Pelvis Flashcards
1
Q
The ilium, ischium and pubis form the
A
Innominate Bones
2
Q
What’s the difference between the iliosacral and sacroiliac joints?
A
Iliosacral is ground up
Sacroiliac is top down
3
Q
True or false; you can only have sacroiliac problems if you were pregnant
A
False
4
Q
True or false; SI does not cause LBP
A
False
5
Q
What are the 3 bones of the innominate?
A
• Ilium • Ischium • Pubis
6
Q
Stability= ________+_________ performance
A
Static and dynamic performance
7
Q
How many sacral vertebrae are there?
A
5 fused
8
Q
How many sacral discs are there?
A
0
9
Q
Greater and lesser sciatic foramina are split by the ___________
A
sacrospinalous lig
10
Q
True or false; the innominate is highly perfused
A
True- rich in marrow
11
Q
Which part of the sacrum articulates with L5 disc?
A
Promontory
12
Q
How are the superior articular sacral facets oriented?
A
Coronal
13
Q
The sciatic nerve is between…
A
The periformis and operator internus
14
Q
True or false; there is a cartilagenous disc between the sacrum and coccyx
A
True
15
Q
The Sacral _____ houses nerves
A
Sacral canal
16
Q
The PSIS is around which sacral level?
A
S2
17
Q
True or false; bony anatomy can be asymmetrical
A
True
18
Q
What do you call the transverse processes of S5?
A
Inferior lateral angle (ILA)
19
Q
What is the facet orientation of the lumbosacral junction?
A
Coronal 45-90
20
Q
What is the promontory inclination?
A
50 degrees
21
Q
What is the angle of the disc between L5 and S1?
A
16
22
Q
What is the sacral inclination?
A
23
23
Q
What are the slippage safe guards of the lumbosacral junction?
A
Facet orientation of L5-S1 junction
Disc shape
Iliolumbar Ligaments
24
Q
How many bones are in the coccyx?
A
4 bones
The last 3 are fused
25
True or false; the coccyx serves as a myofascial attachment, especially for the pelvic floor
True
26
What type of joint is the SI joint?
Amphiarthrodial
27
Which sacral segments make up the part above the "ankle of the boot"? Below?
Above: S1
Below: S2& S3
28
Is the sacral articular surface or the Ilial articular surface coated in hyaline cartilage to be more mobile?
Sacral
29
Is the sacral articular surface or the Ilial articular surface thicker?
Sacral
30
Is the sacral articular surface or the Ilial articular surface relatively concave?
Sacral
31
Is the sacral articular surface or the Ilial articular surface coated in fibrocartilage for weight bearing?
Ilial
32
Is the sacral articular surface or the Ilial articular surface thinner?
Ilial
33
Is the sacral articular surface or the Ilial articular surface convex?
Ilial
34
The sacral articular surface has the greatest motion occuring in females between ...
25 and 45 years of age
35
In _____% of the population, the opposing joint surfaces are flat and parallel; thus creating the potential
for shearing and instability.
10-15%
36
Is the male or female pelvis thinner?
Female
37
Is the male or female pelvis lighter?
Female
38
Is the male or female pelvis broader?
Female
39
How wide is the female pelvic outlet?
125mm
40
Does the male or female pelvis have a smaller, smoother surface?
Female
41
Does the male or female pelvis have a rectangular sacrum?
Female
42
Are male or female pelvises more influenced by relaxin ?
Female
43
It the male or female pelvis thicker?
Male
44
It the male or female pelvis heavier?
Male
45
It the male or female pelvis more vertical?
Male
46
What is the width of a male pelvic outlet?
80mm
47
Does the male or female pelvis have a larger, regular surface?
Male
48
Does the male or female pelvis have a triangular sacrum?
Male
49
What is the center of gravity in a female?
Behind the hip S3
50
What is the center of gravity in a male?
Through the hip S2
51
What is the purpose of the anterior SI lig?
Prevent ventral gapping
52
What is the function of the posterior SI lig?
Prevent dorsal gapping
53
What is the function of the Long Dorsal SI lig?
* Prevents sacral counter-nutation
| * Prevents anterior innominate rotation
54
The long dorsal SI ligament comes under tension when the sacral base is in a pathologically induced ____________ position.
counter-nutated
55
True or false; the long dorsal SI ligament may inhibit the gluteus maximus
True due to arthrokinetic reflex.
Reflex weakness of the ipsilateral gluteus maximus. As a result, the hamstring becomes hypertonic which, through the biceps femoris/ sacrotuberous ligament connection, further counter-nutates the ipsilateral sacral base. This sets up a vicious cycle of pain, dysfunction and muscle weakness.
56
What is the function of the sacrotuberous ligament?
• Prevents posterior iliac
rotation
• Prevents sacral nutation
57
Which nerve can entrap the prudential nerve?
Sacrotuberous lig
58
What is the function of the sacrospinous ligament?
• Prevents posterior iliac
rotation
• Prevents sacral nutation
59
What is the function of the iliolumbar ligament?
* Prevents L4 and L5 contra-lateral rotation
| * Prevents ilial rotation posteriorly
60
True or false; the anterior and posterior longitudinal ligaments stop in the lumbar spine
False; run to sacrum
61
What kind of joint is the pubic symphysis?
Syndesmosis
62
True or false; a normal amount of shear and rotation may occur in the pubic symphysis
True
63
Which ligaments support the pubic symphysis?
* Inferior Arcuate
* Superior Pubic
* Ant/Post Pubic
64
What is the axis of rotation for the iliosacral complex?
Pubic symphysis
65
What are the 3 intermediate muscles of the pelvic floor?
* Levator Ani (3)
* Coccygeus
* Piriformis
66
Although each muscle of the pelvic floor performs a unique task, they collectively function as a unit to...
support and suspend the pelvic contents
67
What are the 4 systems of outer force closure?
Posterior oblique
Anterior oblique
Deep longitudinal
Lateral
68
Which components make up the posterior oblique system?
contra lateral lats. dorsi/ T-L fascia -> ipsi. glut. max.
69
Which components make up the anterior oblique system?
contralateral ext. obliques -> ipsi. int. obliques, hip adductors via anterior abdominal fascia
70
Which components make up the deep longitudinal system?
contralateral erector spinae via deep lamina of T-L fascia -> ipsi. sacrotuberous lig. and biceps femoris
71
Which components make up the lateral system?
ipsi. glut. medius/minimus
| and ipsilateral hip adductors
72
Form closure of a motion segment is undermined by a deficit in ...
normal inter-segmental stability
73
Impaired motor control of deep (local) segmental muscles (force closure) results in...
compensatory activation of torque-producing multi-segmental (global) musculature.
74
Lumbar spine pathology may account for LBP and/or lower extremity symptoms which results in secondary...
The articular/neuromuscular deficits
75
What are the components of the biomechanical treatment model?
1. Mobilize/manipulate segmental hypomobility.
2. Stabilize clinical segmental instability as follows:
a. Attain neutral spinal position.
b. Activate the local segmental muscles of core stability
c. Motor control of the pelvic floor (especially the pubococcygeus).
3. Strengthen the multi-segmental, spinal muscles.
76
What are the principles of stabilization training?
⦿ Isometric contraction of specific muscle
⦿ Low load exercise
⦿ Neutral joint position
⦿ Kinesthetic awareness
⦿ Facilitation of inhibited muscle
⦿ Pain-free exercise
⦿ Perform frequently and regularly to target Type I fibers
⦿ Progress holding time of isometric contraction
77
The sacroiliac region receives innervation from the anterior rami of ______ and posterior rami of______.
Anterior: L2-S2
Posterior: L4-S4
78
As you inhale...
The thoracic spine _______
The lumbar spine _______
The sacrum _______
The thoracic spine extends
The lumbar spine flexes
The sacrum counter-nutates
79
As you exhale...
The thoracic spine _______
The lumbar spine _______
The sacrum _______
The thoracic spine flexes
The lumbar spine extends
The sacrum nutates
80
Which sacral axis is impacted by respiration?
Superior transverse axis
81
Which sacral axis is impacted by craniosacral motion?
Superior transverse axis
82
Which sacral axis is impacted by lumbosacral motion?
Middle transverse axis
83
Which sacral axis is impacted by gait?
Inferior transverse axis
84
Between which phases of gait is the ilium posteriorly rotated?
Heel strike to foot flat
85
Between which phases of gait is the ilium anteriorly rotated?
Mid stance to toe off
86
During single leg stance, which direction may my hip rotate?
Posterior
87
When weight bearing, is it more natural for a pubic symphyseal shift to go superiorly or inferiorly?
Superior
88
My patient has an iliosacral shear dysfunction and a pubic symphysis dysfunction. Which do I treat first?
Iliosacral shear
89
My patient has an iliosacral shear dysfunction and an SI joint dysfunction. Which do I treat first?
Iliosacral shear
90
My patient has an iliosacral shear dysfunction and a Hip joint dysfunction. Which do I treat first?
Iliosacral joint
91
My patient has an iliosacral shear dysfunction and a Type II dysfunction. Which do I treat first?
Iliosacral shear
92
My patient has an iliosacral shear dysfunction and a type I dysfunction. Which do I treat first?
Iliosacral shear
93
My patient has an iliosacral shear dysfunction and a sacroiliac joint dysfunction. Which do I treat first?
Iliosacral shear
94
My patient has an iliosacral shear dysfunction and a iliosacral nonshear dysfunction. Which do I treat first?
Shear
95
My patient has a pubic symphysis dysfunction and a sacroiliac joint dysfunction. Which do I treat first?
Pubic symphysis dysfunction
96
My patient has a pubic symphysis dysfunction and a hip joint dysfunction. Which do I treat first?
Pubic symphysis
97
My patient has a pubic symphysis dysfunction and a type II dysfunction. Which do I treat first?
Pubic symphysis
98
My patient has a pubic symphysis dysfunction and a type I dysfunction. Which do I treat first?
Pubic symphysis
99
My patient has a pubic symphysis dysfunction and an iliosacral non-shear dysfunction. Which do I treat first?
Pubic symphysis
100
My patient has a unilateral sacroiliac joint dysfunction and a hip joint dysfunction. Which do I treat first?
SI
101
My patient has a unilateral sacroiliac joint dysfunction and a Type II dysfunction. Which do I treat first?
SI
102
My patient has a unilateral sacroiliac joint dysfunction and a type I dysfunction. Which do I treat first?
SI
103
My patient has a unilateral sacroiliac joint dysfunction and a bilateral SI joint dysfunction dysfunction. Which do I treat first?
Unilateral
104
My patient has a unilateral sacroiliac joint dysfunction and an iliosacral non-shear dysfunction . Which do I treat first?
SI
105
My patient has a hip joint dysfunction and a type II dysfunction. Which do I treat first?
Hip
106
My patient has a hip joint dysfunction and a type I dysfunction. Which do I treat first?
Hip
107
My patient has a hip joint dysfunction and a bilateral SI joint dysfunction. Which do I treat first?
Hip
108
My patient has a hip joint dysfunction and a iliosacral non-shear dysfunction. Which do I treat first?
Hip
109
My patient has a type II dysfunction and a type I dysfunction. Which do I treat first?
Type II
110
My patient has a type II dysfunction and a bilateral SI joint dysfunction. Which do I treat first?
Type II dysfunction
111
My patient has a type II dysfunction and an iliosacral non-shear dysfunction. Which do I treat first?
Type II
112
My patient has a type I dysfunction and a bilateral SI joint dysfuntion. Which do I treat first?
Type I
113
My patient has a type I dysfunction and an iliosacral non-shear dysfunction. Which do I treat first?
Type I
114
My patient has a bilateral SI dysfunction and an iliosacral non-shear dysfunction. Which do I treat first?
SI
115
Pt presents with
C: groin pain common
H: missed soccer kick (“hit
the ground”)
A: pubic tubercle inferior on affected side
R: (+) standing flexion test
T: TTP, inguinal ligament on the affected side at proximal attachment; hypertonic hip adductor muscles on affected side
What is it?
Inferior pubic shear
116
Pt presents with
C: groin pain common
H: fall onto ischium; rectus abdominis strain (tight on affected side)
A: pubic tubercle superior on affected side
R: (+) standing flexion test
T: TTP, inguinal ligament on affected side at proximal attachment
What is it?
Superior pubic shear
117
Pt presents with
C: SIJ referral
H: vertical fall onto the ischium; missed step off a curb
A: ASIS, PSIS, and iliac crest up on affected side (in stance greater
trochanters level), IT up 6 mm on affected side
R: (+) standing flexion test, (+) stork and reverse stork (upper and lower poles)
T: sacrotuberous lig. lax, TTP at Baer’s point
S: (+) provocation tests
What is it?
Iliac upslip/ superior shear
118
Pt presents with
```
C: SIJ referral
H: fall onto buttock in trunk flexion, lifting in trunk flexion with knees locked, intercourse strains
A: PSIS down/back, ASIS up/back,
medial malleolus short in supine
R: (+) standing flexion test, (+) reverse Stork (upper/lower pole), (+) long sitting test (short to long)
T: tight hamstrings, TTP Baer’s
point, sacrotuberous lig. taut
S: (+) provocation tests
```
What is it?
Posterior iliac rotation
119
Pt presents with
C: SIJ referral
H: golfing, baseball, bowling, etc.
A: PSIS up/forward, ASIS down/forward, medial malleolus long in supine
R: (+) standing flexion test, (+) Stork (upper/lower pole), (+) long sitting (long to short)
T: tight iliopsoas, TTP Baer’s point and Long Dorsal SI lig
S: (+) provocation tests (Distraction, Compression, Posterior Shear, Pelvic Torsion tests)
What is it?
Anterior iliac rotation
