Pelvis Examination Flashcards
Observation
Signs of Trauma or Inflammation
Postural Analysis - Pelvic Malalignment - Scoliosis or kinetic chain?
BBRSS, muscle wastage, alignment, discoloration
Alignment:
Assess gait – foot drop (L4-5), Antalgic, Hemiplegic
Flexion positioning of relief in neurogenic claudication
Lateral shift/antalgic posture with scoliosis d/t disc lesion/radiculopathy
Lateral pelvic tilt – scoliosis
Lordosis - pregnancy can increase lordosis, maybe predispose someone to pain (debatable),Duchannes muscular dystrophy
Hyperlordosis - Spondylolisthesis sill sign d/t anterior translation of VB above (skin wrinkled around an area)
Fat pad prominence at lumbosacral junction (with or without tuft of hair) in spina bifida occulta – may
Muscle Wastage:
Observe leg (atrophy in long term radiculopathy/piriformis syndrome) or changes in tone, fasciculations
Glut Medius atrophy Trendelenburg (can get in spontaneous osteonecrosis)
Palpation
PSIS, ASIS, AIIS & sacral base quite superficial (sensitive – lots of cutaneous nerves & ligaments) -> may
be the cause of the back pain (gap the SI)
Iliac crest level of L4 – gluteal insertion, lateral = ITB, iliacus insertion, vastus lateralis internal rotators
e.g. gemelli, OI tendinopathies or referral in Maigne’s syndrome from TL Junction
o Step defect in spondylolisthesis (prominent)
Lumbar erector spinae for any tenderness (sprains & strains) or muscle guarding
QL from iliac crest to lower ribs (come in laterally – overlies TVPs)
Glut Meds/abductors: looking for trigger points or any atrophy that could indicate (Trendelenburg)
Gluteal pain (hypertonicity in med, max, piriformis) – look for trigger points (piriformis syndrome,
Trendelenburg, tendinopathies)
Piriformis (find L5 then S2 and onto GT – midway between these points)
SIJ: painful in pregnancy – gapping stress anterior SI ligaments & compression for post SI ligaments (can
get SI dysfunction)
Active, passive and resisted ROMs;
Flexion - 135 degrees
Extension - 0-15 degrees
Abduction - 45 degrees
Adduction - 20 degrees
Internal Rotation - 35 degrees
External Rotation - 45 degrees
Resisted isometric movements that stress the SIJ
Forward flexion of the spine (the abdominal muscles stress the symphysis pubis )
Flexion of the hip (iliacus stresses the SIJ)
Abduction of the hip (glut med stresses the SIJ)
Adduction of the hip (adductors stress the symphysis pubis)
Extension of the hip (glut max stresses the SIJ)
Special tests
Sacroiliac restriction
Seated Forward Flexion Test - Purpose: To assess for decreased motion at one of the sacroiliac joints.
Cluster of Laslett
ASIS Distraction/Gapping test
Thigh thrust/Posterior shear
Compresison test (side lying)
Sacral thrust
Sacroiliac vs lumbar
Adams and supproted adams
Double leg raise
Goldthwaite’s
Sacroiiac pathology
Yeoman’s
Hibbs
Nachlas
Gaenslen’s test
Sacral compression/squish test
Faber
