Pelvis - ANATOMY AND KINESIOLOGYpart1 Flashcards
1
Q
PLANES OF MOTION drive
A
2
Q
Frontal/Coronal
Axis
Movement
A
Z or Horizontal Axis,
A-P Axis
Abduction, adduction /
Inversion, Eversion
* Thumb flexion,
extension
3
Q
Sagittal
Axis
Movement
A
X or Transverse Axis,
Coronal Axis
Flexion, extension/
Plantarflexion,
Dorsiflexion
* Thumb Abd & Add
4
Q
Horizontal/Transverse
Axis
Movement
A
Y or Vertical Axis,
Longitudinal Axis
IR, ER
5
Q
Fibrous Joints
(Synarthroses)
A
Movement minimal to none
sutures, syndesmosis and gomphosis
6
Q
Type 0f joint
Movement is minimal to none
A
Fibrous Joints
(Synarthroses)
7
Q
SUTURE
SYNDESMOSIS (Tibia &fibula)
GOMPHOSIS (tooth)
A
Fibrous Joints
(Synarthroses)
8
Q
Hyaline/fibrocartilage
connects one bone
to another
A
Cartilaginous Joints
(Amphiarthroses)
9
Q
Type of Joint:
Slightly movable joints
A
Cartilaginous Joints
(Amphiarthroses)
10
Q
Type of joint
SYNCHONDROSIS (sternum)
SYMPHYSIS
A
Cartilaginous Joints
(Amphiarthroses)
11
Q
5 distinguishing characteristics:
1. Joint cavity
2. Articular cartilage
3. Synovial membrane
4. Synovial fluid
5. Fibrous capsule
A
Synovial Joints (Diarthroses)
12
Q
Type of joint:
Free movement
A
Synovial Joints (Diarthroses)
13
Q
Uniaxial
Biaxial
Multi-axial
A
Synovial Joints (Diarthroses)
14
Q
Synovial Joints (Diarthroses)
5 distinguishing characteristics:
1. J
2. A
3. S
4. S
5. F
A
- Joint cavity
- Articular cartilage
- Synovial membrane
- Synovial fluid
- Fibrous capsule
15
Q
Type of endfeel
Elbow extension
A
Bone to bone (Hard)
16
Q
Type of endfeel
Knee flexion
A
Soft tissue approximation
(Soft)
17
Q
Type of endfeel
Ankle dorsiflexion
A
Tissue stretch
18
Q
Type of abnormal endfeel
Protective spasm after injury
A
Early muscle spasm
19
Q
Type of abnormal endfeel
Spasm due to instability
A
Late muscle spasm
20
Q
Type of abnormal endfeel
Tight muscle
A
“Mushy” tissue stretch
21
Q
Type of abnormal endfeel
UMNL
A
Spasticity
22
Q
Type of abnormal endfeel
Frozen shoulder
A
Hard capsular
23
Q
Type of abnormal endfeel
Synovitis
A
Soft capsular
24
Q
Type of abnormal endfeel
Osteophyte formation
A
Bone to bone
25
Type of abnormal endfeel
Acute subacromial bursitis
Empty
26
Type of abnormal endfeel
Meniscus tear
Springy block
27
The patient performs the action of the
supraspinatus. The axis of the said motion is at the?
Frontal/Coronal plane
28
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
29
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
30
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
31
Deep Posterior Longitudinal
System:
1. ____
2. ____
3. ____
1. Erector Spinae
2. Thoracolumbar Fascia
3. Hamstring
32
Iliac Crest
G med: O- ____
TFL: O- ____
G med: O- post/outer surface of the ilium
TFL: O- Ant aspect
33
Pelvis :
- w____
- s____
- m____
Formed by:
- ____
- ____
- ____
Pelvis :
- weightbearing
- shock absorption
- mobility
Ilium, ischium and Pubis bone
34
Iliac fossa:
medial aspect ; O: ____
Gluteal lines: ____
medial aspect ; O: Iliacus
Gluteal lines: outer surface
35
Ischium:
ischial tub: ____
- prox attachment ____and portion of ____
ischial tub: wt bearing when sitting
- prox attachment hams and portion of Adductor Magnus
36
- smallest of the innominate bones
- body, inf and sup rami
Pubis
37
Pelvic tilt:
Inc angle : ____
Dec angle: ____
Inc angle : Inc APT
Dec angle: PPT
38
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
39
N pelvic inclination:
____ brunstrom
____- magee
50-60 bruns
30 - magee
40
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
41
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
42
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
43
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
44
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
45
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
46
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
47
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
48
Pelvic Rot: ____degrees
Pelvic Rot: 8 degrees
49
Lower Crossed Syndrome:
Shortened: ____
Lengthened: ____
* Hams - tight d/t ____
Shortened: iliopsosas & erectors
Lengthened: G max and Abs
* Hams - tight d/t attempt to PPT
50
(L) HIP HIKE
ipsi and contralateral
Right abduction
Left Adduction
51
(L) pelvic drop
right and left?
Right Adduction
Left Abduction
52
(L) pelvic drop bilateral
Right Adduction
Left Abduction
53
Pelvic rotation of left forward
Right Medial rotation
54
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
55
AIR
L
S
S
ASIS: ____
PSIS: ____
Supine/Standing
Long sitting/Standing with trunk flexion
Sitting with reaching toes
ASIS: INF
PSIS: SUP
56
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
57
Landmarks to get the leg length
*True leg length: ____
*Functional : ____
*True leg length: ASIS to med /lat malleoli
*Functional : Xiphisternum/ umbilicus to med malleoli
58
PELVIC DYSFUNCTION
Anterior Innominate Rotation
Tight?
Stretch?
Strengthen?
Tight iliopsoas muscle
Stretch Iliopsoas
Strengthen the gluteus maximus
59
PELVIC DYSFUNCTION
Posterior Innominate Rotation
caused by?
Stretch?
Strengthen?
Caused by hamstring muscle
Stretch hamstring
Strengthen the quads muscle
(concentric contraction)
60
Case 1:
(R) PSIS higher
(R) ASIS lower
(R) LE longer in supine
(R) AIR
ALSU
61
Case 2:
(L) PSIS lower
(L) ASIS higher
(L) LE longer in long sitting
(L) PIR
62
Case 3:
(R) PSIS higher
(L) ASIS higher
(R) LE shorter when trying to reach the toes
(R) AIR
63
Case 4:
(L) PSIS higher
(L) ASIS higher
(R) LE longer in supine
(L) UPSLIP
kase same side umangat
64
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
65
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
66
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
67
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
68
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
69
SACRAL MOVEMENT
x2
SACRAL MOVEMENT
x2
70
LUMBO-PELVIC RHYTHM
LUMBO-PELVIC RHYTHM
71
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
72
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
73
PELVIC MOTIONS WITH
LUMBAR SPINE MOVEMENT
PELVIC MOTIONS WITH
LUMBAR SPINE MOVEMENT
74
Naming sacral torsion:
______ on ______
1. By the direction that the front of the sacrum
faces
2. By the axis of the movement
If same ang letters: Forward torsion (nutation)
if diff letters: Bwd torsion (counternutation)
Naming sacral torsion:
______ on ______
1. By the direction that the front of the sacrum
faces
2. By the axis of the movement
If same ang letters: Forward torsion (nutation)
if diff letters: Bwd torsion (counternutation)
75
SACRAL MOVEMENTS
L on L
R SB deeper , L ILA more prominent
76
SACRAL MOVEMENTS
R on L:
R SB more palpable, L ILA deeper
77
SACRAL MOVEMENTS
R on R
L SB deeper, R ILA more post
78
SACRAL MOVEMENTS
L on R
L SB more palpable, R ILA deeper
79
FWD torsion: Nutation
PPT
tight : ____
Weak: ____
tight : G max
Weak: iliopsosas
80
BWD Torsion:
Counternutation
- APT
Tight mm: Iliopsoas
weak : G max
Tight mm: ____
weak : ____
81
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
82
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
83
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
84
Superficial Posterior
Oblique System:
1. ____
2. ____
3. ____
1. Latissimus Dorsi
2. Gluteus Maximus
3. Thoracolumbar Fascia
85
Innermost Muscle group:
- actively ____ pelvic jts, lumbar spine
- ____ mm
- actively stabilizing pelvic jts, lumbar spine
- true core mm
86
Anterior Oblique System:
1. ____and ____
2. ____
3. ____
1. Internal and External
Obliques
2. Contralateral Adductors
3. Abdominal Fascia
87
Lateral Muscle System:
1. ____
2. ____
1. Gluteus Medius
2. Contralateral Adductors
88
Innermost Muscle Group:
1. ____
2. ____
3. ____
1. Transverse Abdominis
2. Multifidus
3. Pelvic floor muscles
89
Cartilaginous joint; has a fibrocartilaginous
interpubic disc
Symphysis Pubis
90
Cartilaginous joint between apex of the sacrum
and base of coccyx
Sacrococcygeal Joint
91
TEST FOR SACROILIAC JOINT
INVOLVEMENT
1.
2.
3.
4.
5.
6.
7.
1. APPROXIMATION TEST
2. GAPPING TEST (Transverse Anterior
Stress or Distraction Provocation)
3. SACRAL APEX PRESSURE TEST/AKA PRONE SPRINGING TEST / CRANIAL SHEAR / MIDLINE SACRAL THRUST / SACRAL THRUST
4. 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)
92
APPROXIMATION TEST
Procedure:
(+):
Indication:
- Side-lying
- Downward pressure
over iliac crest
- (+) increase pressure
felt on SI joint
indicates SPRAIN of
POSTERIOR SI JOINT
LIGAMENT
93
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
94
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
95
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
96
GAENLEN’S TEST
97
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
98
SLR (LASEGUE’S TEST)
Procedure:
(+):
Indication:
- 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
99
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
100
Test for Hamstring
tightness
1.
2.
1. Tripod Sign
2. 90-90 SLR
101
Tripod Sign
Procedure:
(+):
Indication:
- Sitting dangling
- Passive extension of each knee
- (+) patient extends the trunk or
patient leans backward
102
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
103
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
104
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
105
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
106
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
107
GOLDTHWAIT’S TEST
GOLDTHWAIT’S TEST
108
Patrick’s Test (FABER, “Figure-4”
or Jansen’s Test)
Patrick’s Test (FABER, “Figure-4”
or Jansen’s Test)
109
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
