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General Orthopedics > Pelvic Girdle & Sacroiliac Joint > Flashcards

Pelvic Girdle & Sacroiliac Joint Flashcards

1
Q

Describe the anatomy of the sacroiliac joint

A
  • largest axial joint in the body
  • connects spine to pelvis
  • allows for transfer of load from lumbar spine to lower extremities
  • held together with several ligaments and fibrous capsule
  • surrounded by muscular support
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2
Q

Do any muscles act directly on the sacroiliac joint

A

No

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3
Q

How are movements of the sacroiliac joint produced

A

By muscles acting on the trunk and lower limbs

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4
Q

What type of loads do the sacroiliac joint transfers?

A

Large bending moments and compression loads

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5
Q

What type of load does the sacroiliac joint does not have much stability against

A

Shear loads

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6
Q

How is shear load resisted

A

Transverse abdominus and pelvic floor muscles (elevator ani) help apply compression load to resist shear

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7
Q

What type of force opposes shear force

A

Compression force

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8
Q

How much flexion/extension is there in sacroiliac joint ROM

A

~ 3 degrees

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9
Q

How much axial rotation in Sacroiliac joint ROM

A

~ 1.5 degrees

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10
Q

How much lateral bending at the sacroiliac joint?

A

~0.8 degrees

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11
Q

What is nutation

A

Sacral flexion
- associated with spinal extension

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12
Q

What is counternutation

A

Sacral extension
- associated with spinal flexion

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13
Q

What direction does the superior sacrum tilt in nutation

A

Anteriorly

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14
Q

What direction does the coccyx tilt in nutation

A

Posteriorly

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15
Q

What structure restricts sacral nutation

A

Sacrotuberous ligament

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16
Q

What muscle helps restrict nutation and where is its attachment

A

Biceps femoris, ichial tuberosity

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17
Q

In what sacral position is load transfer more effective

A

When the sacrum is notated or tilted forward at its superior aspect

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18
Q

Which direction does the coccyx rotate in counter nutation (from mutated state back to neutral state)

A

Rotates anteriorly

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19
Q

What direction does the superior sacrum move in sacral counter nutation

A

Posterior tilt

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20
Q

What structure restricts sacral counter nutation

A

Long dorsal sacroiliac ligament
Can also be achieved by latissimus dorsi though its attachment at the thoracolumbar fascia

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21
Q

What plane does anterior and posterior rotation of the innominate (pelvis) occur

A

Sagittal plane

22
Q

Should anterior rotation occur during weight bearing

A

No.

23
Q

During single leg stance, which direction does innominate (pelvic) rotation occur and why

A

Posteriorly to put sacrum in mutated position - creates close pack position and maximum amount of stability in the joint

24
Q

In what plane does inflate and outflare occur?

A

Transverse plane

25
Q

What kind of motion/tasks do inflare and outflare occur

A

During rotation and lateral bending tasks

26
Q

What is the gold standard diagnosis for SI joint pain

A

Fluoroscopically guided diagnostic steroid injection

27
Q

What is the primary mechanism of SI joint injury

A

Combination of axial loading and abrupt rotation

28
Q

What type of surgery can also increase angular more and stresses across the SI joint

A

Lumbar fusion

29
Q

Wha are the 4 European Guidelines on the Diagnosis and Treatment of Pelvic Girdle Pain

A
  • groin pain
  • pain below L5
  • Pain at the region of the PSiS
  • Absence of midline lumbar pain
30
Q

What are the SI joint provocation test clusters

A
  • FABER
  • Distraction
  • Compression
  • Thigh thrust
  • Sacral thrust
  • Gaenslan’s test

3 positive rests required for diagnosis of SI joint pain

31
Q

What is the FABER test ?

What type of stress is applied to the SI joint?

A

Flexion, abduction, ER
- applies tensile force on anterior aspect of SI joint
- positive test = report suction of pain

32
Q

What is the distraction test?

What type of stress is applied to the SI joint?

A
  • lateral force to bilateral ASIS
  • applies tensile force on anterior aspect of SI joints
  • positive test - reproduction of pain
33
Q

What is Compression test

What type of stress is applied to the SI joint?

A
  • patient sidelying, with application of downward compression on ilium
  • applies compression force across SI joint
    = pain = positive test
34
Q

What is the thigh thrust?

What type of stress is applied to the SI joint?

A
  • patient supine, with affected side flexed to 90 degrees and examiner applies axial pressure through the femur
  • applied anteroposterior shear stress on the SI join
35
Q

What is the sacral thrust test?

What type of stress is applied to the SI joint?

A
  • patient laying prone, examiner applies anteriorly directed force on the sacrum
  • applies anterior shear forces to both SI joints
36
Q

What is Gaenslan’s test?
What type of stress is applied to the SI joint?

A
  • symptomatic leg placed in extension off the table, opposite leg held in flexion
  • applies torsional stress on the SI join
  • modified version performed in side lying
37
Q

Is sacral fusion recommended for SI joint pain

A

No - there is no evidence for sacral fusion surgery

38
Q

Structural/true leg length discrepancy definition

A

Results from inequalities in boney structure

39
Q

Functional LLD deficiency

A

Caused by altered mechanics of the lower extremity

40
Q

What rotation occurs off the innominate (pelvis) and in what plane during functional LLD

A

Anterior rotation, sagittal plane

41
Q

What other downstream effects we can see in function LLD?
Ie how are the femur, the knee, the tibia and the foot affected

A
  • weakness of structural mal alignment of pelvis in frontal plane
  • functional lengthening of the lower limb
  • femoral internal rotation
  • valgus knee aka medial knee excursion
  • tibial internal rotation
  • foot pronation
42
Q

What is the gold standard for measuring LLD

A

Radiographs

43
Q

What re the 2 different clinical measurements of LLD

A
  • with tape measure
    = with a block
44
Q

How to measure structural LLD with a tape measure

A
  • ## ASIS to medial malleolus
45
Q

How to measure functional/apparent LLD with a tape measure

A

Umbilicus go medial malleolus

46
Q

Which clinical measurement of LLD indirect and which is direct

A
  • indirect - blocks
  • direct - tape measure
47
Q

Which LLD is measured first

A
  • structural done prior to the functional
  • ie ASOS to med mal done prior to umbilicus to med mal
48
Q

What is the recommended treatment for Functional LLD?

A

-physical therapy to address underlying issue

49
Q

Treatment options for true LLD?

A
  • conservative (less than 2cm)
  • Surgical
50
Q

What are they surgical treatments for LLD

A
  • epiphesiodesis
  • lower limb shortening’
    • Mac 3inches in femur, max 2 inches in tibia
    • external limb lengthening
    • internal limb lengthening

General Orthopedics (5 decks)

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