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OCS - Current Concepts of Ortho PT > Pelvic > Flashcards

Pelvic Flashcards

1
Q

Blue flag meaning

A

Component of yellow flags and often related to workplace demands, time pressure, and other features that could cause an increase in symptoms

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2
Q

Black flag meaning

A

Component of yellow flags and often related to policy and work conditions that are out of the patient’s control

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3
Q

What ligament is most commonly tender in peripartum females?

A

Long dorsal SIJ ligaments

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4
Q

Appropriate first line of PT tx for nonspecific SIJ pain may include:

A

Manual therapy and therapeutic exercise

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5
Q

Fortin finger sign

A

Patient points with one finger to PSIS (within 1cm)

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6
Q

Manual therapy: which is better - general thrust techniques vs specific techniques?

A

General is JUST AS effective as specific

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7
Q

T/F: there is evidence for use of TENS and manual therapy for facilitating descending inhibitory mechanisms?

A

True

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8
Q

Is palpation reliable for identification of a problem spot and for tx?

A

No

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9
Q

What intra-articular factors make the SIJ stable?

A

The grooves and ridges that increase the coefficient of friction

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10
Q

Form closure

A

Theory that the SIJ is stable due to the sacrum being WEDGED between the ilia and ligaments

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11
Q

Force closure

A

Theory that muscles and ligaments provide a compressive force across the SIJ

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12
Q

Can form and force closures be associated with functional activity limitations/improvements

A

No, lack of contemporary research to associate those theories

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13
Q

SIJ is relatively thin where (anterior/posterior)

A

Anterior, therefore is susceptible to leakage during intra-articular injection

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14
Q

Sacrotuberous ligament blends with what ligament?

A

Long dorsal SIJ ligament

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15
Q

The sacrotuberous ligament has been identified as connected directly to what muscle?

A

Biceps femoris (sometimes completely fused)

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16
Q

What is the only muscle that directly attaches to the SIJ?

A

Piriformis

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17
Q

Anterior SIJ innervation

A

L4-S2 branches

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18
Q

Posterior SIJ innervation

A

L5-S4

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19
Q

Is the SIJ capable of nociception

A

Yes

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20
Q

Vascular claudication of the pelvis can present like what?

A

Mechanical pain with movement, trophic changes, temperature changes, LE pulse abnormalities

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21
Q

Can SIJ motion be detected with palpation

A

No, SIJ motion appears to be sub-clinically detectable and not reliably palpated by PT’s

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22
Q

Nutation

A

PPT, anterior/inferior movement of sacrum, ASIS higher vs PSIS

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23
Q

Counternutation

A

APT, posterior/superior movement of sacrum, PSIS higher vs ASIS

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24
Q

T/F: SIJ movement increases as jt load increases

A

False, it decreases (becomes more stable)

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25
Q

What axis has been shown to have the most mobility in the SIJ?

A

Transverse axis (S2)

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26
Q

Has there been any association between decreased pressure pain thresholds (PPT) and SIJ issues?

A

Yes, lower PPTs in group with SIJ pain

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27
Q

Pain in Fortin’s area (with/without) pain in the ischial tuberosity is likely to be of SIJ origin

A

Without

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28
Q

Risk factors for NEGATIVE prognosis of antepartum population with PGP

A

Prior hx of pregnancy, orthopedic dysfunctions, high BMI, smoking, work dissatisfaction, lack of belief in improvement

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29
Q

What other structures should be screened prior to diagnosis of PGP or SIJ pain?

A

Lumbar spine and hips

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30
Q

T/F: clinicians can cautiously use pain provocation tests to invetigate the SIJ as potential pain source

A

True, it’s been found that the tests alone or in a cluster do not demonstrate diagnostic value

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31
Q

T/F: Pain referral to lumbopelvic region from visceral disorders are rare

A

False, it’s not uncommon = should abdominal screen

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32
Q

Pelvic floor is innervated by what nerve

A

Pudendal nerve

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33
Q

Questionnaire to determine neuropathic pain

A

Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS)

OR

Pain Detect questionnaire

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34
Q

+ Babinski

A

DF of big toe = UMN lesion

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35
Q

DTR - Patella (levels)

A

L3-L4

36
Q

DTR - Achilles (levels)

A

L5-S1

37
Q

Upper motor neuron lesions (DTR, babinski, bladder actvitiy)

A

DTR: hyper-reflexive
Babinski: +
Bladder: overactivity

38
Q

Lower motor neuron lesions (DTR, babinski, bladder actvitiy)

A

DTR: hypo-reflexive
Babinski: -
Bladder: hypoactive

39
Q

Anal reflex

A

S2-S5, presence of voluntary sphincter contraction - intact pelvic floor innervation

40
Q

Bulbocavernosus reflex

A

S2-S4, squeezing the penis gland or clitoris = reflex contraction of external anal sphincter

Absence = sacral nerve damage

41
Q

2 types of sacral stress fractures

A

1) Insufficiency fx’s
2) Fatigue fx’s

41
Q

Demographics/risk factors for insufficiency fractures

A

Think “OLD” and SUDDEN
- Mean age 70.5 y/o

Risk factors: post-menopausal, older, female w/hx of osteoporosis, hx of pelvic radiation, RA, and long-term corticosteroid use

Sudden onset and pain w/ walking

42
Q

Demographics/risk factors for fatigue fractures

A

Think “YOUNG” and GRADUAL
- Mean age 21.5 y/o

Risk factors: Increased training, deficient diet

Sudden onset and pain w/ walking

43
Q

What is the best imaging tool for diagnosis of sacral fractures?

A

MRI

44
Q

Most concordant sign with sacral stress fractures?

A

Pain with palpation over sacrum or SIJ

45
Q

Role of PT in management of sacral fractures?

A

Appropriate load management

46
Q

Is non-radiographic (nr-axSpA) or radiographic (axSpA) commonly known as ankylosing spondylitis (AS)?

A

radiographic (axSpA)

47
Q

T/F: damage from nr-axSpA can be visible when using magnetic resonance imaging (MRI)

A

True (most of the time)

48
Q

Individuals with both types of axSpA typically present in what manner? And demographics?

A

<40 y/o, males (2/3)

Long duration of symptoms that include: morning stiffness (especially in buttock), stiffness of spine, fatigue

Other complaints may include tendon insertion pain, eye irritation, inflammatory bowel disease

49
Q

T/F: vertebral fx is common with axSpA

A

True - d/t association with low bone mineral density

50
Q

Best test that is most informative vs functional tests when identifying someone with nr-axSpA

A

FABER (moderate)

51
Q

What antigen is commonly found in those with AS?

A

HLA-B27

Present in 85-90% of those with AS

52
Q

Osteitis condensans ilii

A

Self-limiting condition marked by sclerosis of the iliac bone

53
Q

Demographics of osteitis condensans ilii

A

Women who have had children, 40’s

Typically asymptomatic

54
Q

Best tx of osteitis condensans ilii

A

Unknown, use impairment-based approach

55
Q

Blood tests for AS

A

Increased levels of inflammatory markers:
C-reactive protein, erythrocyte sedimentation rate

Presence of HLA-B27

56
Q

Best approach to management of AS: meds vs PT

A

A combo of both is best

57
Q

(Flexion/extension) exercises have been shown to be beneficial for axSpA

A

Extension

58
Q

Cardiovascular & strengthening exercises VS traditional tx (posture, stretching, breathing) for tx of AS?

A

Cardio and strength = better

59
Q

(Low/high) intensity exercise best improves the overall quality of life and reducing disease progression of axSpA.

A

High intensity

60
Q

5 types/classifications of PRPGP (pregnancy-related pelvic girdle pain)

A

1) Pelvic girdle syndrome
2) Symphysiolysis
3) One-sided sacroiliac syndrome
4) Double-sided sacroiliac syndrome
5) Misc

61
Q

Pelvic girdle syndrome:

Pain location
+ tests

A

Pain in BOTH SIJ and pubic symphysis

FABER, thigh thrust

62
Q

Symphysiolysis syndrome:

Pain location
+ tests

A

Pain in symphysis pubis

TTP over SP, pain w/ trendelenburg test

63
Q

One-sided sacroiliac syndrome:

Pain location
+ tests

A

Pain in one SIJ

+ thigh thrust

64
Q

Double-sided sacroiliac syndrome:

Pain location
+ tests

A

Pain in bilat SIJ

+ thigh thrust

65
Q

Miscellaneous (PRPGP) category:

Pain location
+ tests

A

Daily pain in 1 or more pelvic jt’s

Inconsistent findings

66
Q

IS PRPGP self-limiting

A

Overall yes

67
Q

Being physically active during pregnancy (does/does not) reduce the odds of developing pain during pregnancy or post-pregnancy

A

Does not

HOWEVER, physical activity can be preventative for LBP

68
Q

Education or a stabilization belt alone (are/are not) good as a stand alone tx’s for PRPGP

A

are not needs to be a combo

69
Q

When selecting exercises for PRPGP, what is the best approach

A

Exercises should address the patient’s weakness and functional limitations

ALSO emphasize return to regular activity as able

70
Q

Study for PRPGP: exercise with highest amount of gluteus medius activation

A

Side-plank (aka side-bridging)

71
Q

Study for PRPGP: exercise with highest amount of gluteus maximus muscle activity

A

Bird-dog

Also good for TA activation

72
Q

Study for PRPGP: exercise with highest amount of lumbar multifidus activation

A

Free-weight exercises

73
Q

What level of evidence for manual therapy in PRPGP patients? (A-E)

A

Level C

Including HVLA

74
Q

T/F: manual techniques are all equal when treating PRPGP population

A

True, one is not better vs the others

Still Level C evidence but no evidence to show harm

75
Q

Is it reasonable to apply tx concepts for non-specific LBP to those with non-specific PGP?

A

Yes

76
Q

Are core stabilization exercises better vs other forms during tx of PGP?

A

No

77
Q

T/F: Is TENS is okay to use on someone with nociplastic pain

A

Yes, however the evidence is conflicting regarding the efficacy. TENS activates descending inhibitory systems in the CNS

78
Q

Is manual therapy indicated in tx of central nociplastic pelvic girdle pain?

A

Some evidence, can increase both pressure and thermal pain thresholds

Many techniques have an isometric muscle contraction component

79
Q

Is exercise indicated in tx of central nociplastic pelvic girdle pain?

A

Yes, but limited evidence in how much improvement it can really make

80
Q

T/F: there is a significant relationship between poor sleep and pelvic pain?

A

Yes, in chronic pelvic pain

Should education re sleep hygiene

81
Q

Does diet play a role in pelvic pain?

A

Yes, it appears that it does

82
Q

Only outcome questionnaire developed specifically for PGP

A

Pelvic girdle questionnaire (PGQ)

83
Q

What test was the strongest predictor of ODI score at 1yr post-partum

A

ASLR test

84
Q

Oswestry disability index vs Roland Morris disability questionnaire for high/low disability

A

ODI = higher disability
RMDQ = lower disability

Tests are not better vs the other

85
Q

Step count associated with lower all cause mortality

A

8,000 steps per day

86
Q
A

OCS - Current Concepts of Ortho PT (12 decks)

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