Pelvis - ANATOMY AND KINESIOLOGYpart1 Flashcards
PLANES OF MOTION drive
Frontal/Coronal
Axis
Movement
Z or Horizontal Axis,
A-P Axis
Abduction, adduction /
Inversion, Eversion
* Thumb flexion,
extension
Sagittal
Axis
Movement
X or Transverse Axis,
Coronal Axis
Flexion, extension/
Plantarflexion,
Dorsiflexion
* Thumb Abd & Add
Horizontal/Transverse
Axis
Movement
Y or Vertical Axis,
Longitudinal Axis
IR, ER
Fibrous Joints
(Synarthroses)
Movement minimal to none
sutures, syndesmosis and gomphosis
Type 0f joint
Movement is minimal to none
Fibrous Joints
(Synarthroses)
SUTURE
SYNDESMOSIS (Tibia &fibula)
GOMPHOSIS (tooth)
Fibrous Joints
(Synarthroses)
Hyaline/fibrocartilage
connects one bone
to another
Cartilaginous Joints
(Amphiarthroses)
Type of Joint:
Slightly movable joints
Cartilaginous Joints
(Amphiarthroses)
Type of joint
SYNCHONDROSIS (sternum)
SYMPHYSIS
Cartilaginous Joints
(Amphiarthroses)
5 distinguishing characteristics:
1. Joint cavity
2. Articular cartilage
3. Synovial membrane
4. Synovial fluid
5. Fibrous capsule
Synovial Joints (Diarthroses)
Type of joint:
Free movement
Synovial Joints (Diarthroses)
Uniaxial
Biaxial
Multi-axial
Synovial Joints (Diarthroses)
Synovial Joints (Diarthroses)
5 distinguishing characteristics:
1. J
2. A
3. S
4. S
5. F
- Joint cavity
- Articular cartilage
- Synovial membrane
- Synovial fluid
- Fibrous capsule
Type of endfeel
Elbow extension
Bone to bone (Hard)
Type of endfeel
Knee flexion
Soft tissue approximation
(Soft)
Type of endfeel
Ankle dorsiflexion
Tissue stretch
Type of abnormal endfeel
Protective spasm after injury
Early muscle spasm
Type of abnormal endfeel
Spasm due to instability
Late muscle spasm
Type of abnormal endfeel
Tight muscle
“Mushy” tissue stretch
Type of abnormal endfeel
UMNL
Spasticity
Type of abnormal endfeel
Frozen shoulder
Hard capsular
Type of abnormal endfeel
Synovitis
Soft capsular
Type of abnormal endfeel
Osteophyte formation
Bone to bone
Type of abnormal endfeel
Acute subacromial bursitis
Empty
Type of abnormal endfeel
Meniscus tear
Springy block
The patient performs the action of the
supraspinatus. The axis of the said motion is at the?
Frontal/Coronal plane
Your patient tries to perform heel raises but was only able to lift at a few mm from the floor. Accurate muscle grade?
3 minus
PROM assessment of the knee towards
extension. Approximating the end range you felt a springy block that limited you to bring the knee towards extension.
Meniscus tear
Pelvis landmark:
ASIS:
AIIS:
PSIS: vs ASIS
ASIS: pelvic position, Leg length, q-angle
- Sartorius, inguinal lig, TFL (SIT)
AIIS: O- straight of Rectus femoris
PSIS: vs ASIS - To know the pelvic position. Psis higher than asis
Deep Posterior Longitudinal
System:
- ____
- ____
- ____
- Erector Spinae
- Thoracolumbar Fascia
- Hamstring
Iliac Crest
G med: O- ____
TFL: O- ____
G med: O- post/outer surface of the ilium
TFL: O- Ant aspect
Pelvis :
- w____
- s____
- m____
Formed by:
- ____
- ____
- ____
Pelvis :
- weightbearing
- shock absorption
- mobility
Ilium, ischium and Pubis bone
Iliac fossa:
medial aspect ; O: ____
Gluteal lines: ____
medial aspect ; O: Iliacus
Gluteal lines: outer surface
Ischium:
ischial tub: ____
- prox attachment ____and portion of ____
ischial tub: wt bearing when sitting
- prox attachment hams and portion of Adductor Magnus
- smallest of the innominate bones
- body, inf and sup rami
Pubis
Pelvic tilt:
Inc angle : ____
Dec angle: ____
Inc angle : Inc APT
Dec angle: PPT
Pelvic Inclination:
Inc: ____
dec: ____
Neutral Position:
- __SIS > __SIS ( ___ FB)
-Lumbar spine: Neutral ; N lordosis - Hip neutral
N Pelvic tilt: ave- _degrees
Inc: APT
dec: PPT
Neutral Position:
- least amt of stress
- PSIS > ASIS ( 1-2 FB)
-Lumbar spine: Neutral ; N lordosis - Hip neutral
N Pelvic tilt: ave- 11 degrees
N pelvic inclination:
____ brunstrom
____- magee
50-60 bruns
30 - magee
APT/ Ant Innom Rot ( AIR)
- Inclined ____
- ____Up, ____down
- Lumbar spine: ____ lordosis
- hip jt: ____
- Inclined fwd
- PSIS Up, ASIS down
- Lumbar spine: inc lordosis
- hip jt: flexion
Posterior Pelvic Tilt/ PIR
- Inclined ____
- ____Up; ____down
- Lumbar spine: ____-> dec lordosis
- hip jt: ____
- Inclined bwd
- ASIS Up; PSIS down
- Lumbar spine: flexion-> dec lordosis
- hip jt: extension
Hip Hiking:
- elev of the ____side of pelvis
- Hiking of R pelvis around L hip jt = L hip abduction
Hip Hiking:
- elev of the opp side of pelvis
- Hiking of R pelvis around L hip jt = L hip abduction
Pelvic Drop:
- drop of the ____pevis
- Dropping on R pelvis around the left jt= L joint Adduction
Pelvic Drop:
- drop of the opp pevis
- Dropping on R pelvis around the left jt= L joint Adduction
PELVIC MOTION to hip mvmts
Anterior pelvic tilt - ____
Posterior pelvic tilt - ____
Lateral pelvic tilt(Pelvic drop – RLE stance) - ____
Lateral pelvic tilt(Pelvic hike – RLE stance) - ____
Forward rotation(RLE stance) - ____
Backward rotation(RLE stance) - ____
Anterior pelvic tilt - Hip flexion
Posterior pelvic tilt - Hip extension
Lateral pelvic tilt (Pelvic drop – RLE stance) - Right hip adduction
Lateral pelvic tilt(Pelvic hike – RLE stance) - Right hip abduction
Forward rotation(RLE stance) - Right hip medial rotation
Backward rotation(RLE stance) - Right hip lateral rotation
HIP to innominate rotation
Flexion
Extension
Medial rotation
Lateral rotation
Abduction
Adduction
INNOMINATE
Flexion - Posterior rotation
Extension - Anterior rotation
Medial rotation - Inflare (medial rotation)
Lateral rotation - Outflare (lateral rotation)
Abduction - Superior glide
Adduction - Inferior glide
ANTERIOR PELVIC TILT
L.A.C.E.
Strong muscles:
Weak muscles:
Lordosis
Anterior pelvic tilt
Counternutation
Extension of back
- Strong muscles: Hip flexors &
lumbar extensors - Weak muscles: Hip extensors
& abdominals
POSTERIOR PELVIC TILT
Kyphosis
Posterior pelvic tilt
Nutation
Flexion of back
Strong muscles: ____
Weak muscles: ____
Kyphosis
Posterior pelvic tilt
Nutation
Flexion of back
Strong muscles: Hip extensors &
abdominals
Weak muscles: Hip flexors &
lumbar extensors
Pelvic Rot: ____degrees
Pelvic Rot: 8 degrees
Lower Crossed Syndrome:
Shortened: ____
Lengthened: ____
- Hams - tight d/t ____
Shortened: iliopsosas & erectors
Lengthened: G max and Abs
* Hams - tight d/t attempt to PPT
(L) HIP HIKE
ipsi and contralateral
Right abduction
Left Adduction
(L) pelvic drop
right and left?
Right Adduction
Left Abduction
(L) pelvic drop bilateral
Right Adduction
Left Abduction
Pelvic rotation of left forward
Right Medial rotation
hip flexion c knee extension muscles involved mm?:
Abdominals: PPT - stabilize pelvis
if weak ABS: ____
rec fem, APT
Abdominals: PPT - stabilize pelvis
if weak ABS: inc lordosis
AIR
L
S
S
ASIS: ____
PSIS: ____
Supine/Standing
Long sitting/Standing with trunk flexion
Sitting with reaching toes
ASIS: INF
PSIS: SUP
Posterior Innominate Rotation
S
L
L
ASIS: SUP
PSIS: INF
Supine/Standing
Long sitting/Standing with trunk flexion
Sitting with reaching the toes
ASIS: SUP
PSIS: INF
Landmarks to get the leg length
*True leg length: ____
*Functional : ____
*True leg length: ASIS to med /lat malleoli
*Functional : Xiphisternum/ umbilicus to med malleoli
PELVIC DYSFUNCTION
Anterior Innominate Rotation
Tight?
Stretch?
Strengthen?
Tight iliopsoas muscle
Stretch Iliopsoas
Strengthen the gluteus maximus
PELVIC DYSFUNCTION
Posterior Innominate Rotation
caused by?
Stretch?
Strengthen?
Caused by hamstring muscle
Stretch hamstring
Strengthen the quads muscle
(concentric contraction)
Case 1:
(R) PSIS higher
(R) ASIS lower
(R) LE longer in supine
(R) AIR
ALSU
Case 2:
(L) PSIS lower
(L) ASIS higher
(L) LE longer in long sitting
(L) PIR
Case 3:
(R) PSIS higher
(L) ASIS higher
(R) LE shorter when trying to reach the toes
(R) AIR
Case 4:
(L) PSIS higher
(L) ASIS higher
(R) LE longer in supine
(L) UPSLIP
kase same side umangat
Upslip:
- sup subluxation of innominate on the sacrum
- Upslip limb: ____
- sup positioning of ASIS, PSIS, Iliac crest , pubic tubercle and ischial tub
- tight ____
Tx: ____, ____
Upslip:
- sup subluxation of innominate on the sacrum
- Upslip limb: shorter
- sup positioning of ASIS, PSIS, Iliac crest , pubic tubercle and ischial tub
- tight Quadratus Lumborum
Tx: jt mobilization, distraction forces
SACROILIAC JOINT
PRIMARY LIGAMENTS
1.
2.
3.
SECONDARY LIGAMENTS
1.
2.
Function of ligaments?
PRIMARY LIGAMENTS
1. Anterior sacroiliac
2. Posterior sacroiliac
3. Interosseous
SECONDARY LIGAMENTS
1. Sacrotuberous
2. Sacrospinous
For stability and prevents rotation
Sacrum:
- base- sup: ______
- apex: inf , ______
Inf lat angle: ______- point where the lower portion of sacrum curves med
- base- sup: ______
- apex: inf , ______
Inf lat angle: ______- point where the lower portion of sacrum curves med - base- sup: Sacral Promontory
- apex: inf , coccyx
Inf lat angle: ILA - point where the lower portion of sacrum curves med
SI Jt:
- transfer of wt from ______ to ______
- S ______
- Relative ______- young;
______as age progresses
- transfer of wt from spine to LE
- Shock absorber
- Relative mobile- young; stiffen as age progresses
SACROILIAC JOINT
Resting position: ______
Close pack: ______
Open pack: ______
Capsular pattern: Pain when joints are ______
Resting position: Neutral
Close pack: Nutation
Open pack: Counternutation
Capsular pattern: Pain when joints are stressed
SACRAL MOVEMENT <drive></drive>
x2
SACRAL MOVEMENT <drive></drive>
x2
LUMBO-PELVIC RHYTHM <drive></drive>
LUMBO-PELVIC RHYTHM <drive></drive>
Sacrum
Nutation
Short part: ______
Long part: ______
Sacrum: ______
Pelvis : ______
Counternutation
Long arm: ______
Short arm: ______
Sacrum: ______
Pelvis: ______
Nutation
Short part: down
Long part: post
Sacrum: Ant torsion
Pelvis : PPT
Counternutation
Long arm: slide ant
Short arm: Sup
Sacrum: Backward torsion
Pelvis: APT
Lumbopelvic rhythm:
a.) Head and trunK fwd
b.) ____dg - nutate ( PPT)
c.) ____deg - counternutation (APT)
= reach more
** Hams and gluts - eccentric contraction to control
Head and trunK fwd
45 dg - nutate ( PPT)
60 deg - counternutation (APT)
= reach more
** Hams and gluts - eccentric contraction to control
PELVIC MOTIONS WITH
LUMBAR SPINE MOVEMENT <drive></drive>
PELVIC MOTIONS WITH
LUMBAR SPINE MOVEMENT <drive></drive>
Naming sacral torsion:
______ on ______
- By the direction that the front of the sacrum
faces - By the axis of the movement
If same ang letters: Forward torsion (nutation)
if diff letters: Bwd torsion (counternutation)
Naming sacral torsion:
______ on ______
- By the direction that the front of the sacrum
faces - By the axis of the movement
If same ang letters: Forward torsion (nutation)
if diff letters: Bwd torsion (counternutation)
SACRAL MOVEMENTS
L on L
R SB deeper , L ILA more prominent
SACRAL MOVEMENTS
R on L:
R SB more palpable, L ILA deeper
SACRAL MOVEMENTS
R on R
L SB deeper, R ILA more post
SACRAL MOVEMENTS
L on R
L SB more palpable, R ILA deeper
FWD torsion: Nutation
PPT
tight : ____
Weak: ____
tight : G max
Weak: iliopsosas
BWD Torsion:
Counternutation
- APT
Tight mm: Iliopsoas
weak : G max
Tight mm: ____
weak : ____
Sphinx position: Prone to
POE
- ____
(Asymmetrical) BACKWARD torsion - ____
FORWARD
torsion
Extension of the spine-> APT =
counternutation
Sulcus deeper/prominent
(Asymmetrical) BACKWARD torsion
Sulcus symmetrical FORWARD
torsion
Extension of the spine-> APT =
counternutation
Sphinx position:
Ex:
Prone: L SB is deeper than R
POE: L SB is level c R SB
- inc symmetry - ant torsion of sacrum/ nutate
- R axis
Sphinx position:
Prone: L SB is deeper than R
POE: L SB is even deeper than the R
(non moving landmark)
- dec symmetry - post torsion ( counternutate)
- L axis
Superficial Posterior
Oblique System:
- ____
- ____
- ____
- Latissimus Dorsi
- Gluteus Maximus
- Thoracolumbar Fascia
Innermost Muscle group:
- actively ____ pelvic jts, lumbar spine
- ____ mm
- actively stabilizing pelvic jts, lumbar spine
- true core mm
Anterior Oblique System:
- ____and ____
- ____
- ____
- Internal and External
Obliques - Contralateral Adductors
- Abdominal Fascia
Lateral Muscle System:
- ____
- ____
- Gluteus Medius
- Contralateral Adductors
Innermost Muscle Group:
- ____
- ____
- ____
- Transverse Abdominis
- Multifidus
- Pelvic floor muscles
Cartilaginous joint; has a fibrocartilaginous
interpubic disc
Symphysis Pubis
Cartilaginous joint between apex of the sacrum
and base of coccyx
Sacrococcygeal Joint
TEST FOR SACROILIAC JOINT
INVOLVEMENT
1.
2.
3.
4.
5.
6.
7.
- APPROXIMATION TEST
- GAPPING TEST (Transverse Anterior
Stress or Distraction Provocation) - SACRAL APEX PRESSURE TEST/AKA PRONE SPRINGING TEST / CRANIAL SHEAR / MIDLINE SACRAL THRUST / SACRAL THRUST
- THIGH THRUST TEST
AKA OOSTAGARD, 4P, SACROTUBEROUS STRESS,
OR POSTERIOR PELVIC PAIN PROVOCATION TEST
5. GAENLEN’S TEST
6. SACROILIAC ROCKING TEST aka Knee to
Shoulder or Sacrotuberous Test
7. SLR (LASEGUE’S TEST)
APPROXIMATION TEST
Procedure:
(+):
Indication:
- Side-lying
- Downward pressure
over iliac crest - (+) increase pressure
felt on SI joint
indicates SPRAIN of
POSTERIOR SI JOINT
LIGAMENT
GAPPING TEST (Transverse Anterior
Stress or Distraction Provocation)
Procedure:
(+):
Indication:
- Supine (pushes down &
outward) - (+) unilateral gluteal
pain/posterior leg pain
indicates SPRAIN OF THE
ANTERIOR SACROILIAC
LIGAMENT
SACRAL APEX PRESSURE TEST
AKA PRONE SPRINGING TEST / CRANIAL SHEAR / MIDLINE
SACRAL THRUST / SACRAL THRUST
Procedure:
(+):
Indication:
- Prone
-Base of his or her hand
at the apex of the
patient’s sacrum ->
pressure - (+) pain over the joint
indicate a SACROILIAC
JOINT PROBLEM
THIGH THRUST TEST
AKA OOSTAGARD, 4P, SACROTUBEROUS STRESS,
OR POSTERIOR PELVIC PAIN PROVOCATION TEST
Procedure:
(+):
Indication:
- Supine,90 deg of hip
flex - Palpate SI joint, thrust
down - (+) pain on SI joint
GAENLEN’S TEST <drive></drive>
SACROILIAC ROCKING TEST aka Knee to
Shoulder or Sacrotuberous Test
Procedure:
(+):
Indication:
- Supine
- Flex the knee and
hip fully then
adduct - (+) Pain in SI joint
SLR (LASEGUE’S TEST)
Procedure:
(+):
Indication:
<drive>
</drive>
- Patient in supine, passive hip
flexion with knee extended - (+) SI joint pathology
Confirmed with unilateral SLR
– pain is elicited >70 degrees hip
flexion
Confirmed with bilateral SLR
– (+) pain < 70 degrees of hip
flexion
SLR (LASEGUE’S TEST)
- ____ patients
- Compare active SLR only
vs active SLR with
compression (squeezing
innominate bones together)
(+):
Indication:
- Postpartum patients
- Compare active SLR only
vs active SLR with
compression (squeezing
innominate bones together) - (+) Easier to SLR / pain
decreases with compression
indicates SI JT PROBLEM - SI belt
Test for Hamstring
tightness
1.
2.
- Tripod Sign
- 90-90 SLR
Tripod Sign
Procedure:
(+):
Indication:
- Sitting dangling
- Passive extension of each knee
- (+) patient extends the trunk or
patient leans backward
90-90 SLR
Procedure:
(+):
Indication:
- 90 hip flex, 90 deg knee flexion
- Actively extend each knee
- N: within 20 deg of full extension
- (+) <125 deg angle between tibia and
femur
STANDING FLEXION..
Procedure:
(+):
Indication:
- Palpate PSIS (sacrum / SI jt)
- Ask pt to bend forward
- N: pelvis -> APT -> PSIS up
- (+) PSIS moves upward less
than the other -> HYPOMOBILE
ILIUM ON THE SACRUM
FLAMINGO TEST
Procedure:
(+):
Indication:
- aka One leg standing
- (+) pain on SI joint or Symphysis
pubis - Inc stress: hop on leg
- Stress Xray position: symphysis pubis
GILLET’S TEST (ipsilateral
posterior rotation test)
Procedure:
(+):
Indication:
- palpate: PSIS & sacrum
- One leg stance, ask patient to
flex other knee - N: PIR -> PSIS down
- (+) PSIS moves minimally or up =
hypomobility or block
IPSILATERAL ANTERIOR
ROTATION TEST
Procedure:
(+):
Indication:
- Palpate: PSIS, sacrum (SI jt)
- Ask step back - hip extends
- N: AIR -> PSIS up (sup and lat)
- (+) no identified movement of
PSIS = SI JOINT PROBLEM
GOLDTHWAIT’S TEST <drive></drive>
GOLDTHWAIT’S TEST <drive></drive>
Patrick’s Test (FABER, “Figure-4”
or Jansen’s Test) <drive></drive>
Patrick’s Test (FABER, “Figure-4”
or Jansen’s Test) <drive></drive>
PIEDALLU’S SIGN
Procedure:
(+):
Indication:
- Sit on stable and firm surface
(stab. Pelvis)
Palpate: PSIS
Active forward flexion
N: sacrum - ant, pelvis - no
movement
(+) PSIS move up - ant rot of pelvis
-> SI JOINT -HYPOMOBILITY
