OMM Spring 2020 Exam 1 Flashcards
The sacrum is viewed as part of the _______ and the paired inominates are viewed as part of the ________
In the human infant, the pelvis is narrow and unsupportive, but as we begin to walk, the pelvis broadens and tilts while the sacrum descends into its articulation with the ilia. Also, the lumbar curve of the lower back develops.
Sacrum: vertebral axis
Inominates: Lower extremities (x2)
The pelvic inlet/brim is composed of
a. sacral promontory
b. iliopectineal line
c. superior border of pubic symphysis
d. left rami of pubic arch
A-C
NOTE: pelvic outlet is confined by the pubic symphysis, right and left rami of the pubic arch, ischial tuberosities, sacrotuberous ligaments and tip of the coccyx
Difference between male and female pelvis includes:
The male pelvis is sturdier with more height, while the female pelvis grows more ______ in diameter. It is larger with a more rounded inlet and outlet, and has a larger _______ angle.
Female: transverse growth, larger infrapubic angle
*greater distance between ischial tuberosities and coccyx
What is the most common pelvic type?
Gynecoid
The inominates of the pelvis are composed of three main parts:
- Ilium
- Ischium
- Pubis
The ilium accounts for the width of the _____, while the ischium is where the weight falls while seated.
Ilium: widgth of the hips
**all 3 unite in early adulthood at the acetabulum (triangular suture)
A fibrocartilaginous joint that joins the two inominate bones ANTERIORLY. The muscular forces can cause rotation at the symphysis along the transverse axis.
Pubic Symphysis
Bilateral L-shaped joints that join each innominate to the sacrum.
Sacroiliac joint
*injections for inflammation (arthrodial joint)
NOTE: sacral side = hyaline cartilage; ilial side = fibrocartilage
The Pelvis is surrounded by:
- anterior sacroiliac ligaments
- interosseous sacroiliac ligaments
- posterior sacroiliac ligaments
- accessory ligaments (sacrotuberous, sacrospinous, iliolumbar)
Which of the above are true ligaments?
- anterior sacroiliac ligaments
- interosseous sacroiliac ligaments
- posterior sacroiliac ligaments
NOTE:
ventral: iliolumbar, ant. sacroiliac
dorsal: sacrospinous, sacrotuberous, post. sacroiliac
Motions within the pelvic girdle are numerous and occur around various axes
- sacral
- inominate (ilia)
- pubic
True/False: Dysfunction of motion around any of these axes may be reflected by muscle spasm, back or pelvic pain, gait disturbance/leg pain, changes in or creation of compensatory patterns, and/or increased energy demands.
True
Fred Mitchell describes 3 transverse axes and 2 oblique axes. Transverse axes include:
- Superior transverse axis (STA)
- Middle transverse axis
- Inferior transverse axis
This axis is located approximately at S2. Flexion/Extension is associated with respiration and cranial sacral motion.
Superior transverse axis
NOTE:
Inhale: sacral base posterior into sacral extension.
Exhale: moves ant. into flexion
Fred Mitchell describes 3 transverse axes and 2 oblique axes. Transverse axes include:
- Superior transverse axis (STA)
- Middle transverse axis
- Inferior transverse axis
This axis is located between the upper and lower limbs of the SI joint. This is the site where postural motion (flexion/extension) occurs.
MIddle transverse axis
NOTE:
-bend forward: sacral base moves ant.
(at terminal flexion, sacrotuberous lig. becomes tight and base moves posteriorly)
Fred Mitchell describes 3 transverse axes and 2 oblique axes. Transverse axes include:
- Superior transverse axis (STA)
- Middle transverse axis
- Inferior transverse axis
This axis is located posterior-inferior to the SI joint. It is involved in inominate/ilia rotation (anterior/posterior) during walking.
Inferior transverse axis
“Ilials around the inferior axis - I for an I”
True/False: Inominate motion around the ITA is anterior and posterior motion that occurs while walking, weight shifts, standing, sitting, and muscular forces of the lower extermities.
True
There are two oblique sacral axes:
- RIght oblique (Right base to Left ILA)
- Left bolique (left base to Right ILA)
This is a dynamic axis in which the sacrum engages during walking. For example, weight bearing on the left leg (by stepping forward with the right) will engage the _____ axis and cause the sacrum to turn towards the ______.
Left axis and turn to the Left
To recap, there are 4 different types of physiologic motion of the sacrum and inominates.
DRIP
- ________: sacram motion during walking around oblique axes.
- _____: sacram motion during breathing around the STA.
- _____: rotation around the ITA
- _____: sacral motion with bending forward and backward around the MTA
- Dynamic
- Respiratory
- Innominate
- Postural
Pubic symphysis is amphiarthrosis with strong ligaments and varying opposing surfaces. It is susceptible to hormonal changes and action of the adductor muscles.
True/False: Physiologic motion may occur about the transverse axes while walking.
True
*motion also occurs with one legged standing, childbirth
Pelvic Shear: Most often occurs superior/inferior. It results in
a. uneven tension on the pelvic/urogenital diaphragm
b. low back pain
c. anterior thigh pain
d. constipation, urinaty symptoms, dyspareunia, suprapubic pain
ALl of the above
What are the two important principles involves in physcial exam diagnosis of pelvic pain/dysfunction?
- Use at least 2 static landmarks
* find assymetry; ASIS heights) - Use a lateralizing test
* indicates side of dysfunction at SI joint
ex: AP compression test; Standing forward bending (Innominate/Pubic) and Seated Forward Bending (Sacrum)
Lateralizing tests indicate what side is more dysfunctional.
In the standing forward bending test (StFBT), a positive test usually indicates _______ dysfunction of the ______. It is sensitive to lower extremity restrictors (such as tight hamstrings)
Iliosacral dysfunction (innominate/pubes)
*PSIS moves greatest distance = dysfunctional
Lateralizing tests indicate which side is more dysfunctional. Seated forward bending tests is indicative of _____ dysfunction (i.e. sacrum). The lower extremity mechanics are eliminated.
Sacroiliac
**PSIS with most movement/greatest distance
What are the landmarks used to assess anterior pelvic dysfunction?
Iliac crest, ASIS, PSIS, pubic tubercles, medial malleoli (leg length)
Pelvis: The following findings describe what pelvic dysfunction?
- ASIS: superior
- PSIS: Superior
- Iliac crest: superior
- Pubic tubercle: superior
- Medial malleolus: superior
*abdominals, thoracolumbar fascia, pelvic floor
-Superior subluxation/Superior inominate shear
- Standing flexion test positive on that side
- non-physiologic dysfunction
NOTE: Symptoms: painful anywhere in pelvis, lower back or extremities
Pelvis: Describe treatment for a superior shear
- Hold above patient’s ankle
- abduct leg to 20 degrees; internally rotate hip
- apply traction and HVLA
- Recheck
Pelvis: The following findings describe what dysfunction?
- Inferior ASIS
- Inferior PSIS
- Inferior Iliac Crest
- Inferior medial malleolus
- Inferior pubic tubercle
Inferior inominate shear (down slipped ilia; minute inferior subluxation of inominate)
**rare, non-physiologic dysfunction
Patient tends to treat with ambulation
Symptoms: like superior shear