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OPP IV Exam 1 part 2 (only do Reproductive Lab) > Pelvis and Pubes > Flashcards

Pelvis and Pubes Flashcards

1
Q

Why study the innominates?

A

Pelvis is central hub of the body
Central role in coupling mechanical forces of the LE with the axial skeleton
Fascial and muscular connections to the rest of the body
Innominates are integral part of creating a stable and mobile pelvic ring

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2
Q

self-bracing mechanism

A

Attained by form + force closure
Model that allows for efficient locomotion and weight transfer
Form closure via structural anatomy of wedge shaped sacrum
Force closure requires horizontal, compressive force and friction to withstand vertical load

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3
Q

Form closure

A

Form Closure describes the stability of the joint from the design of the pelvic anatomy. 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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4
Q

Form closure of the pelvis

A

Structural anatomy of the wedge shaped sacrum

Internal structure of the sacroiliac joints

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5
Q

Common ligaments cited for force closure (KNOW THESE)

A

Creates compressive lateral force and friction to withstand vertical load
Accomplished by:
Sacrotuberous and sacrospinous ligaments
Multifidus, Latissimus dorsi, Piriformis, Gluteus maximus, Biceps femoris

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6
Q

Innominate motions

A

3 types of movements: Rotation (anterior/ posterior)
Flaring (lateral/ medial)
Shearing (Superior/ Inferior)

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7
Q

Screening tests (innominate somatic dysfunction)

A

standing flexion

SI compression test

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8
Q

Landmarks

A

ASIS
PSIS
(pubic rami)

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9
Q

The test you need

A

Standing flexion test
Give the laterality of the somatic dysfunction
Positive test on the right = right innominate somatic dysfunction

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10
Q

SI compression test

A

Another test for laterality of somatic dysfunction
Tells you which SIJ is dysfunctional
Can tell you about the sacrum OR the innominate
Positive test on the right = somatic dysfunction on the right

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11
Q

what to do with landmarks

A

compare side to side
inferior/ superior
medial/ lateral

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12
Q

Innominate Motion-Rotational

A

Relationship of innominates to one another

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

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13
Q

physiologic motion of the innominate

A

Anterior rotation happens with extension of the hip

Posterior rotation happens with flexion of the hip

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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14
Q

Dx: Anteriorly Rotated Innominate

A 
Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test- ipsilateral
ASIS inferior (caudad)
PSIS superior (cephalad)
Inferior pubes - ipsilateral
Etiology (potential)
Tight quads, leg length discrepancy
Patient may c/o hamstring tightness, spasm or even sciatica on ipsilateral side. 
Treatment: ME 
(HVLA or Traction Tug, BLT, Still)
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15
Q

Anterior Rotation

A

RIGHT anteriorly rotated innominate

Standing flexion test positive: right
ASIS: inferior right
PSIS: superior right
Pubic tubercle: inferior right

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16
Q

Dx: Posteriorly Rotated Innominate

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS superior (cephalad)
PSIS inferior (caudad)
Superior pubes-ipsilateral
Patient may c/o
inguinal/groin pain (due to rectus femoris dysfunction)
Medial knee pain (due to sartorius dysfunction)
Treatment: ME
HVLA/Traction Tug, BLT, Still

17
Q

Posterior Rotation

A

Standing Flexion Test: positive right
ASIS: superior right
PSIS: inferior right
Pubic tubercle: superior right

=RIGHT posteriorly
rotated innominate

18
Q

Innominate Flare

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
Another physiological motion:
During gait extension, innominate will flare in
During gait flexion innominate will flare out

19
Q

Medial innominate flare

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test- ipsilateral
ASIS medial
PSIS lateral
Patient may c/o pelvic or sacroiliac joint pain.
Tender sacroiliac ligaments and inguinal ligaments (on either side), tender pubic symphysis
Treatment: ME

20
Q

DX: Innominate ouflare (lateral flare)

A

Diagnostic Criteria on Side of Restriction:
ASIS lateral
PSIS medial
(+) Standing Flex test- ipsilateral
Patient may c/o pelvic or sacroiliac pain.
Tender sacroiliac ligaments and inguinal ligaments (on either side)
Treatment: ME

21
Q

physiologic vs non physiologic flares

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
Shear is a non-physiologic motion
The body is not meant to move that way
Painful  the ligaments cannot compensate

22
Q

Innominate Shear

A

Traumatic positional change

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

23
Q

DX: superior innominate shear (upslip)

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS superior
PSIS superior
Pubic tubercle superior
Patient may c/o pelvic pain
Palpatory findings: Tissue texture changes and tenderness at ipsilateral SI and pubes

24
Q

DX: inferior innominate shear (downslip)

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS inferior
PSIS inferior
Pubic tubercle inferior
Patient may c/o pelvic pain.
Palpatory findings: Tissue texture changes and tenderness at ipsilateral SIJ and pubes.

25
Q

Pubic symphysis somatic dysfunction

A 
Three diagnoses
Superior
Inferior
Compressed
Generally seen with saddle injuries or other trauma
26
Q

superior pubic shear

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle superior
Patient may c/o pelvic pain or pubic arch pain
Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes

27
Q

Inferior pubic shear

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle inferior
Patient may c/o pelvic pain or pubic arch pain
Hypertonic adductors
Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes

28
Q

Compressed pubic symphysis

A

Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-equivocal
ASIS and PSIS level
pubic tubercle level, but very tender
Patient may c/o pelvic pain or pubic arch pain (runners, extreme athletes…)
Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes

(the KEY is the tenderness over the pubic tubercle with no other findings)

OPP IV Exam 1 part 2 (only do Reproductive Lab) (5 decks)

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