by principles of MET 3.5x
Reassess
Inflare of the innominate SD MET
Patient in FABER with dysfunctional leg flexed
Patient internally rotates against physician force
3-5x
Reassess
Outflare of the Innominate SD MET
FABER with leg of dysfunctional side
Patient abducts and ER against physician’s force (IR and adduction)
3-5x
Reassess
Pubic dysfunction MET
Hips flexed to 45. Knees to 90 Fixed compression - pt tries to adduct Fixed gapping - pt tries to abduct 3-5x Reassess
Sacral lateralization tests
Seated flexion test or pelvic compression test
Positive finding on a seated flexion test is the side that
PSIS moves farther superiorly at the end of option
Usually first to move too
ASIS compression test positive finding
Hard end feel or restriction of motion on one side
Active motion testing of the sacrum
Backward bending/sphinx test
Sacral mobility during respiration
In what direction does the sacral base move during inspiration? The Apex?
In what direction does the sacral base move during expiration? The apex?
During inspiration the base moves posteriorly and the apex moves anteriorly
During expiration the base moves anteriorly and the apex moves posteriorly
If a pt has a bilaterally flexed sacrum, what motion at the sacral base is restricted?
Posterior motion at sacral base
If a pt has a bilaterally extended sacrum, what movement at the sacral base is restricted?
Anterior movement of the base is restricted
Passive motion testing of the sacrum
4 point sacral eval
Load and spring
Lumbosacral spring test
Sacral rock (oblique axis passive evaluation)
Gapping the posterior SI joint facilitates what movement
Extension
Gapping the anterior SI joint facilitates what movement
Flexion
Extended sacrum === ______ rotation
External
If the sacrum is extended, the backward bend test makes it better/worse
Makes it worse
Setup for unilaterally extended sacrum E
Prone
Monitor SI joint, abduct leg until motion is felt as SI
ER leg to gap anterior SI joint
Place heel of hand on sacral base
ART: spring anteriorly and inferiorly
MME : apply anterior/inferior force to engage RB
Encourage exhalation and resist inhalation
3-5x
Reassess
Unilaterally flexed sacrum ART/ME setup
Monitor SI joint
ABduct leg until motion is felt
IR to gap the posterior aspect of SI joint
ART: spring anterior/superior
ME: force anterior/superior to engage RB
Encourage inhalation and resist exhalation
3-5x
Reassess
L/L or R/R ME treatment
Modified sims with axis side down
Hips/knees flexed to 90, arms hugging table
Flex hips and knees until motion is felt at SI joint
Lower patients ankles towards floor by pushing until reaching sidebending restrictive barrier
Pt raises feet to ceiling
3-5
Reassess
L/R Sacral torsion ME
Lateral recumbent with axis side down
Flex hip and knees to 90, and place top leg on docs leg
Pull lower arm toward physician and induce posterior rotation
Have patient reach back with top arm and take 2-3 breaths
Stand facing patient, monitor L5-s1 and induce further flexion of top hip/knee. Press patients knee towards floor and have patient abduct
3-5x
Reassess
