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Pathology AT 531 > Pelvic Girdle > Flashcards

Pelvic Girdle Flashcards

1
Q

What are the 11 joints that make up Pelvic Girdle?

A 
L4-L5 intervertebral
L5-S1 intervertebral
L4-L5 facet joints
L5-S1 facet joints
(R) and (L) SIJ
Pubic-symphasis
2 hip joints
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2
Q

True Pelvic Girdle made up of:

A

2 SIJs

1 PS

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3
Q

Innominate formed by?

A

fusion of ilium, ischium, and pubis

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4
Q

Anterior Ilial Rotation

A

5 degrees
ASIS moves anterior and inferior
PSIS moves superiorly
Occurs during hip extension

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5
Q

Posterior Ilial Rotation

A

5 degrees
ASIS moves posterior and superior
PSIS moves inferior
Occurs during hip flexion > 90 degrees

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6
Q

Inflare

A

ASIS moves anterior and medial

PSIS moves anterior and lateral

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7
Q

Outflare

A

ASIS moves posterior and lateral

PSIS moves posterior and medial

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8
Q

Ilial upslip

A

superior shear

normally occurs during heel strike

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9
Q

Ilial downslip

A

inferior shear

return from upslip during swing phase gait

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10
Q

Ilial upslip Injury

A

Ilium is forced into upslip it will move into either
Upslip with anterior rotation
Upslip with posterior rotation

To realign manipulate with leg pull–correct upslip first.

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11
Q

How to notice an upslip?

A

ASIS look level–it takes a 2cm difference to be worried for PSIS to be uneven= anterior rotation upslip

ASIS uneven, PSIS are level for posterior rotation upslip

Posterior pull leg in supine; Anterior pull leg in prone

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12
Q

Sacral Flexion (Nutation)

A

base moves anterior and inferior
occurs during initiation of spinal extension, exhalation, and completion of spinal flexion

*will feel thumbs on PSIS go in when person extends

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13
Q

Sacral Extension (counternutation)

A

base moves posterior
early spinal flexion
inhalation

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14
Q

Sacral Rotation

A

(R) and (L) rotation around a (R)/(L) oblique axis

SB (R)- sacrum rotates (L)

Think of it as the L6 vertebra…SB (R) it will rotate (L). SB (R) (R) thumb on PSIS should go forward.

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15
Q

Treatment of rotated sacrum

A

Stuck in right rotation= unable to left rotate. Sacral sulcus test reveals that the right joint is not moving. Treat by using isometric contraction of right pirifomis
Stuck in right rotation= unable to rotate left. Sacral sulcus test reveals that the left joint isn’t moving. Treat by contracting the left multifidi.

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16
Q

Anterior Sacroiliac ligament

A

runs from sacrum to ilium laterally and inferiorly
reinforced by ilio-lumbar ligament

stressed during ilial outflare, hyper hip ER
taut in hip flexion and ilial ER

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17
Q

Ilio-lumbar

A

Attaches from TP of L4 and L5 to ilium

Checks posterior ilial rotation and contralateral lumbar SB and rotation

taut in post. rotation, can help prevent lateral shift

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18
Q

Short Posterior SI ligament

A

runs from PSIS promentory to the sacrum. Limits all ilial motion on sacrum mainly anterior ilial rotation

tender with SI malalignment

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19
Q

Long Posterior SI ligament

A

runs from the inferior margin of PSIS to lower 1/2 sacrum

checks anterior ilial rotation

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20
Q

Sacrotuberus

A

runs from the ischial tuberosity to distal 1/3 sacrum

checks:
sacral flexion
ipsilateral sacral rotation
ilial posterior rotation
becomes taut when biceps femoris is stretched
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21
Q

Sacrospinous

A

deep to sacrotuberous (cannot palpate)

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22
Q

Pelvic Girdles need for load transfer

A

Mobility-ilium moves on sacrum AROM hip in OC and sacrum on ilium in spine flexion, extension, SB, and ROT
Stability- static and dynamic stabilizers

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23
Q

Self locked/closed pack position of SIJs

A

full posterior innominate rotation=ideal position for loading tasks
sacral (nutation) during active flexion and extension of the spine the sacrum nutates (flexes)

24
Q

Form Closure-static stabilizers

A

ability to transfer loads through the PG, while keeping joint surfaces stable.

25
Q

Dynamic Stability-force closure

A

Optimal muscle fxn provides PG with dynamic stability=force closure

26
Q

Local muscle system

A

Pelvic floor muscles
Diaphragm
Transverse Abdominus
Lumbo-sacral multifidi

27
Q

Global muscle system

A

Opposite Latissimus dorsi and glut max
abdominal obliques and adductors
glut med in weight bearing

28
Q

Diaphragm-local PG

A

the roof, provides stability by increasing intra-abdominal pressure

29
Q

Pelvic floor muscles-local PG

A

need to activate for PG stabilization and bladder control. Co-activated with TA contraction

30
Q

Multifidi and TA-Local PG

A

both put tension on the thoraco-dorsal fascia creating a corset of support for the LB and PG—circle of integrity

31
Q

Posterior Oblique Sling

A

aides in force closure

(L) lats with (R) glut max and intervening thoracodorsal fascia

32
Q

Anterior Oblique Sling

A

External Oblique and opposite internal oblique and opposite adductor of thigh and intervening abdominal fascia

33
Q

Lateral Sling

A

Stabilizes body in frontal plane in single limb support

Keeps pelvis level–prevents ilial upslip

Stance leg glut med and adductors and opposite side Quad Lumb

34
Q

Glute Med in single limb stance

A

keeps pelvis level, prevents trendelenberg

limits unwanted superior shear or upslip forces of the ilium on sacrum

35
Q

Role of Biceps femoris for CC and ECC

A

It is coupled with erector spinae through sacrotub ligament. At end of swing phase hamstrings eccentrically contract to control hip flexion and knee extension.

Contraction of BF pulls sacrotub taut, assists in stabilizing SIJ

36
Q

Motor Control & PG Fxn

A

In a healthy back and PG CNS anticipates when muscles need to activate to handle an oncoming load and muscle fire before the load or required motion occurs.

37
Q

Integrated model of function

A

Form Closures-Bones, Jts, Ligs
Force Closure-Muscle, Fascia
Motor Control-Neural patterning
Emotions-Awaremess

38
Q

MOI to PG

A 
LLD
Superior shearing force-causes innominate upslip
weak lateral sling and jump landing
hormonal influence-relaxin
systemic hypermobility
39
Q

Hyperabduction force to hip

A

Separation force to PS

40
Q

Hyperflexion force of hip

A

excessive posterior ilial rotation, stresses sacrotub and ilio-lumbar ligs

41
Q

Hyperextension force of hip

A

excessive anterior rotation of ilium, stresses short and long SI ligs

42
Q

Hyper ER of hip

A

possible damage to anterior SI ligament and possible PS separation

43
Q

Common PG S&S

A

Local SI joint pain and tender palpation
Local PS pain and tender palpation
Unilateral complaint
Pain with stairclimbing, gait, standing, sitting
**Referred pain buttock to posterior thigh with SI involvement
**Referred pain to adductors with PS involvement
Painful palpation of one or more SI ligaments
Painful palpation of hip adductors and lower RA with pubic problem
Active SLR sign

44
Q

PG Assessment

A 
S&S
Posture/LLD
Palpate
Special tests
Core and sling fxn
Muscle length
** No one test proves anything in this area of the body mulitple tests showing it will
45
Q

Restricted SIJ

A

(+) March and/or flare test
Local ligament tenderness
Referred pain buttock/thigh
(+) pain provocation tests such as Squish
ASIS or PSIS asymmetry
(B) hip ROM asymmetry
(-) hypermobility tests such as ASLR and posterior ilial translation.

46
Q

Hypermobile PS

A

MOI=childbirth or forced hip abduction or ER
Hypermobility
Hormonal influences
Poor tolerance to sitting standing or walking
(+) pain over pubic tube, adductors or RA
(+) ASIS gapping test
(+) FABER

47
Q

Hypermobile SIJ

A

Hx of hypermobility
Hormonal influences
Local SIJ pain and referred pain buttock and thigh
Local ligament tenderness
Difficulty holding stable pelvic posture in stork standing
(+) pain on squish, ASIS gapping, FABERs
(+) ASLR
(+) Sidelying posterior ilial translation test
(B) hip ROM asymmetry

48
Q

PG Treatments

A

Direct mobilization-upslip correction (leg pull)
Isometric mobilization “muscle energy”
Soft tissue mobilization- massage hypertonic muscles
Lumbopelvic taping/strapping
Core stabilizing-improves force closure
Improve motor control-muscle fire sequencing
deal with emotional compoinent
prolotherapy

49
Q

Upslip treatment

A

Upslip with anterior rotation
- Prone leg pull-manipulation
Upslip with posterior rotation
-Supine leg pull-manipulation

50
Q

Anterior Ilial Rotation

A

Direct mobilization into posterior rotation

Isometric contraction of gluteus maximus or RA; opposite limb gives a counterforce

51
Q

Posterior Ilial Rotation

A

Direct mobilization into anterior rotation

Isometric contraction of hip flexors, hip adductors, opposite limb gives counterforce

52
Q

Ilial inflare

A

isometric mobilization using gluteus medius and minimus

53
Q

Ilial outflare

A

isometric mobilization using iliacus

54
Q

Prolotherapy

A

intraligamentous or intratendinous injection at a fibro-osseous jxn (SI or PS) of a solution induces temporary inflammatory reaction.

55
Q

How does prolotherapy work?

A

6-10 treatments at 1-2 week intervals

activity limited

56
Q

Who is a candidate for prolo?

A

patient with disabling joint pain and instability that has lasted greater than 6 months
demonstrates significant joint instability
(+) hypermobile tests
cannot tolerate prolonged sitting or standing

Pathology AT 531 (3 decks)

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