Pelvis Flashcards
What SI ligament limits anterior pelvic rotation
posterior SI ligament
one of the strongest ligaments in the body - major connection between the sacrum and ilium
interosseous SI ligament
- refers to the close packed position of the joint
- describes the stability of the joint from the design of pelvic anatomy
- refers to the shape of the joint in question
what is this?
form closure
nutation is also known as?
sacral flexion
sacral locking
in nutation, which way does the sacral base move
anteriorly and inferiorly
apex moves posteriorly and superiorly
which ligament limits anterior pelvic rotation (sacral counternutation)
long posterior SI ligaments
what ligament limits all pelvic and sacral movement
short posterior SI ligament
articular surface of the ilium is covered in….
fibrocartilage
articular surface of the sacrum is covered in…
hyaline cartilage
which ligament stabilizes the L5 on the ilium
iliolumbar
what is one of the strongest ligaments in the body and is the major connection between the sacrum and the ilium
interosseous SI ligament
what mechanisms are the SI joints stabilized through
form and force closure
form closure is also known as…
close packed position of the joint
Pubis Symphysis joint type
fibrocartilaginous joint held together by the pubic ligament
theres a disc of fibrocartilage between the 2 joint surfaces called inter-pubic disc
where is the sacrococcygeal joint found
between apex of sacrum and base of coccyx
Si joints are commonly injured by?
sudden jarring / fall on butt
describe SI joint pain
deep, diffuse, dull, undefined
difficult to localize
unilateral
referred to posterior thigh, iliac fossa and butt
can sometimes spread to abdominal and groin
when is pain caused by the SI usually felt
turning in bed
getting out of bed
stepping up w affected leg
often pain is constant and can be unrelated to the position
nutation is also know as
sacral locking
sacral flexion
posterior pelvic tilt
which way does the base of the sacrum move in nutation
forward
(backward rotation of the ilium on the sacrum)
in nutation do the ilia move closer and ischial tuberosities move further apart?
yea
what is the most stable position of the SI joint
nutation
its an example of form closure
if nutation occurs on one side only what would you find
the ASIS is higher and PSIS is lower on that side
functional short leg on same side
what ligaments limit nutation
anterior SI
sacrospinous
sacrotuberous
anterior rotation of ilium on sacrum
or
backward motion of base of sacrum on pelvis is called what
counternutation
iliac bones move apart
ischial tuberosities approximate
counternutation (sacral unlocking) is known as what pelvic position
anterior pelvic tilt
lordotic
ASIS and PSIS on one side are higher than the ASIS and PSIS on other side it is called…
upslip of ilium on sacrum on the high side, a short leg on the opposite side
ASIS tends to be slightly forward
ASIS higher on one side and PSIS lower at same time =
anterior torsion of sacrum on that side
posterior horizontal thrust of the femur would create a
anterior rotational dysfunction where the sacrum is lower on the side of the pelvis that has rotated backward
what is the most common rotation of the innominate bones
left posterior torsion/rotation
can be caused by falling on ischial tuberosity, standing on one leg repeatedly, lifting when body is forward flexed and knees straight
what would indicate a backward torsion of ilium on one side
ASIS is higher and pubic bone is higher
during forward flexion of the trunk what do the innominate bones and pelvic girdle do
rotate as a whole, rotate anteriorly as a unit on the femoral head bilaterally
same with supine to sitting
during counternutation (anterior rotation) the innominate bones
slide posteriorly along its long arm and inferiorly down its short arm
(opposite for posterior rotation)
during side flexion what do the innominate bones do
bend to the same side and the sacrum rotates in the opposite direction
condition that is the result of pressure or entrapment of the lateral femoral cutaneous nerve near ASIS
meralgia paresthetica
pt experiences sensory alteration or burning pain on the lateral aspect of the thigh
Ilioinguinal nerve
- lies within transverse abdominus mm
- associated w L1 dermatome
- pain occurs in superior aspect of anterior thigh
- sensory only
functions of piriformis
- internally rotate femur when hip is fully flexed
2.restrain vigorous IR of hip - externally rotate femur when hip is extended
- horizontally abduct thigh when hip is flexed to 90
when applying a posterior lateral glide on the ilium on the sacrum it would correct
an inflare
nutation of the base of the sacrum =
form closure
flexion of lumbar spine causes sacrum to move towards
counternutation
lumbar extension causes nutation increasing SI joint stability
what nerve roots make up the sciatic nerve
L4-S2/3
supine to sit test , tests what
functional leg length discrepancy
what test for SI joint hypomobility
Gillet
test for pathology in the anterior SI ligament
Yeomans
test for lesions in pubic symphysis or SI joints
flamingo
test for SI joint dysfunction or hip pathology, L4 nerve root lesion
Gaenslens
Piriformis Syndrome S&S
unilateral
shortening and tension in piriformis
guarding of affected side
ataxic gait due to pain
torsion of hips
pain often decreased w ER of hip
weakness in abduction, flexion, IR of hip
in supine = excessive ER of leg on affected side
with pelvic degeneration which surface is usually affected first
iliac surface
non inflammatory bone formation on the iliac side of SIJ
in younger adults, bilateral
what diagnoses?
Osteitis Condensans Ilii
making a C with pelvis is counternutation (anterior pelvic tilt)
contract abs tight = posterior pelvic tilt = nutation
ideal pelvic alignment =
ASIS on the same vertical plane as symphysis pubis
tests for sprain of anterior SI ligaments (2)
Gapping Test
positive = uniltaeral gluteal or posterior leg pain
FABERS
positive pain in the SI region, tensile stress across anterior SI ligaments
test to assess tight rec fem , upper lumbar joint lesion, upper spine nerve root leseion, hypomobile SI joint
prone knee bending (Nachlas)
test for abnormaility in the torison movement at the SI joint
Piedallu’s
tests for sciatic nerve compression by piriformis
FAIR and Pace Abduction
the compression generated by the mm’s and through them, the tensing of the ligaments when they act to accomodate specific load citations
force closure
self bracing mechanism
what is an example of form closure
nutation
if nutation (posterior pelvic tilt) occurs only on one side, the examiner would find that the ASIS is ________-
higher, and the the PSIS is lower on that side
what is nutation (posterior pelvic tilt) limited by (ligaments)
anterior SI
sacrospinous
sacrotuberous
if counternutation only occurs on one side the lower limb on that side would be
medially rotated
during counternutation the sacrum will slide _____ along its long arm and then _______ up its short arm
anteriorly, superiorly
counternutation is resisted by what ligaments
posterior SI ligaments supported by multifidus
nutation of the sacrum refers to the sacrum moving which way?
anterior rotation of sacrum, back ward rotation of ilium
counternutation of sacrum refers to it moving which way
posterior rotation of sacrum
during nutation, which way does the base of the sacrum move
anteriorly and inferiorly
during counternutation, which way does the apex of the sacrum move
anterior
it locks the SI joints for stability
nutation
what is the functional significance of nutation in weight bearing activities
it increases stability of the pelvis
when the sacrum goes into counternutation and the pelvic bones go into nutation (rotate anteriorly) the overall effect is that the pelvis moves __________–
posteriorly
at the lumbar spine there is a reduction of lumbar lordosis
where is the axis around which the anterior-posterior nutation occurs
around S2
during nutation, there is an _____ translatory movement of sacrum
inferior
which movement does the long dorsal ligament prvent
extension
in inhalation the curves of spine flatten, the base of sacrum rotates _______
posteriorly
positive seated flexion test indicat on the R means ______
right side is stuck and the axis is left
which plane do nutation/counternutation occur in
sagittal
asymmetrical moves on transverse plane
nutation - iliac on sacrum movement
PSIS moves posterior in relation to sacrum
sacral & iliac: sacral base moves anterior and PSIS moves posterior together =
nutation
muscle slings that contribute to force closure
multifidus attaching to sacrum
deep layer of throacolumbar fascia
long head of biceps femoris attaching to sacrotuberous ligament
in forward flexion test, if one PSIS moves upward less, the hypomobile side if considered ___________
positive for limited movement of the ilium on the sacrum
lateral border at sacrum and under 1/3 of the way medial from greater trochanter = TRPS for what mms
piriformis
refers to SI region, buttocks, over hip joint
with piriformis syndrome which ROMs will have weakness
abduction
flexion
internal rotation of hip
pain can decrease w external rotation of hip
