Pelvis and Hip 1 Flashcards
describe the SI joint
synovial
non-axial
sacrum + 2 ilial bones
VERY stable
why is the SI so stable
irregular articular surfaces
key stone is the sacrum
fibrous capsule is reinforced by ligaments in multiple directions
describe the pubic symphysis
located midline
R and L pubic bones joined with fibrocartilage disk and ligaments
amphiarthrodial joint
what is the superior pubic ligament
attaches at the pubic tubercles on each side
strengthens the joint superiorly and anteriorly
what is the inferior pubic ligament
attaches between two inferior pubic rami
strengthens the joint inferiorly
describe the motion of the SI joint
designed for stability
very little mobility
tiny movements that may be clinically in-detectable (even if pt has SI dysfunction)
how is movement at the SI confirmed
RSA
highly accurate technique of imaging 3D position and motion
incidence of SI dysfunction
20% during pregnancy
13% not pregnant with LBP
risk factors for SI
laxity
hormonal changes
prior LBP/pelvic trauma + pregnancy
etiology of SI joint dysnfunction
peri partum
immature skeletins due to lack of bony irregularity and congruency
trauma
disease (autoimmune like AS)
symptoms of SI dysfunction
localized to SIJ
gluteal region and lateral hip
possibly pubic symphysis P!
often like hypermobility (can’t get any more hypomobile)
what is often accompanied with SI joint dysfunction
back hypermobility
NOT caused by SI but often pts have more than 1 thing going on at a time
what would the thoracolumbar A/PROM show woth SI dysfunction
no consistent pattern with just SI
may have a concurrent lumbar condition though
what might resisted/MMT show woth SI dysfunction
impaired local muscles
weak anti gravity hip muscles
stress test findings for SI dysfunction
SI provocation tests
at least 3 are +
lack of support unless they are clustered together
is palpation effective for determining SI dysfunction
no
palpating for position is unreliable and there are poor studies
most effective motion test for the SI joint
+ march or gillet is most useful but still unreliable
others are even more unreliable
results of ASLR with SI dysfunction
+ for local impaired muscles
is imaging helpful at SI
not diagnostic
what is the gold standard for diagnosis of the SIJ
SI block
PT Rx for SI J
POLICED
STM
Muscle energy
modalities
acupuncture
all above for pain and muscle guarding
pelvic belt
effectiveness of JM for SIJ
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)
MET focus for SIJ
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
important edu for pt with SI dysfunction
reduce fear
early mobilization without provocation
general anatomy, BM, and benefits of coordination ther ex
reassurance of a good prognosis
MD Rx options for SI joint
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
prognosis for SI joint dysfunction
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
