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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
what is the tx for SIJ **hypo mobility**
manual techniques and core exercises
26
**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
arthritis (sacroilitis)
27
what are the S&S for **SIJ arthritis (sacroilitis)** and what 2 test are positive
* 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
what is the tx for SIJ arthtisis (Sacroilitis)
NSAIDs + ice and then core and LE exercises
29
what are the 2 **pelvic girdle instability**
form closure and force closure
30
what is the pathology for **FORM CLOSURE** for pelvic girdle instability
* Lack of passive stabilization → abnormal movement pattern
31
Form closure for pelvic girdle instability is a ___ stability of the SIJ provide by what 3 things
* high friction coefficient between articular surfaces * -wedge shaped sacrum * integrity of ligamentous support passive
32
what is the tx for **form closure**
SIJ compression belt
33
what is the pathology for **FORCE CLOSURE** for pelvic girdle instability
* Lack of force closure (activitly) → abnormal movement pattern
34
is force closure a passive or active problem
active
35
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
• External: erector spinae, glut max, lat, biceps femoris • Internal: TA, sacral multifidi, pelvic floor and hip ER
36
what is the tx for **force closure** for pelvic girdle instability
core stabilization ex’s ## Footnote but if they haveforce and form closure together then u would treat the form closure first with SIJ belt and then force
37
• 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
piriformis syndrome
38
what is the tx for piriformis syndrome
manual techniques . stretching and core ex’s
39
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
low back, sacrum, buttocks, hip, post thigh and popliteal space sitting or squatting ER LE
40
how do u handle stability pain and mobility ? in what order ?
pain >> mobility >> stability
41
if a patient comes in and they have LBP but also have SIJ pain what would u treat 1st
LBP first always !!!! even if there is hip pain always treat for LBP first
42
if there is a hypomobile side which side would u treat first q
the side that is hypomobile
43
* 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
opposite that
44
when would a patient get radiographs done for SIJ dysfunction
• acute pelvic/ SIJ pain and pt at risk for osteoporotic or stress fx • Trauma w/ (+) clinical signs and/or altered consciousness
45
when would a patient get **MRI** done for SIJ dysfunction and what is it **best at detecting**
*suspect pain related to cancer or infection *suspect signifcant disc pathology best at detecting SI joint changes
46
when would a patient get **bone scans** done for SIJ dysfunction
never bc they are not appropriate for this
47
when would a patient not get nay imaging done for SIJ dysfunction
if the pt is awake and alert w an absence of trauma w/ no clincial signs and no indications of pathology
48
what diagnostic imaging is the best at detecting SIJ changes
MRI
49
if a pelvis breaks in one spot will there be a break in another spot ?
yes there will never be an isolated fx
50
• 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
conservative
51
for PT.. a joint w **decrease mobility** should be treat used what 4 things
* HVLAT * Mobilizations * Muscle energy techniques * ROM exercises
52
for PT… a joint w excessive mobility or instability should be treated using what 3 things
• Stabilization exercises • NM control exercises • External bracing to provide compression to unstable joint
53
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>
- joint fibrosis > mobilizations - excessive mm tone > mm energy techniques , STM , biofeedback
54
what are minor and major side effect of spinal manipulations
• Minor: temporary soreness/fatigue (1-2 days) • Major: Fx, ischemia, cauda equina
55
what for side effects of SI belt
• Uncomfortable • Skin irritation
56
what are the 2 main injections used for SIJ dysfunction
- prolotherapy - platelet rich plasma,
57
what is prolotherapy
injection of dextrose solution into SI joint space
58
what is the platelet rich plasma injecttin
injection of autologous biological blood derived product
59
what are the top 2 side effects of pharmalogic treatment
-addiction and OD
60
when do they select SI joint fusion for patients
only w chronic , unresolved symptoms last resort
61
what are the 5 post op rehab after SIJ sx
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
what is **LBP + SIJ** pain commonly seen in
during pregnancy or w trauma
63
what is the best treatment approach for SIJ dysfucntion
conservative
64
if u have a patient who has SI pain , LBP pain and Hip pain what order do u treat
LBP > hip > SIJ
65
what is the most valuable contribution PTs can make to decrease burden
PREVENT ACUTE PAIN BC THAT WILL LEAD OT CHORNIC PAIN AHHHHH

MSK: LQ (22 decks)

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