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SPRING MSK II - Exam 2 > Pelvis and Hip Intro - SIJ > Flashcards

Pelvis and Hip Intro - SIJ Flashcards

1
Q

What kind of joint is the SIJ?

A

synovial, non-axial

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2
Q

What composes to make the SIJ?

A

Sacrum and two ilial bones

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3
Q

Is the SIJ a stable joint?

A

Yes

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4
Q

What makes the SIJ stable?

A
  • irregular articular surfaces
  • keystone sacrum
  • fibrous capsule reinforced by ligaments in multiple directions
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5
Q

Where is the pubic symphysis?

A
  • located in the midline of the body
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6
Q

What makes up the pubic symphysis?

A

right and left pubic bones joined with fibrocartilage disc and ligaments

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7
Q

What kind of joint is the pubic symphysis?

A

Amphiarthrodial joint

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8
Q

Where is the superior pubic ligament? Where does it strengthen the joint?

A
  • attaches the pubic tubercles on each side
  • strengthens the joint superiorly and anteriorly
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9
Q

Where is the inferior pubic ligament? Where does it strengthen the joint?

A
  • attaches between the two inferior pubic rami
  • strengthens the joint inferiorly
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10
Q

What is the motion of the SIJ?

A
  • little mobility
  • tiny movements that may be clinically undetectable
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11
Q

What is the SIJ designed for?

A

stability

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12
Q

Do those with SIJ dysfunction have more movement?

A

still tiny movement!!!!

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13
Q

What is SIJ movement confirmed by?

A

RSA, a highly accurate technique of imaging 3D position and motion

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14
Q

What percentage of SIJ dysfunction happens during pregnancy?

A

20%

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15
Q

What percentage of SIJ dysfunction occurs with those not pregnant with LBP?

A
  • 13%
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16
Q

What are risk factors for SIJ dysfunction?

A
  • laxity and hormonal changes
  • during pregnancy
    > prior LBP
    > prior pelvic trauma

** none located for those not pregnant

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17
Q

What is the etiology of SIJ dysfunction?

A
  • peri-partum (time in and around pregnancy)
  • immature skeletons
  • trauma
18
Q

When is the skeleton ‘immature’?

A

under 8 years old due to lack of bony irregularity and congruency

19
Q

What are the pathomechanics of SIJ dysfunction?

A

hypermobility/instability

20
Q

What are symptoms of SIJ dysfunction?

A
  • localized to SIJ 100% of time
  • Gluteal region and lateral hip
  • possible pubic symphysis pain
  • like hypermobility/instability
21
Q

What are some hypermobility / instability symptoms we can have with SIJ dysfunction?

A
  • Hurts when I…
  • static positions painful
  • catching w quick motions
  • self manipulation
  • prefer gentle movement
22
Q

What will we see with thoracolumbar A/PROM with SIJ dysfunction?

A
  • no consistent pattern with just SI dysfunction
  • may have concurrent lumbar condition
23
Q

What will we find with resisted testing/MMT with SIJ dysfunction?

A
  • impaired local muscles
  • weak anti-gravity hip muscles
24
Q

What will we find with stress tests with SIJ dysfunction?

A
  • SI provocation tests
    > at least 3 positive

** lack support unless clustered together!!

25
Q

What are some palpation special tests for SIJ dysfunction?

A
  • palpation for position
  • unreliable for poor studies for SIJ
  • leg length discrepancy clinical methods questionable at best and unacceptable for clinical decision making
26
Q

How can we diagnose a leg length discrepancy?

A
  • standing x-ray
27
Q

What is a motion special test for SIJ dysfunction?

A
  • positive March or Gillet test = MOST useful but still unreliable
  • others even more unreliable
28
Q

What other possible positive special tests can be found?

A
  • positive ASLR
  • Positive FABER
29
Q

Is imaging diagnostic for those with SIJ dysfunction?

A

NOT diagnostic!!!!

30
Q

What is the gold standard for diagnosis for SIJ dysfunction?

A

SI block (Injection)

31
Q

What is the PT rx for SIJ dysfunction?

A
  • POLICED
  • STM/ Muscle energy techniques / modalities / acupuncture for SHORT TERM pain/muscle guarding
  • pelvic belt
32
Q

What are JM used for with SIJ dysfunction?

A
  • improved symptoms and clinical test findings
  • positive soft tissue and muscle influence from manipulation
33
Q

What do JM NOT do for SIJ dysfunction?

A
  • alter positions per RSA imaging
34
Q

What is the focus of MET for SIJ dysfunction?

A
  • stabilization!!!
35
Q

What hip muscles blend with sacrotuberous ligament?

A

hamstrings and glute max

36
Q

What hip muscles does the thoracolumbar fascia blend with?

A
  • Lat, TA, erector spinae, and iliolumbar ligaments
37
Q

What pt education can we do for SIJ dysfunction?

A
  • reduce fear
  • early mobilization without provocation
  • general anatomy, biomechanics, benefits of coordination and there x
  • reassurance of good prognosis
38
Q

What should we know about injections for SIJ dysfunction?

A
  • intra-articular SIJ injections NOT recommended unless for SI jt pain associated with ankylosing spondylitis
39
Q

What has SHORT term benefit for SIJ dysfunction?

A
  • pain/anti-inflammatory meds
40
Q

What is there NO EVIDENCE FOR with SIJ dysfunction?

A

prolotherapy or fusion

41
Q

What is the prognosis for SIJ dysfunction after pregnancy?

A
  • declines during first 3 months after pregnancy
42
Q

What percentage of people have “serious pain” during pregnancy with symptoms 2 years later?

A

21%

SPRING MSK II - Exam 2 (6 decks)

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