PELVIC HEALTH/SI JOINT LAB 4-5

Question 1

What is a screening outcome measure for pelvic floor?

Answer 1

3IQ
(during last 3 months, have you leaked urine? When? When most often?

Question 2

If your patient is female, what should you make sure to ask?

Answer 2

Is there a chance you might be pregnant?

Question 3

If someone has lower back and hip pain, ask about….

Answer 3

urinary, constipation, pain with sex activity, abdominal pain

Question 4

groin pain: screening questions for men

Answer 4

scrotal or penile pain?
erectile dysfunction?
pain with ejaculation?

Question 5

female athletes: screening questions

Answer 5

leakage? with what activities?
menstrual cycle status?
history of stress fx

Question 6

older adults screening questions

Answer 6

loss of urine/stool control

Question 7

patients on pain meds

Answer 7

how often are you having bowel movement/ Are you straining /pain?

Question 8

screening questions for patient with diabetes/peripheral neuropathy

Answer 8

Erectile dysfunction, increased urgency, frequency, nocturia, weak stream, incomplete emptying

Question 9

What can hip pain/labral tears present as and vice versa?

Answer 9

pelvic floor (obturator internus)

Question 10

WHAT ARE EXAM OPTIONS for SI joint exams?

Answer 10

1. lumbar spine
2. lumbar spine + SI joint
3. hip
4. hip + SI joint
5. lumbar + SI + hip
   SI IS NEVER IN ISOLATION

Question 11

Why is SI exam special?

Answer 11

super hard to parce out
important to diff dx !
can have more than 1 DX
1. localized
2. referred
3. radiating

Question 12

What is Fortin’s sign?

Answer 12

unilateral pain just medial to PSIS

Question 13

first, rule out ____ before moving onto pelvic/SI joint

Answer 13

L-spine or hip dysfunction

Question 14

pain with transitional movements (sitting to standing, sitting to lying down), SLS (stairs, walking)

what is prob involved?

Answer 14

*SI JOINT

Question 15

Decreased ability to squat or PAIN is a sign towards

Answer 15

hip joint

Question 16

positive trendelenburg is a sign of

Answer 16

hip joint dysfunction

Question 17

positive sign of buttock test is a sign of

Answer 17

hip joint

Question 18

pain with coughing/sneezing and symptoms decreased with walking are signs towards…

Answer 18

lumbar disc pathology

Question 19

lumbar spine joint pathology have these signs:

Answer 19

pain with coughing/sneezing
pain with extension/flexion
pain with PA joint glides

Question 20

When should you perform a full SI joint exam during LQ scanning?

Answer 20

ANY OF THESE FOUR SIGNS
1. Fortin’s
2. SI joint stress tests (gapping or compression)
3. TTP at post SI ligaments
4. pain/weak with SLS

Question 21

What is Fortin’s Sign?

Answer 21

1. localize pain with 1 finger
2. area within 1 cm of PSIS (infero-medial)
3. patient points to same area 2 or more times consistently

Question 22

If 3 or fewer of these 5 tests are POSITIVE, then SI joint dysfunction is NOT INVOLVED

Answer 22

1. compression
2. distraction
3. Gaeslen’s test
4. FABER*****
5. thigh thrust

Question 23

If more than 3 out of these 5 tests are positive, it is probably SI joint dysfunction

Answer 23

Compression
Distraction
Sacral thrust*****
Gaeslen test
Thigh thrust

Question 24

when would you use the pubic stress test?

Answer 24

superior-inferior
ANTERIOR PAIN only
not CPR, not to rule in or out

Question 25

what is the sign of buttock test?

Answer 25

INDICATES SERIOUS PATHOLOGY!
1. tumor
2. fracture
3. infection (osteomyelitis, muscle abcess)
4. septic arthritis

SLR +
return leg to neutral
flex hip with knee flexed: POSITIVE PAIN

Question 26

If someone has
Hx of immunosuppression
Prolonged fever &/or recent illness
Hx of drug use

Answer 26

infection

Question 27

Medication (i.e. corticosteroids)
Mild trauma >50 y/o
Age >70 y/o
Hx of osteoporosis
Recent major trauma
(+) sign of buttock test
THINK…

Answer 27

fracutre! (vertebra, pelvis, hip)

Question 28

B&B dysfunction, sexual dysfunction, saddle/LE paresthesias
THINK…

Answer 28

cauda equina

Question 29

If someone has short hams, weak hip flexors
what posture?

Answer 29

flattened spine
*possible disc, stenosis, lateral shift

Question 30

If someone has short ES/hip flexors, core and hip extensors are weak, possible pelvic crossed syndrome….

Answer 30

excessive lordosis

Question 31

If someone has Thoracic kyphosis + posterior pelvic tilt
hips are extended

Answer 31

swayback psoture

Question 32

Gillet’s test is positive when

Answer 32

PSIS DOES NOT MOVE INFERIOR to sacrum on stance leg**
or pain

Question 33

(+) test = if pt able to perform ASLR test w/ less pain OR fewer compensatory patterns when compressive force was applied

Answer 33

form closure problem

Question 34

(+) test = if pt able to perform ASLR test w/ less pain OR fewer compensatory patterns when core mm. activated

Answer 34

force closure problem

Question 35

outcome measures for SI joint pain

Answer 35

Modified Oswestry Disability Index
Roland-Morris Back Pain Disability Questionnaire
Fear Avoidance Behavior Questionnaire (FABQ)
Patient Specific Functional Scale (PSFS)

Question 36

how should the hip position be in long axis traction?

Answer 36

extension, slight abd, IR (closed pack of hip)

Question 37

prone SI joint mobilization does what?

Answer 37

restore anterior innominate rotation (for a posterior innominate)

PT extends LE, stabilize PSIS
use PA glide in hip extension to push anterior rotation of pelvis with thumb

Question 38

supine with hip flexion and extension
isometric holds

Answer 38

1. patient supine, one PT hand on knee, other on posterior thigh
2. hip flexion (anterior rotation), hip extension (pulls into posterior rotation

Question 39

MET: adduction isometrics are for

Answer 39

anterior pelvic pain
*3 second holds

Question 40

Which two mm are really important for SI joint stability?

Answer 40

GLUTES AND PELVIC FLOOR
(also lumbar extensors)