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Spinal Tx 600 > Pelvis > Flashcards

Pelvis Flashcards

1
Q

Lumbar-Pelvic-Hip Complex

A

One mechanical unit

4th & 5th lumbar joints (4 apophyseal joints)
Sacrum (2 synovial)
Two Acetab-Fem joints
Pubic symphysis

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2
Q

The lumbar-pelvic-hip complex is the centre for:

A

Static weight bearing
Normal biomechanics
Posture

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3
Q

Pelvis

A

Bony ring formed by two innominates, the sacrum, and the cavity formed by them

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4
Q

Pelvis is the keystone of

A

postural aligment

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5
Q

Sacrum is the keystone of

A

the pelvis

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6
Q

Sacrum is the seat of

A

Transverse centre of gravity

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7
Q

Most important mechanical function of pelvic girdle

A

Transmit weight of upper body to lower limbs

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8
Q

Pubic symphysis

A

Cartilaginous joint with fibrocartilage disc

Affected by SIjt mobility

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9
Q

Force of body weight does what to sacrum?

A

Separates sacrum from ilia

Pushes first sacral segment into nutation/flexion

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10
Q

Sacrococcygeal joint

A

Fused symphysis with fibrocartilage disc. Occasionally synovial

Flexion/extension (no lateral flexion)

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11
Q

Sacroiliac Joint

A

Part synovial (C-shaped – anterior and inferior)

Part syndesmosis

Sacral surface concave and hyaline
Ilium convex and fibrocartilage

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12
Q

Function of SI joint

A

Transfers weight from spine to lower limbs

Provides elasticity to pelvic ring

Decreases transfer of jarring forces from legs to spine.

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13
Q

SI jt: resting position

A

Neutral

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14
Q

SI jt: Capaular pattern

A

Pain when joints are stressed.

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15
Q

SI: close pack

A

Nutation

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16
Q

SI: loose pack

A

Counter nutation

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17
Q

Anterior SI ligament

A

Anterior lateral sacrum –>
Margin of auricular surface of ilium, preauricular sulcus

Prevents over outflare

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18
Q

Short posterior SI ligament

A

Horizontal (ish)

Transverse tubercles of sacrum –>
Ilial tuberosity

Limits all movement, especially inflare

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19
Q

Long posterior SI ligament

A

PSIS –> sacrum

Oblique

Limits inflare/ anterior rotation

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20
Q

Sacrospinous ligament

A

Outer edge of sacrum and coccyx –>
Spine of ishium

Creates border between greater and lesser sciatic notch

Prevents rotation of ilium past sacrum

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21
Q

Sacrotuberous ligament

A

Lower transverse sacral tubercle, upper coccyx –> Ischial tuberosity

Limits nutation and posterior inominate nutation.

Provides vertical stability.

Can trap pudental nerve

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22
Q

Iliolumbar ligament

A

TVP of L5 –> upper margin of ilium

Maintains lumbosacral stability by limiting lateral flexion

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23
Q

In a neutral pelvis, where are the ASIS’s?

A

Same vertical plane as the pubic symphysis

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24
Q

Pelvic tilt

A

Angle between a line joining ASIS and PSIS and a horizontal line

7-15º

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25
Q

Lumbosacral Angle

A

Junction between middle of L5 vertebral body and the sacrum

140º

26
Q

Lumbar lordotic curve

A

Angle formed when a line is drawn from the top of L1 vertebral body and the base of the L5 vertebral body

50º

27
Q

Sacral angle

A

Angle formed when a line is drawn from the top of the sacral base and compared to the horizon

30º

28
Q

Pelvic angle

A

Angle formed when a line is drawn from S2 to the top of the pubic symphysis and compared to the horizon.

30 degrees

29
Q

Sacral locking

A

AKA nutation

Top of sacrum shifts forward, Ilia approximate, Ischial tuberosities move apart.

More stable that counternutation

30
Q

What ligaments control nutation?

A

Sacrospinous
Sacrotuberous
anterior interosseus and/or anterior SI ligaments

31
Q

Sacral unlocking

A

Aka counternutation

Top of sacrum shifts forward, ilia move apart, Ischial tuberosities approximate

Less stable than nutation

32
Q

What limits counternutation?

A

Posterior SI ligaments, supported by multifidis

33
Q

When the sacrum counternutation what direction does its articular surface move?

A

Anterior-superior

34
Q

Stability of the sacrum is determined by what two forces:

A

Form closure and force closure

35
Q

Form closure

A

Sacral stability achieved by the passive “locking in” of pelvic structures.

36
Q

Force closure

A

Sacral stability achieved through the tension generated by muscles, joint capsule, and other intrinsic forces, love the sacrum into nutation.

37
Q

Upslip

A

Both ASIS and PSIS on one ipsilaterally higher.

May have short leg on down side or muscle spasm in lumbar.

MOI usually traumatic (sudden landing on one leg)

38
Q

Outflare/Inflare

A

Unilateral or bilateral

Movement of innominates outward and inward (around vertical axis in transverse plane)

Can present with ASIS not being equidistant from midline.

39
Q

Outflare

A

ASIS more lateral
PSIS more medial

Often presents with posterior rotation of same innominate

40
Q

Inflare

A

ASIS more medial
PSIS more lateral

Often presents with anterior rotation of same innominate

41
Q

Down slip

A

Both ASIS and PSIS unilaterally lower

Often traumatic MOI

42
Q

Anterior torsion of sacrum

A

Pathological unilateral nutation

May result in spinal scoliosis or altered functional leg length

43
Q

Anteriorly rotated innominate

A

PSIS higher than ASIS on affected side

Most often after forced diagonal pattern. May be combined with sacral torsion.

44
Q

Unilateral movement of innominate with hip flexion

A

Standing single leg raise

Landmark sacral spine and PSIS
PSIS should move down

Landmark isch tube and sacral spine
Ischial tubes should move lateral and inferior

45
Q

Seated forward flexion

A

Landmark base of sacrum and inferior lateral angles.

Check for symmetry (ant-post)

46
Q

Bilateral extension of the innominate with hip extension

A

Standing trunk extension

Landmark PSIS’s. They should move inferiority

47
Q

Bilateral sacral nutation with partial hip flexion

A

Standing slow forward flexion

Landmark PSISs

First 45 degrees: nutation
After 60 degrees: counternutation

48
Q

Trendelenburg Sign

A

Stand on one leg

Test: weakness or instability of hip abductors (glute med) on stance side

Positive: pelvis drops on nonstance side

49
Q

Stork Standing Test

A

Mod tree pose. (Eyes open, closed)
Watch for lateral force applied to knee

Tests for: integrity of pelvic joints; stability and proprioception of pelvis and legs.

Positive: pain in any pelvic joint; can’t balance

50
Q

Flamingo

A

Stand on one leg. Left foot just barely off ground

Tests for lesion in pubic symphysis or SI joint.

Positive: pain in either joint. Pelvis on stance side rotates.

51
Q

Gillet’s test

A

Aka sacral fixation test, ipsilateral posterior rotation test

Standing hip flexion

Testing hypomobile SI jt.

Positive: PSIS moves minimally, or upward

52
Q

Ipsilateral anterior rotation test

A

Standing hip extension

(If can’t bring hip into flexion)

Palpate PSIS and sacrum

Test: hypomobile SI jt

Positive: PSIS doesn’t move, or moves
Inferiority

53
Q

Ipsilateral prone kinetic test

A

Tests for : SI jt hypomobility, possible posterior rotation/outflare

One thumb on PSIS, the other on sacrum

Positive: hip extension elicits abnormal PSIS movement

54
Q

Squish test

A

Supine

Tests: posterior SI ligament integrity

Push ASIS’s down and in at 45 degrees

Positive: pain

55
Q

Gapping test

A

Transverse anterior stress test

Supine

Tests anterior SI ligament.

Push ASIS’s down and out

Positive: pain in glutes or posterior leg

56
Q

Thomas test

A

Supine, one leg off table

Tests for hip flexion contracture.

Positive:
Iliopsoas: thigh off table
Quad: knee extension
TFL/ITB: J stroke

57
Q

Obers Test

A

Side lying

Tests TFL/ITB

Stabilize hip. Abduct and extend top leg; allow to lower.

Positive: leg doesn’t drop; pain in hip (trochanteric bursitis).

58
Q

Sharp, bright, burning pain

A

Nerve pain

59
Q

Deep, boring, localized pain

A

Bone

60
Q

Diffuse, aching, poorly localized, possibly referred pain

A

Vascular

61
Q

Dull, aching, hard to localize pain. Aggravated by movement and stretch.

A

Muscle pain.

62
Q

Somatic pain

A

Severe chronic or aching pain inconsistent with injury or pathology.

Spinal Tx 600 (9 decks)

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