Pelvis Flashcards
What are the functional units of the pelvis? Stability is provided by what?
- 2 innominate
- sacrum
- bilateral hip jts and L5/S1
- Stability is provided by
o Form closure
o Force closure - the stability comes from the interlocking grooves and ridges
What equates to a stable system?
passive system = jt congruency and ligamentus support
What are the major lig supports at the pelvis
interosseous ventral and dorsal SI ligament sacrotuberous sacrospinous long dorsal lig
What are the most important muscles for the pelvis
muscles that cross perpendicular to jt surfaces
ex. glut max and TA
OPTIMAL alignment is balance btw form and force closure
What is the self locking mechanism of the pelvis
The fact that its kept stable via form and force closure
What do we know regarding the biomech. arthrokinematics; and total ROM of the pelvis
axis of motion is not known same with arthrokin. there is a total of 4degrees of movt.
- need this movt. for shock absorption…
- thought asymmetry = pain
Does the Innominate rotate or nutate
INNOMINATE = ROTATION
DOES THE sacrum rotate or nutate?
Sacrum = nutation (sacral nod) = flexion
* sulcus deepens
What is the most stable position for the SI jt
Nutation (flexion) b/c it tensions the sacrotuberous and spinous ligaments
What does counter nutation equate to
extension of sacrum
sulcus is shallow and base tips back
“unstable position of SI”
what are some differential diag for pelvic girdle pain syndrome (PGPS)
- inflam condition (AKS)
- Systemic disease reiters
- peliv inflam disease
- visceral dysfunction
- lumbar spine and hip dysfun
- *get them to draw pain diagram very good tool**
Your pt presents with SI symptoms do you send them for Xray?
NO dont show anything
Nor does MRI
Unless u think tumor or AKS
Do active tests tell you what is wrong in the pelvis
No u need to do passive tests to get an idea of what is going on
What are some general outcome measures for PGP
Quebec back pain disability scale
Oswestry back pain disability questionnaire
Disability rating index
What increases your chance for pelvic pain postpartum?
Having asymmetry jt laxity during prego
What do you need to consider when clinically diagnosing PGP
1) rule out LBP; ask about P. W. prolonged sitting or standing, location of shading on P. diagram
2) SI jt. P - Posterior Pelvic pain provocation test (P4 test), Fabers (P. must be in SI jt.), Gaenslens tests & TOP over long dorsal lig.
3) Pub. sym dys - TOP >5sec; modified trendelenburg
4) Mechanical Pelvic issues - Active straight leg raise (ASLR) give form closure/then try force then together see if P. decreases–if form helps = SI belt ; if Force = muscle training
A patient has an option of MRI or PT Ax for diagnosis what would you recommand to them
PT most effect in SI jt dysfunc
Pt has SI dysfunction what are the recommendations for Rx
exs. including water exs for pregnant women
SI belts short periods
What is a + gaenslens; FABRS & P4 test?
Gaenslens = P. at SI jt P4 = P in SI region FABRS = SI patho P. in SI region
What are the pain provocation test of the pelvis?
1) Gaenslens test
2) FABRS
3) P4
4) Cyriax
5) Palpation
6) Modified trendel.
7) Active SLR
What is indicative of SI/public sum path?
local P. at SI jt or pubic symphysis
When doing the cyriax test what position gives you ant traction and post compression
- supine with hands crossed over
What are the criteria needed to call something a lesion
ex ant lesion would mean on PASSIVE testing the innom. can not move post.
** if there is no restriction passively then its a positionally = muscle fault
What are common lesions to the pubic sym
Women - peri-partum, can be superior or inf.
men - post herination, of post abd wall
