LAB - Innominate Dx + Tx Flashcards
trendelenburg test?
testing for gluteus medius
lift one leg and bend at the knee.
watch the pelvis.. a positive test will drop on the leg that is being lifted. the other leg has a weak gluteus medius
Thomas test?
Psoas contracture if +
supine and tell them to flex one leg towards test
if extended leg rises off the table, it’s psoas tightness or contracture
Ober test?
lie recumbent, hip and knees flexed
stand behind patient, one hand stabilize hip, other Hand grabs the top leg and say you’re going to drop it quickly.
you should see it drop
a + test would be if it’s ratchety going down or slow going down would be a tight IT band
How do you determine the side of dysfunction of the innominate?
Standing flexion test OR ASIS compression test
If you have a + standing flexion test on the right you should also have a + ASIS compression test on the right
How do you evaluate for rotations and/or shears?
inflares or outflares?
evaluating for pubic dysfunction?
PSIS height, ASIS height, Iliac Crest Height, Medial Malleoli Height
ASIS to midline
Pubic tubercles
How does the standing flexion test work?
evaluate the ilium moving on the sacrum.
make sure your eyes are at the same level as the PSIS
find the PSIS the finding the iliac crest and coming down, once you find the boney part it’s the PSIS (on the iliac crest)
Put your thumbs on those boney parts and add a little bit of compression so you can keep the thumbs following those PSIS
patient bends forward slowly and comes back
***you’re seeing which thumb goes higher up compared to the other one
if the right thumb goes up a little bit that’s the side of dysfunction!! right.
When you have your patient supine, what are you wanting to do FIRST?
“reset the hips”
have them bend their knees, place feet on table, lift hips off the table, place back down and extend the knees into full supine position
ASIS compression test?
your patient is supine (dominant eye midline)
your arms should be bent because when you’re putting both palms on either ASIS, you need to push MEDIALLY AND POSTERIORLY (angle of the hips).
you load and spring looking for hard end feel..
ASIS and standing flexion test should both be the same. (so if right PSIS up, you should have right ASIS compression is harder)
ALL COMPARISONS ARE ON WHAT SIDE FOR THE PATIENT?
How do you compare landmarks of the ASIS?
how do you label this depending on your results from the standing flexion/asis compression
How do you find ASIS to midline
Iliac crest
medial malleoli
PSIS
Pubic tubercles?
all of the following are supine except for PSIS in prone.
you put them supine, reset the hips, find the ASIS and put your fingers inferior to the ASIS.. comparing which side is higher or lower.
we are only caring about the side of the problem.. so if you have a left side dysfunction and your left ASIS is lower. you say your Left ASIS is lower (dysfunctional side)
visually compare the distance between the ASIS to the belly button
whichever one is higher or lower
come down to the feet and put your hands on the inferior portion of the malleoli and see which one is higher or lower
similar process
heel of hand and start above the iliac crest and then move down until your palm reaches the pubic tubercle. you put your thumb on each side and there ya go.
What is anterior innominate rotation?
Standing flexion test is positive on side of dysfunction
PSIS is superior for the side of dysfunction
ASIS is inferior for the side of dysfunction
Medial malleoli: inferior on side of dysfunction
Iliac crest heights = even
anterior innominate SD MET/ART?
1) Patient supine and standing on side of dysfunction.
2) you’re going to passively flex the hip and knee to the edge of the restrictive barrier (this induces a posterior rotation)
3) ask the pt to extend the hip, hold for 3-5, engage new barrier, and do 3-5x or until no new barrier
4) reassess –> patient reset hips, check the landmarks again!
What is a Posterior Innominate Rotation?
Standing flexion test = positive on side of dysfunction
PSIS = inferior on side of dysfunction
ASIS = superior on side of dysfunction
Medial Malleoli = superior (short) on side of dysfunction
Iliac Crests = Even
Posterior Innominate SD MET? (supine)
you can be on either side of the dysfunction
Raise the table.
patient braces themselves by having the opposite arm holding the table
leg off the table, bend at the knee
stabilize the opposite ASIS
extend the leg to induce barrier
have patient flex against 3-5s
new barrier 3-5x,
reassess with landmarks
Superior Innominate Shear?
everything on the affected side is going to be positive!
Superior Innominate Shear SD MET?
patient is supine with the feet off the table
you grab the tibia and fibula just above the ankle
abduct and internally rotate to gap the SI joint.
you are wanting to bring it back down since it’s superior shear so you lean back and apply a traction
then tell the pt to pull their hip to their shoulder
new barrier, 3-5x 3-5s
reassess
