Pelvis and Hip Intro - SIJ Flashcards
What kind of joint is the SIJ?
synovial, non-axial
What composes to make the SIJ?
Sacrum and two ilial bones
Is the SIJ a stable joint?
Yes
What makes the SIJ stable?
- irregular articular surfaces
- keystone sacrum
- fibrous capsule reinforced by ligaments in multiple directions
Where is the pubic symphysis?
- located in the midline of the body
What makes up the pubic symphysis?
right and left pubic bones joined with fibrocartilage disc and ligaments
What kind of joint is the pubic symphysis?
Amphiarthrodial joint
Where is the superior pubic ligament? Where does it strengthen the joint?
- attaches the pubic tubercles on each side
- strengthens the joint superiorly and anteriorly
Where is the inferior pubic ligament? Where does it strengthen the joint?
- attaches between the two inferior pubic rami
- strengthens the joint inferiorly
What is the motion of the SIJ?
- little mobility
- tiny movements that may be clinically undetectable
What is the SIJ designed for?
stability
Do those with SIJ dysfunction have more movement?
still tiny movement!!!!
What is SIJ movement confirmed by?
RSA, a highly accurate technique of imaging 3D position and motion
What percentage of SIJ dysfunction happens during pregnancy?
20%
What percentage of SIJ dysfunction occurs with those not pregnant with LBP?
- 13%
What are risk factors for SIJ dysfunction?
- laxity and hormonal changes
- during pregnancy
> prior LBP
> prior pelvic trauma
** none located for those not pregnant
What is the etiology of SIJ dysfunction?
- peri-partum (time in and around pregnancy)
- immature skeletons
- trauma
When is the skeleton ‘immature’?
under 8 years old due to lack of bony irregularity and congruency
What are the pathomechanics of SIJ dysfunction?
hypermobility/instability
What are symptoms of SIJ dysfunction?
- localized to SIJ 100% of time
- Gluteal region and lateral hip
- possible pubic symphysis pain
- like hypermobility/instability
What are some hypermobility / instability symptoms we can have with SIJ dysfunction?
- Hurts when I…
- static positions painful
- catching w quick motions
- self manipulation
- prefer gentle movement
What will we see with thoracolumbar A/PROM with SIJ dysfunction?
- no consistent pattern with just SI dysfunction
- may have concurrent lumbar condition
What will we find with resisted testing/MMT with SIJ dysfunction?
- impaired local muscles
- weak anti-gravity hip muscles
What will we find with stress tests with SIJ dysfunction?
- SI provocation tests
> at least 3 positive
** lack support unless clustered together!!
What are some palpation special tests for SIJ dysfunction?
- palpation for position
- unreliable for poor studies for SIJ
- leg length discrepancy clinical methods questionable at best and unacceptable for clinical decision making
How can we diagnose a leg length discrepancy?
- standing x-ray
What is a motion special test for SIJ dysfunction?
- positive March or Gillet test = MOST useful but still unreliable
- others even more unreliable
What other possible positive special tests can be found?
- positive ASLR
- Positive FABER
Is imaging diagnostic for those with SIJ dysfunction?
NOT diagnostic!!!!
What is the gold standard for diagnosis for SIJ dysfunction?
SI block (Injection)
What is the PT rx for SIJ dysfunction?
- POLICED
- STM/ Muscle energy techniques / modalities / acupuncture for SHORT TERM pain/muscle guarding
- pelvic belt
What are JM used for with SIJ dysfunction?
- improved symptoms and clinical test findings
- positive soft tissue and muscle influence from manipulation
What do JM NOT do for SIJ dysfunction?
- alter positions per RSA imaging
What is the focus of MET for SIJ dysfunction?
- stabilization!!!
What hip muscles blend with sacrotuberous ligament?
hamstrings and glute max
What hip muscles does the thoracolumbar fascia blend with?
- Lat, TA, erector spinae, and iliolumbar ligaments
What pt education can we do for SIJ dysfunction?
- reduce fear
- early mobilization without provocation
- general anatomy, biomechanics, benefits of coordination and there x
- reassurance of good prognosis
What should we know about injections for SIJ dysfunction?
- intra-articular SIJ injections NOT recommended unless for SI jt pain associated with ankylosing spondylitis
What has SHORT term benefit for SIJ dysfunction?
- pain/anti-inflammatory meds
What is there NO EVIDENCE FOR with SIJ dysfunction?
prolotherapy or fusion
What is the prognosis for SIJ dysfunction after pregnancy?
- declines during first 3 months after pregnancy
What percentage of people have “serious pain” during pregnancy with symptoms 2 years later?
21%
