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MSK: LQ > lecture 4b: Sacroiliac Joint Examination, Evaluation and Interventions > Flashcards

lecture 4b: Sacroiliac Joint Examination, Evaluation and Interventions Flashcards

1
Q

if a patient has SIJ pain where else COULD it be coming from

A

LBP or hip pain , always evaluate those areas as well

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2
Q

what are teh 3 categories that SIJ pain is typically divided in

A

• Pregnancy related
• Pathology related
• Non-specific

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3
Q

• Appendicitis

-Gynecologic disorders
• Uterine
• Ovarian
• Cervical

  • Urinary tract disorders
    • Bladder/UTI
    • Kidney stones
  • Digestive tract disorders
    • IBS/Crohn’s
    • Gallstones
  • Vascular compromise
    • AAA
    • Gluteal
    • Femoral

these are causes of pelvic/SI joint pain but from what origin

A

visceral

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4
Q

-Infection (iliopsoas abscess/hematoma)
• Tuberculosis
• Osteomyelitis

-Fracture
• L-spine
• Pelvic
• Femur

-Neoplasms
• Gynecological
• Prostate
• Colon

-Inflammatory disorders
• Ankylosing spondylitis
• Septic arthritis, RA

these are causes of pelvic/SIJ pain ,, what origin

A

serious

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5
Q

what are casues of pelvic/ SI joint pain that is MSK origin

A
  • SI joint dysfunction
    • Trauma (i.e. fall)
    • Instability
    • Pregnancy/post-partum
    • Hx of hyperlaxity
  • L-spine disorders
    • DDD
    • Stenosis

-Hip joint dysfunction
• OA
• Avascular necrosis
• Tendinitis/tendinosis

-Hernia
• Abdominal
• Sports (athletic pubalgia)

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6
Q

what is the most common complaint during the subjective hx for SIJ dysfucntion

A

TTP(pain) over region of PSIS

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7
Q

what is the Fortin FInger Test

A

u ask patient where their pain is and they point directly at the PSIS

painful activities with stepping up , sitting , sit to stand

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8
Q

what are 4 other common complaints for SIJ dysfunction

A

• Pain w/ transitional movements
• Pain w/ SLS activities
• Pain w/ end range active SLR
• Prolonged sitting/standing

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9
Q

Rarely (if ever) just SI joint dysfunction
responsible for pt’s pain.. it will always be coupled with something .. what are the 2 main things it could be couples with

A

• LBP + SI joint dysfunction
• Hip joint dysfunction + SI joint dysfunction

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10
Q

what are things that we would think it is a SIJ problem ?

A
  • TTP over region of PSIS
  • no symptoms below the knee
    -no neuro S&S
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11
Q

Most pts w/ acute LBP present w/ at least _-
red flag (>80%)

A

1

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12
Q

what can presence of yellow flags do

A

increase complexity of symptoms and decrease pt outcomes

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13
Q

SI joint exam is ALWAYS performed in addition to what other things

A

lumbar spine exam OR hip joint exam

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14
Q

what are types of SI joint special test and what is the statistically the best to do

A

-provocation/ stress tests
-alignment/symmetry/ positional test
-mobility/functional test

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15
Q

what are the 6 provocation/stress test for SI joint special test

A

• Faber/Figure 4/Patrick
• Distraction
• Thigh thrust
• Compression
• Sacral thrust
• Gaenslen’s test

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16
Q

what are the 4 positional test that u can do for SIJ special test

A

• Iliac crest heights
• ASIS heights
• PSIS heights
• Ischial tuberosity heights

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17
Q

what is the 4 mobility./functional tests that can be done for the SIJ special test

A
  • Standing flexion test
  • Seated flexion test
  • Stork/Gillet/Marching
  • Supine to Long Sit tes
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18
Q

which SI joint special test is the most reliable

A

provocation/ stress tests

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19
Q

what are 5 common SIJ diagnoses

A

-referred pain (lumbar spine or hip joint)

• SI joint hypomobility
• SI joint arthritis
• Pelvic girdle instability( insufficient form or force closure)
• piriformis syndrome

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20
Q

what are the referred pain patterns of the SI joint

A

from the SI joint or TO the SI joint

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21
Q

Innominate rotation , upslip , down slip , and pubis lesions are examples of SIJ____

A

hypo mobility

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22
Q

what is innominate rotation

A

when someone has an anterior innominate one side while post. innominate on the other side

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23
Q

what is the difference between an upslip and a downslip and what is more common

A

upslip: ASIS, PSIS and ischial tuberosity go up on the same side compared to the opposite side (MORE COMMON)

donwslip: ASIS, PSIS and ischial tuberosity go down on the same side

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24
Q

how are some MOI from SIJ hypo mobility

A
  • repeated unilateral stnading
  • -fall on ischial tuberosity
  • -vertical thrust onto extended LE
  • back lifting
  • golf/baseball swig
  • -dashboard injury
  • -forceful diagonal movements
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25
Q

what is the tx for SIJ hypo mobility

A

manual techniques and core exercises

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26
Q

S&S
* Pain in post sacrum or groin (rare)
* Radiating pain into post thigh
* ↑ w/ walking at heel strike or at mid-
stance (unilateral WB) and hopping
* ↑ when turning in bed
* Lumbar extension most painful, flex least
painful
* (+) SI stress tests
* (+) Compression test w/ SI belt

if these are the patients S&S what SIJ diagnosis is it

A

arthritis (sacroilitis)

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27
Q

what are the S&S for SIJ arthritis (sacroilitis) and what 2 test are positive

A
  • Pain in post sacrum or groin (rare)
  • Radiating pain into post thigh
  • ↑ w/ walking at heel strike or at mid-
    stance (unilateral WB) and hopping
  • ↑ when turning in bed
  • Lumbar extension most painful, flex least
    painful
  • (+) SI stress tests
  • (+) Compression test w/ SI belt
28
Q

what is the tx for SIJ arthtisis (Sacroilitis)

A

NSAIDs + ice and then core and LE exercises

29
Q

what are the 2 pelvic girdle instability

A

form closure and force closure

30
Q

what is the pathology for FORM CLOSURE for pelvic girdle instability

A
  • Lack of passive stabilization →
    abnormal movement pattern
31
Q

Form closure for pelvic girdle instability is a ___ stability of the SIJ provide by what 3 things

A
  • high friction coefficient between articular surfaces
  • -wedge shaped sacrum
  • integrity of ligamentous support

passive

32
Q

what is the tx for form closure

A

SIJ compression belt

33
Q

what is the pathology for FORCE CLOSURE for pelvic girdle instability

A
  • Lack of force closure (activitly) → abnormal
    movement pattern
34
Q

is force closure a passive or active problem

A

active

35
Q

force closure is active stability of SIJ provided by external … internal .. and T-L facia + mic ontraction leading to effect to force close SIJ joint.. what is included in the external and internal force couples

A

• External: erector spinae, glut max, lat,
biceps femoris
• Internal: TA, sacral multifidi, pelvic floor
and hip ER

36
Q

what is the tx for force closure for pelvic girdle instability

A

core stabilization ex’s

but if they haveforce and form closure together then u would treat the form closure first with SIJ belt and then force

37
Q

• S&S
• Persistent, severe referred pain in low back, sacrum, buttocks, hip, post thigh and popliteal space
• (+) severe pain w/ provocation of piriformis, sulcus or GT
• (+) pain w/ sitting or squatting
• Persistent hip ER on affected side
• Difficulty lying or standing comfortably
• (+) LE paresthesias

if someone presents w these S&S what SIJ diagnoses is it

A

piriformis syndrome

38
Q

what is the tx for piriformis syndrome

A

manual techniques . stretching and core ex’s

39
Q

S&S for piriformis syndrome
• Persistent, severe referred pain in what 6 places
• (+) severe pain w/ provocation of piriformis, sulcus or GT
• (+) pain w/ ___ or ___
• Persistent hip ___ on affected side
• Difficulty lying or standing comfortably
• (+) ___ paresthesias

A

low back, sacrum, buttocks, hip, post thigh and popliteal space

sitting or squatting

ER

LE

40
Q

how do u handle stability pain and mobility ? in what order ?

A

pain&raquo_space; mobility&raquo_space; stability

41
Q

if a patient comes in and they have LBP but also have SIJ pain what would u treat 1st

A

LBP first always !!!! even if there is hip pain always treat for LBP first

42
Q

if there is a hypomobile side which side would u treat first q

A

the side that is hypomobile

43
Q
  • May have pain and hypermobility on SAME side and need to tx ___ side
  • May have pain and hypomobility on SAME side and need to tx side
A

opposite

that

44
Q

when would a patient get radiographs done for SIJ dysfunction

A

• acute pelvic/ SIJ pain and pt at risk for osteoporotic or stress fx
• Trauma w/ (+) clinical signs and/or altered
consciousness

45
Q

when would a patient get MRI done for SIJ dysfunction and what is it best at detecting

A

*suspect pain related to cancer or infection
*suspect signifcant disc pathology

best at detecting SI joint changes

46
Q

when would a patient get bone scans done for SIJ dysfunction

A

never bc they are not appropriate for this

47
Q

when would a patient not get nay imaging done for SIJ dysfunction

A

if the pt is awake and alert w an absence of trauma w/ no clincial signs and no indications of pathology

48
Q

what diagnostic imaging is the best at detecting SIJ changes

A

MRI

49
Q

if a pelvis breaks in one spot will there be a break in another spot ?

A

yes there will never be an isolated fx

50
Q

• Physical therapy
• HVLAT (manipulation)
• SI belt
• Exercise (therapy)
• Pt education
• Acupuncture/dry needling
• Massage therapy
• Yoga/Pilates
• Progressive relaxation
• Cognitive behavioral therapy
• Intensive interdisciplinary rehabilitation

what kind of treatment progression is this from SIJ dysfunction

A

conservative

51
Q

for PT.. a joint w decrease mobility should be treat used what 4 things

A
  • HVLAT
  • Mobilizations
  • Muscle energy techniques
  • ROM exercises
52
Q

for PT… a joint w excessive mobility or instability should be treated using what 3 things

A

• Stabilization exercises
• NM control exercises
• External bracing to provide compression to unstable joint

53
Q

for PT .. A joint that demo S&S of excessive compression should be treated based on the cause of the compression:
- joint fibrosis>
- excessive mm tone>

A
  • joint fibrosis > mobilizations
  • excessive mm tone > mm energy techniques , STM , biofeedback
54
Q

what are minor and major side effect of spinal manipulations

A

• Minor: temporary soreness/fatigue (1-2 days)
• Major: Fx, ischemia, cauda equina

55
Q

what for side effects of SI belt

A

• Uncomfortable
• Skin irritation

56
Q

what are the 2 main injections used for SIJ dysfunction

A
  • prolotherapy
  • platelet rich plasma,
57
Q

what is prolotherapy

A

injection of dextrose solution into SI joint space

58
Q

what is the platelet rich plasma injecttin

A

injection of autologous biological blood derived product

59
Q

what are the top 2 side effects of pharmalogic treatment

A

-addiction and OD

60
Q

when do they select SI joint fusion for patients

A

only w chronic , unresolved symptoms

last resort

61
Q

what are the 5 post op rehab after SIJ sx

A
  1. pain contrl
  2. early mobility w/ WB precautions
  3. mobility/stabilty ex’s
  4. functional activity tolerance training
    5/ maintain and D/C planning
62
Q

what is LBP + SIJ pain commonly seen in

A

during pregnancy or w trauma

63
Q

what is the best treatment approach for SIJ dysfucntion

A

conservative

64
Q

if u have a patient who has SI pain , LBP pain and Hip pain what order do u treat

A

LBP > hip > SIJ

65
Q

what is the most valuable contribution PTs can make to decrease burden

A

PREVENT ACUTE PAIN BC THAT WILL LEAD OT CHORNIC PAIN AHHHHH

MSK: LQ (10 decks)

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