Pelvis and Hip 1

Question 1

describe the SI joint

Answer 1

synovial
non-axial
sacrum + 2 ilial bones
VERY stable

Question 2

why is the SI so stable

Answer 2

irregular articular surfaces

key stone is the sacrum

fibrous capsule is reinforced by ligaments in multiple directions

Question 3

describe the pubic symphysis

Answer 3

located midline

R and L pubic bones joined with fibrocartilage disk and ligaments

amphiarthrodial joint

Question 4

what is the superior pubic ligament

Answer 4

attaches at the pubic tubercles on each side

strengthens the joint superiorly and anteriorly

Question 5

what is the inferior pubic ligament

Answer 5

attaches between two inferior pubic rami

strengthens the joint inferiorly

Question 6

describe the motion of the SI joint

Answer 6

designed for stability

very little mobility

tiny movements that may be clinically in-detectable (even if pt has SI dysfunction)

Question 7

how is movement at the SI confirmed

Answer 7

RSA

highly accurate technique of imaging 3D position and motion

Question 8

incidence of SI dysfunction

Answer 8

20% during pregnancy

13% not pregnant with LBP

Question 9

risk factors for SI

Answer 9

laxity
hormonal changes
prior LBP/pelvic trauma + pregnancy

Question 10

etiology of SI joint dysnfunction

Answer 10

peri partum

immature skeletins due to lack of bony irregularity and congruency

trauma

disease (autoimmune like AS)

Question 11

symptoms of SI dysfunction

Answer 11

localized to SIJ

gluteal region and lateral hip

possibly pubic symphysis P!

often like hypermobility (can’t get any more hypomobile)

Question 12

what is often accompanied with SI joint dysfunction

Answer 12

back hypermobility

NOT caused by SI but often pts have more than 1 thing going on at a time

Question 13

what would the thoracolumbar A/PROM show woth SI dysfunction

Answer 13

no consistent pattern with just SI

may have a concurrent lumbar condition though

Question 14

what might resisted/MMT show woth SI dysfunction

Answer 14

impaired local muscles

weak anti gravity hip muscles

Question 15

stress test findings for SI dysfunction

Answer 15

SI provocation tests

at least 3 are +

lack of support unless they are clustered together

Question 16

is palpation effective for determining SI dysfunction

Answer 16

no

palpating for position is unreliable and there are poor studies

Question 17

most effective motion test for the SI joint

Answer 17

+ march or gillet is most useful but still unreliable

others are even more unreliable

Question 18

results of ASLR with SI dysfunction

Answer 18

+ for local impaired muscles

Question 19

is imaging helpful at SI

Answer 19

not diagnostic

Question 20

what is the gold standard for diagnosis of the SIJ

Answer 20

SI block

Question 21

PT Rx for SI J

Answer 21

POLICED

STM
Muscle energy
modalities
acupuncture

all above for pain and muscle guarding

pelvic belt

Question 22

effectiveness of JM for SIJ

Answer 22

improved symptoms and clinical test findings

did NOT alter RSA imaging

likely a positive soft tissue and muscle influence per manipulation (i.e. helps with muscle activation)

Question 23

MET focus for SIJ

Answer 23

main focus = stabilization

work on local muscles (like lumbar instability)

hip muscles like hamstrings and Gmax blend with the sacrotuberous ligaments SO ligament benefits from contraction of said muscles

thoracolumbar fascia blends with lat, TA, erector spinae, and iliolumbar ligaments

Question 24

important edu for pt with SI dysfunction

Answer 24

reduce fear

early mobilization without provocation

general anatomy, BM, and benefits of coordination ther ex

reassurance of a good prognosis

Question 25

MD Rx options for SI joint

Answer 25

intra-articular injections (under imaging guidance) for AS ; other than this injections are not recommended

pain and anti-inflammatory meds have mixed/short term benefits

no evidence for prolotherapy or fusion

Question 26

prognosis for SI joint dysfunction

Answer 26

symptoms rapidly decline during the first 3 months after pregnancy

serious pain during pregnancy left 21% with symptoms 2 years later

breast feeding after pregnancy can alter timeline of when things settle; i.e if they do breastfeed relaxin is still released and ligaments remain in a more lax state