Pelvis and sacrum Flashcards
What are the three types of nociceptive pain?
Mechanical: joint capsule stretch, bony impingement
Inflammatory: chemically caused. May present with swelling, redness, heat
Ischemic: tendinopathy, due to lack of tissue perfusion
What is central sensitization?
pathophysiological process in which the CNS undergoes changes that alter its processing of pain and other sensory stimuli
CNS undergoes structural, functional and chemical changes to make it more sensitive to pain and other sensory stimuli
SIJ pain is common in which populations?
people who participate in lifting and twisting activities
Sports with repetitive unilateral loads and unidirectional pelvic shear and/or torsional forces
Pregnancy
What are the SIJ pathology pain regions?
Buttock
Thigh
Groin
Back
Knee
What are the differential diagnoses of SIJ pathology?
Precise SIJ pain
Symptoms radiate into thigh, buttocks, and groin
No neurological deficits reported
Pain with transitional movements
Pregnancy related S/S
Is the sacrum usually the issue?
no usually the ilium or lumbar spine are the issue
What is dyspareunia?
Pain with penetration
What is pelvic girdle pain?
More notably in pregnancy
Often names/conditions: SIJ pain dysfunction, sacral/gluteal pain, pubic symphysis, etc…
What is endometriosis?
When tissue similar to lining of uterus implants abnormally outside of uterus to form lesions, cysts, nodules and other growths. Can be found on any pelvic organ
What are some GI symptoms of endometriosis?
Constipation, diarrhea or cycling between the two, abdominal bloating, nausea/vomiting, painful bowel movements
What is diastasis recti?
Increased distance between RA muscle bellies due to a stretch of linea alba
What are the tests to diagnose SIJ Pain?
Patrick’s (FABERS)
Posterior Shear
Sacral compression
Active SLR
Sacral thrust tests
Patient is diagnosed with SIJ pain if 3/5 are positive
What is the posterior shear test?
Supine, knee flexed, hip flexed at 90
Place hand under sacrum
Create an axial load through femur
+ve: pain provoked in posterior aspect of SIJ below L5
What is the sacral compression test?
Side lying
examiner places a downward pressure on the ilium
+ve: increased feeling of pressure in SIJ and or pain
What is the active SLR?
Supine do an active SLR if painful AT applies pressure on both sides of pelvis.
+ve: if pain decreases or it is easier to do
What is the sacral thrust?
Prone
AT places base of palm on the apex of patients sacrum
Pressure applied, causing a shearing force at sacrum and ilium
+ve= pain at SIJ
What is Gaenslen’s Test?
Pt lies on side with upper leg being the test leg
Pt hold the lower leg flexed against chest
Examiner adds some downward pressure on test leg
+ve: pain at SIJ or low back during testing
What are tests that indicate SIJ movement dysfunctions?
Sacral sulcus
Sitting flexion
Long sitting
Gillet
Standing flexion
Palpation
What is the sacral sulcus test?
Laying prone
palpate sacral sulcus and inferior angle of sacrum on each side
look for symmetry
What is the gillet test?
Patient standing with examiner palpating PSIS and S2
Ask patient to flex hip to 90 degrees
Examiner should see PSIS on same side drop
Hypomobility= thumb moves cranially or doesn’t drop
What is the standing forward flexion test?
Palpate both PSIS
Ask patient to bend forward from standing position
-ve: if both PSIS move equally and symmetrically
+ve: if one PSIS moves cranially more than the other
What is the sitting flexion test?
Patient seated with hips and knees at 90degrees
examiner palpates PSIS
Pt instructed to bend forward with arms between knees
+ve: side that PSIS continues to move cranially is restricted
What is the long sitting test?
Pt supine
ask pt to bridge then drop
Passively extend legs
place hands under medial malleolus, look for symmetry
Ask pt to sit up, and see if position of the medial malleolus changed or remained the same
+ve: if one medial malleolus moved differently relative to the other
What is Gossip’s test?
Global test for SIJ movement
Pt standing
Examiner palpates bilat PSIS
Ask patient to bend one leg (when knee drops, hip flexes and L/S side bends at L5)
+ve: decreased inferior movement of PSIS
