Lecture 4B Flashcards
SI joint dysfunction usually appears with ________________, not usually by itself
Hip pain or LBP
What are the 3 categories of SIJ pain
pregnancy related
pathology related
nonspecific
If symptoms of SI joint pain cannot be reproduced with movement, what are we thinking?
Potentially visceral origin?
Appendicitis, UTI, Digestive disorders, vascular disorders
Where is the first area of pain you’ll typically have with ankylosing spondylitis
SI joint
What is the most common complaint of people with SIJ pain?
Fortin’s sign AKA tenderness to palpation over the PSIS
List of common complaints of people with SIJ pain?
Pain over PSIS
Pain w/ transitional movemnets
Pain w/ SLS
pain at end of SLR
pain with prolonged sitting standing
What are the 3 symptoms that will hint us that a patient has SIJ dysfunction?
Pain at PSIS
No symptoms below knee
No neurological signs or symptoms
Sacral Nutation causes __________ lumbar lordosis
Decreased
Presence of Serious pathology in pts with LBP and SIJ dysfunction is ___________
low
take vital signs! look for multiple red flags and consistent patterns
What kind of SIJ tests are best?
provocation/stress tests
you need to do a lot of tests to determine SIJ dysfunction, because none of the tests alone are very accurate
6 provocation/stress tests for SI
Faber/figure 4/patrick
Distraction
Thigh Thrust
Compression
Sacral Thurst
Gaenslen’s test
What kind of SI joint problem occurs in the frontal plane?
Upslip
note: downslips are very rare
Pain radiating into posterior thihg
increases w/ walking at heel strike or at mid stance (unilateral WB)
Increases when turning in bed
lumbar extension most painful
Positive SI joint stress test
Positive Compression Test
SI joint arthritis (Sacroilitis)
Pelvic girdle instability
Form Closure vs Force Closure
Form closure is passive
Force Closure is active
Passive stability of SI joint is provided by what
High friction b/t articular surfaces
wedge shaped sacrum
integrety of interosseous ligament
Active stability of the pelvic girdle is supplied by what
External: Erector Spinae, glute max, lat, bicep femoris
Internal: TA, Multifidi, Pelvic floor and hip ER
TFL
Persistent severe pain in low back, sacrum, buttocks, hip, posterior thihg, popliteal space
positive severe pain with provocation of piriformis
positive pain with sitting or standing
persistent hip ER on affected side
Difficulty lying or standing comfortably
LE Paresthesias
Piriformis syndrome
Sequence of SIJ exam
Confirm presence of SIJ problem w/ provocation tests
Determine side of hypomobility
Determine what pathology
Determine passive or active
select intervention
Order of priority when treating SIJ dysfunction
Pain > Mobility > Stability
What should we treat first when treating patients w/ SIJ dysfunction
Any lumbar or hip dysfunction
What is the best imaging for detected SIJ changes
When is no imaging indicated?
MRI
Awake and Alert patient, no Trauma, no clinical signs of serious pathology
When treating SIJ dysfunction we should start w/
Conservative treatments -> Pharmacologic -> Surgery
