Lecture 4B

Question 1

SI joint dysfunction usually appears with ________________, not usually by itself

Answer 1

Hip pain or LBP

Question 2

What are the 3 categories of SIJ pain

Answer 2

pregnancy related

pathology related

nonspecific

Question 3

If symptoms of SI joint pain cannot be reproduced with movement, what are we thinking?

Answer 3

Potentially visceral origin?

Appendicitis, UTI, Digestive disorders, vascular disorders

Question 4

Where is the first area of pain you’ll typically have with ankylosing spondylitis

Answer 4

SI joint

Question 5

What is the most common complaint of people with SIJ pain?

Answer 5

Fortin’s sign AKA tenderness to palpation over the PSIS

Question 6

List of common complaints of people with SIJ pain?

Answer 6

Pain over PSIS
Pain w/ transitional movemnets
Pain w/ SLS
pain at end of SLR
pain with prolonged sitting standing

Question 7

What are the 3 symptoms that will hint us that a patient has SIJ dysfunction?

Answer 7

Pain at PSIS

No symptoms below knee

No neurological signs or symptoms

Question 8

Sacral Nutation causes __________ lumbar lordosis

Answer 8

Decreased

Question 9

Presence of Serious pathology in pts with LBP and SIJ dysfunction is ___________

Answer 9

low

take vital signs! look for multiple red flags and consistent patterns

Question 10

What kind of SIJ tests are best?

Answer 10

provocation/stress tests

you need to do a lot of tests to determine SIJ dysfunction, because none of the tests alone are very accurate

Question 11

6 provocation/stress tests for SI

Answer 11

Faber/figure 4/patrick

Distraction

Thigh Thrust

Compression

Sacral Thurst

Gaenslen’s test

Question 12

What kind of SI joint problem occurs in the frontal plane?

Answer 12

Upslip

note: downslips are very rare

Question 13

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

Answer 13

SI joint arthritis (Sacroilitis)

Question 14

Pelvic girdle instability

Form Closure vs Force Closure

Answer 14

Form closure is passive

Force Closure is active

Question 15

Passive stability of SI joint is provided by what

Answer 15

High friction b/t articular surfaces

wedge shaped sacrum

integrety of interosseous ligament

Question 16

Active stability of the pelvic girdle is supplied by what

Answer 16

External: Erector Spinae, glute max, lat, bicep femoris

Internal: TA, Multifidi, Pelvic floor and hip ER

TFL

Question 17

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

Answer 17

Piriformis syndrome

Question 18

Sequence of SIJ exam

Answer 18

Confirm presence of SIJ problem w/ provocation tests

Determine side of hypomobility

Determine what pathology

Determine passive or active

select intervention

Question 19

Order of priority when treating SIJ dysfunction

Answer 19

Pain > Mobility > Stability

Question 20

What should we treat first when treating patients w/ SIJ dysfunction

Answer 20

Any lumbar or hip dysfunction

Question 21

What is the best imaging for detected SIJ changes

When is no imaging indicated?

Answer 21

MRI

Awake and Alert patient, no Trauma, no clinical signs of serious pathology

Question 22

When treating SIJ dysfunction we should start w/

Answer 22

Conservative treatments -> Pharmacologic -> Surgery