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OPP II > Pelvis and Innominates > Flashcards

Pelvis and Innominates Flashcards

1
Q

What 3 bones make up the innominate?

A

Made up of :
Ilium
Ischium
Pubis

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2
Q

What does the pelvis begin to fuse?

A

16 years

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3
Q

What are the 3 major joints of the pelvis?

A

SI
Pubic Symphysis
Acetabulum

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4
Q

Why does SD of the pelvis have far-reaching effects? Why does SD affect the pelvis so much?

A

Through muscular and fascial connections, the Pelvis directly connects to every other area in the body—torso, upper extremity, axial spine, head, rib cage, lower extremity! Somatic dysfunction here can have far reaching effects.

Conversely, somatic dysfunction distally can have effects on the pelvis.

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5
Q

Why is the pelvis the central hub of the body?

A

Fascial and muscular connections to the rest of the body

Central role in coupling mechanical forces of the LE with the axial skeleton

Innominates are integral part of creating a stable and mobile pelvic ring

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6
Q

What is structural integrity in the context of the pelvis?

A

Structural integrity is the ability to maintain structure in the face of a torso and forces of gravity on top of it.

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7
Q

Why does the pelvis allow for mobility?

A

In order for us to move through our world with a fair amount of ease, the pelvis must also have a certain degree of mobility.

The joints, particularly the SIJ, must be able to move in response to muscle action without losing the structural integrity.

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8
Q

What is the self bracing mechanism of the pelvis?

A

Attained by form + force closure

Model that allows for efficient locomotion and weight transfer

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9
Q

How is form closure of the pelvis attained?

A

Form closure via structural anatomy of wedge shaped sacrum

Internal anatomy and shape of bones in the SIJ

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10
Q

How is force closure of the pelvis attained?

A

Force closure requires horizontal, lateral compressive force and friction to withstand vertical load
- from mm supporting the pelvis

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11
Q

What kind of joint is the SIJ?

A

The SIJ is a synovial joint between the auricular surfaces ofthe sacrum bone and the two ilium bones.

The auricular surfaces are covered in hyaline cartilage and are broader above and narrower below.

The SIJ is also a true diarthrodial joint, as it has a joint space, filled with synovial fluid between the matching articulating surface and a fibrous capsule. However it is different to other diarthrodial joint as it has fibrocartilage and hyaline cartilageon the auricular surfaces

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12
Q

What is the main role of the SIJ?

A

2]The SIJmain roles are to provide stability and offset the load of the trunk to the lower limbs

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13
Q

How is movement done at the SIJ? About how much movement is there? On what plane does movement happen?

A

There is very limited movement at the SIJ, with some literature suggesting as little as4 degrees

The two main movements occur when the sacrum moves relative to theiliac bones in the sagittalplane

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14
Q

What is nutation?

A

Nutationdescibes when the sacrum is rotated forwards relative to the iliac bones

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15
Q

What is counternutation?

A

Counternutationdescribes when the sacrum is rotated backwards relative to the iliac bones

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16
Q

Which is more stable, nutation or counternutation?

A

Nutation can be regarded as anticipation for joint loading, as it is a more stabile than counternutation

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17
Q

What happens during nutation to increase stability? During what activities does this occur?

A

During nutation the posterior parts of the iliac bones are compressed into the “keystone-like” shape, and the joint is in the lockedand close packed position.

This normally occurs during increased load bearing situations e.g. standing and sitting, to increase stability

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18
Q

What bony features increase form closure? How does the SIJ contribute? The sacrum?

A

The sacrum and the ilium eachhave one flat surfaceandoneridged surfacewhich interlock together, promoting stability.The symmetrical grooves and ridges allow the highest coefficient of friction of any diarthrodial joint and protect the joint against shearing.

The position of the bones in the SIJ creates a “keystone-like” shape which adds to the stability in the pelvic ring. This “keystone” shape is created, as the sacrum has a wider side superiorly, which allows the sacrum to be “wedged” in between the ilium

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19
Q

Why is force closure needed?

A

Although form closure provides stability to the SIJ, for mobility to occur further joint compression and stabilisation is required to withstand a vertical load.

Force closure is the term used to describe the other forces acting across the joint to create stability.

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20
Q

What specific features of structures allow them to create force closure?

A

This force is generated by structures with a fibre direction perpendicular to the sacroiliac joint and is adjustable according to the loading situation.

Muscles, ligaments and the thoracolumbar fascia all contribute to force closure.

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21
Q

When is force closure important?

A

. Force closure is particularly important during activities such as walking when unilateral loading of the legs creates shear forces

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22
Q

How does force closure affect form closure?

A

Force closure creates greater friction and therefore increased form closure and what is called “self-bracing” or “self-locking” of the joint.

According toWillard et al.force closure reduces the joint’s ‘neutral zone’ therebyfacilitating stabilisation.

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23
Q

Other than form and force closure, what else provides stability to the pelvis?

A

As the ilium and sacrum only meet for approximately a third of the surfaces, the rest of the stability between the bones is provided by the ligaments

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24
Q

What specific structures contribute to force closure?

A

Sacrotuberous and sacrospinous ligaments

Multifidus
Latissimus dorsi
Piriformis
Gluteus maximus
Biceps femoris
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25
Q

What 2 general things should be addressed when treating the pelvis?

A

Joint motion

Muscular imbalances

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26
Q

What are the 3 types of movements of the innominate?

A

Rotation
Flaring
Shearing

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27
Q

What are physiological motions of the innominates? Non-physiologic? What are the possible directions of each motion?

A

Physiological

  • rotation - ant and post
  • flaring - lat and med

Non-physiologic
- Shearing - sup and inf

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28
Q

How do you screen for pelvis SD?

A

Standing flexion test

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29
Q

What landmarks do you note when diagnosing pelvic SD?

A

Anterior superior illiac spine
Posterior superior iliac spine
(pubic rami)

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30
Q

What information does the standing flexion test give you?

A

Give the laterality of the somatic dysfunction

Positive test on the right = right innominate somatic dysfunction

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31
Q

How do you use landmarks in Dx of the pelvis?

A

Compare side to side

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32
Q

What does rotation of the innominates have to do with the landmarks? What axis does this occur on?

A

Relationship of innominates to one another

Anterior/Posterior rotation occurs about the inferior transverse axis of the sacrum

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33
Q

Extension of the hip = ?

A

Anterior rotation

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34
Q

Flexion of the hip = ?

A

Posterior rotation

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35
Q

Why is rotation considered an SD if the motion is physiologic?

A

This is physiologic motion: it is supposed to happen.

Only a problem when it gets stuck in one position or the other

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36
Q

What is the Dx criteria for an ant rotated innominate on the side of restriction?

A 
Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test- ipsilateral
ASIS inferior (caudad)
PSIS superior (cephalad)
Inferior pubes - ipsilateral
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37
Q

What is the etiology of an ant rotated innominate?

A

Tight quads, leg length discrepancy

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38
Q

What are common patient complaints with an ant rotated innominate?

A

Patient may c/o hamstring tightness, spasm or even sciatica on ipsilateral side.

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39
Q

What are treatment techniques that work for ant rotated innominate?

A

Treatment: ME

HVLA or Traction Tug, BLT, Still

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40
Q 
What's your Dx:
Standing flexion test positive: right
ASIS: inferior right
PSIS: superior right
Pubic tubercle: inferior right
A

Right anteriorly rotated innominate

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41
Q

What is the Dx criteria for a post rotated innominate on the side of restriction?

A

(+) Standing Flex test-ipsilateral
ASIS superior (cephalad)
PSIS inferior (caudad)
Superior pubes-ipsilateral

42
Q

What are common patient complaints with a post rotated innominate?

A

inguinal/groin pain (due to rectus femoris dysfunction)

Medial knee pain (due to sartorius dysfunction)

43
Q

What are treatment techniques that work for pot rotated innominate?

A

Treatment: ME

HVLA/Traction Tug, BLT, Still

44
Q 
What's your Dx:
Standing Flexion Test: positive right
ASIS: superior right
PSIS: inferior right
Pubic tubercle: superior right
A

Right posteriorly rotated innominate

45
Q 
What's your Dx:
Standing flexion test positive left
ASIS superior left
PSIS inferior left
Pubic rami superior left
A

Left posteriorly rotated innominate

46
Q 
What's your Dx:
Standing flexion test positive left
ASIS superior right
PSIS inferior right
Pubic rami superior right
A

Left anteriorly rotated innominate

47
Q

What happens with an innominate flare? About what axis does this happen?

A

Lateral positional change
- ASIS medial or lateral compared to its usual position

May be thought of as rotation of an innominate along a vertical axis

48
Q

What is the Dx criteria for a medial innominate inflare?

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test- ipsilateral
ASIS medial
PSIS lateral

49
Q

What are common patient complaints with a medial innominate inflare?

A

Patient may c/o pelvic or sacroiliac joint pain.

50
Q

What symptoms do you find with a medial flare?

A

Tender sacroiliac ligaments and inguinal ligaments (on either side),
tender pubic symphysis

51
Q

What are appropriate techniques for treating innominate inflares?

A

ME

52
Q

What is the Dx criteria for an innominate outflare/lateral flare?

A

Diagnostic Criteria on Side of Restriction:
ASIS lateral
PSIS medial
(+) Standing Flex test- ipsilateral

53
Q

What are common patient complaints with a lateral innominate outflare?

A

Patient may c/o pelvic or sacroiliac pain.

54
Q

What symptoms do you find with a lateral flare?

A

Tender sacroiliac ligaments and inguinal ligaments (on either side)

55
Q

What are appropriate techniques for treating innominate outflares?

A

ME

56
Q

How do you assess relative placement of ASIS with suspected flares?

A

Transverse Axis between ASIS’s
Triangulate to the umbilicus
Drop a perpendicular
Compare the distances

57
Q 
What's your Dx?
Standing flexion test positive right
ASIS medial right
PSIS lateral right
Pubic rami equivocal (and likely tender)
A

Right medial innominate flare

58
Q 
What's your Dx?
Standing flexion test positive right
ASIS medial left
PSIS lateral left
Pubic rami equivocal (and likely tender)
A

Right innominate lateral outflare

59
Q

Do rotation and flare happen often? Why? Are they more or less painful?

A

Rotation and Flare are physiologic motions
- Happen with every step

Inflaring happens with extension of the hip, or anterior innominate rotation

Outflaring happens with flexion of the hip, or posterior innominate rotation

These somatic dysfunction’s tend to be less painful - the ligaments can compensate

60
Q

Does shear happen often? Why? Is this more or less painful?

A

Shear is a non-physiologic motion
- The body is not meant to move that way

Painful  the ligaments cannot compensate

61
Q

What can cause an innominate shear?

A

Traumatic position change

- Apparent vertical transmission of the entire innominate within the S-I joint, either superiorly or inferiorly

62
Q

Why are shears painful?

A

Strains the ligaments, which cannot compensate = Pain

Anything beyond 3-5mm of motion is strain

63
Q

What are the Dx criteria for a superior innominate shear/upslip?

A 
Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS superior
PSIS superior
Pubic tubercle superior
64
Q

What are common patient complaints with a superior innominate shear? Inferior innominate shear?

A

Pelvic pain

65
Q

What are the palpatory findings with a superior innominate shear? Inferior innominate shear?

A

Palpatory findings: Tissue texture changes and tenderness at ipsilateral SI and pubes

66
Q

What are the Dx criteria for an inferior innominate shear/downslip?

A 
Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS inferior
PSIS inferior
Pubic tubercle inferior
67
Q 
What's your dx?
Standing flexion test positive right
ASIS superior right
PSIS superior right
Pubic ramus superior right
A

Right superior innominate shear/upslip

68
Q 
What's your Dx?
Standing flexion test positive left
ASIS superior right
PSIS superior right
Pubic ramus superior right
A

Left inferior innominate shear/downslip

69
Q

What are the 3 possible Dx’s for pubic symphysis dysfunction?

A

Three diagnoses:
Superior
Inferior
Compressed

70
Q

What are pubic symphysis SDs generally seen with?

A

Generally seen with saddle injuries or other trauma

71
Q

What is the Dx criteria for a superior pubic shear?

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle superior

72
Q

What are the common patient complaints for a superior pubic shear? Inferior shear?

A

pelvic pain or pubic arch pain

73
Q

What are the palpatory findings associated with a superior pubic shear?

A

Tissue texture changes and tenderness at ipsilateral pubes

74
Q

What is the Dx criteria for a inferior pubic shear?

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle inferior

75
Q

What are the palpatory findings associated with a inferior pubic shear?

A

Tissue texture changes and tenderness at ipsilateral pubes

- Hypertonic adductors

76
Q

What is the Dx criteria for a compressed pubic symphysis?

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-equivocal
ASIS and PSIS level
pubic tubercle level, but very tender

77
Q

What are the common patient complaints for a compressed pubic symphysis?

A

Patient may c/o pelvic pain or pubic arch pain (runners, extreme athletes…)

78
Q

What are the palpatory findings for a compressed pubic symphysis?

A

Tissue texture changes and tenderness at ipsilateral pubes

79
Q 
What's your Dx?
53 yocm with 3 month history of left leg and hip pain s/p MVC.
ASIS right inferior
PSIS left inferior
Pubis right inferior
Standing flexion test (+) right
A

Right anteriorly rotated innominate

80
Q 
What's your Dx?
27 year old dancer with long term left “hip pain”.
Left ASIS superior
Left PSIS superior
Standing flexion test (+) R
Left pubis superior
A

Right downslip/inferior shear

81
Q 
What's your Dx?
45 yocf with achy pelvic pain.
ASIS medial left
PSIS medial right
Tender pubic symphysis
Standing flexion test (+) left
A

Left medial flare/inflare

82
Q 
What's your Dx?
37 year old female with pelvic pain that started after she fell while mountain biking and hit groin on bike support bar. 
Standing flexion test positive: right
ASIS: level
PSIS: level
Pubis tender and superior right
A

Right superior pubic shear

83
Q

Review:

Muscles above the pelvis.

A 
Longissimus
Iliocostales
Quadratus lumborum
Latissimus dorsi
Rectus abdominis
Obliquus abdominis
	-externus
	-internus
Transversus abdominis
Pyramidalis
84
Q

Review:

Action of Longissimus thoracics & Iliocostales

A

action: bends spine backwards & laterally; provides lateral stabilization of lumbar spine

85
Q

Review:

Action of Quadratus lumborum

A

action: flexing & SB trunk

86
Q

Review:

Action of Latissimus dorsi.

A

action: adducts, internally rotates & extends the humerus; stabilizes ilia & lumbosacral aponeurosis (co-contracts w/ LAT)

87
Q

Review:

Action of rectus abdominis.

A

action: flexes T/L spine & pelvis

88
Q

Review:

Action of obliquus abdominis.

A

Externus
action: rotates the T-spine in relation to pelvis
Internus
action: rotates T-spine in relation to pelvis

89
Q

Review:

Action of transversus abdominis.

A

action: segmental lumbar stabilization, rotates T-spine in relation to pelvis

90
Q

Review:

Action of pyramidalis.

A

action: supports abd viscera

91
Q

Review:

Action of iliopsoas.

A

action: assists rectus abdominis in flexing lumbar segments, assists iliacus in flexing hip joint, flexes & externally rotates femur on pelvis, flexes & lateral bends indiv. lumbar; psoas (major & minor) flex the pelvis on spine

92
Q

Review:

Action of adductors of thigh

A

Action: adduction/flexion of thigh, except gracilis (internal rotation thigh); all participate in external rotation of leg

93
Q

Review:

Action of sartorius.

A

Action: external rotator of thigh, flexion of leg on thigh and thigh on pelvis

94
Q

Review:

Action of rectus femoris.

A

Action: assists in flexing thigh & extending the leg (when tight, it tilts pelvis forward on femur)

95
Q

Review:

Action of obturator internus/externus.

A

Action: stabilizes femur in acetabulum, weak external rotators

96
Q

Review:

Action of tensor fascia latae.

A

Action: abducts femur & transmits tension from fibular head to iliac crest; assists in flexing & medially rotating thigh

97
Q

What causes iliosacral motion?

A

Caused by leg movement

Movement of the ilia on a stationary sacrum

98
Q

What causes sacroiliac motion?

A

Changes in vertebral column position

Movement of sacrum in relation to stationary ilia

99
Q

What axis does iliosacral motion occur on? Where is this axis?

A

Pubic transverse axis

Passes through symphysis pubis

Find anterior/posterior rotations at sacroiliac joint in this axis

Motion occurs as “iliosacral”

100
Q

Why does iliosacral motion occur? What provides stability?

A

Occurs as part of normal walking cycle
Independent rotation of ilia in opposite directions via the pubic symphysis and iliosacral joint

Stability of this axis of rotation provided by abdominal & upper thighs

101
Q

Why does the inferior transverse axis occur?

A

Inferior Transverse Axis

Loading sacroiliac joint (walking or standing on one leg) requires stable pivot point around which ilium rotate physiologically

102
Q

What is unusual about the inferior transverse axis? Is it just one point?

A

2 separate, independent left or right pivot points
Occurring one at a time
Not correspond to perfect anatomical location (on each side of lowest pole of the sacroiliac joint)

OPP II (2 decks)

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