Pelvis/SIJ

Question 1

prevelance

Answer 1

in nonpregnant, post-pregnant and pregnant population is 20-45%

often NOT isolated from LBP

Question 2

innominates

Answer 2

ilium
ischium
pubis

Question 3

nutation

Answer 3

sacrum moves downward, forward, and rotates to the opposite side of the ilium

illium rotates posteriorly

Question 4

load transfer

Answer 4

more effective when sacrum is nutated or tilted forward

Question 5

amplitude of sacral nutation

Answer 5

controlled by pelvic floor muscles and sacral multifidus activation

Question 6

SIJ

anatomy

Answer 6

anteriorly = more synovial articulations
posteriorly = more fibrocartilagenous

designed for STABILITY

Question 7

intrinsic ligaments

anatomy

Answer 7

ant SI ligs = thin and weak
post SI ligs = thick and heavy

Question 8

extrinsic ligaments

anatomy

Answer 8

sacrotuberous
sacrospinous
iliolumbar

Question 9

muscular attachments

Answer 9

35 attach to pelvic and/or sacrum

Question 10

posterior

muscle attachments

Answer 10

lats
erector spinae
QL
Glute max
HS
Multifidi

Question 11

anterior

muscle attachment

Answer 11

abdominals
obliques
iliopsoas
rec fem
TFL
sartorius

Question 12

lateral

muscle attachment

Answer 12

glute med
QL
glute min
piriformis

Question 13

medial

muscle attachment

Answer 13

IR of hip
pectineus
adductor longus
gracilis
adductor brevis
adductor magnus

Question 14

stability muscles

Answer 14

force closure and decreased shear
glute max
bicep femoris
erector spinae
lats

Question 15

preset tension

Answer 15

muscles needed before movement initiation
trasnversus abdominis
multifidi
piriformis
pelvic floor

dysfunction of SI = delay of muscle

Question 16

single ilial motion

planar motion

Answer 16

single ilial motions
- rotations
- outflare/inflare
upslip/downslip

Question 17

sacral motion between ilia

plnar motions

Answer 17

nutation/counternutation
rotations

Question 18

pubic motions

planar motions

Answer 18

upslip

Question 19

major purpose of SIJ

Answer 19

shock absorption system between lower spine and LE

self bracing system

Question 20

amount movement of SIJ

Answer 20

rotation = 3 deg or less
translation = 2mm or less

Question 21

amount of movement pubic symphysis

Answer 21

walking = 2.2 vertically and 1.3 mm sagitally

Question 22

SIJ dysfunction

Answer 22

when stabilization is lost or when asymm stabilizationis between 2 sides SIJ

anterior rotation of the innominate = main pain and instability for chronic pelvic pain

posterior-rotated innominate = stable position

Question 23

3 ways SIJ is protected from shear

Answer 23

1. wedge shaped anatomy
2. interlocking furrows and ridges
3. shape of the surface cartilage

Question 24

surface irregularities

Answer 24

is possible for the jt to move and have a new position that is locked into position of displacement

Question 25

pelvic tilt

Answer 25

both anterior and posterior-superior iliac spines will be lower on 1 side than the other = leg length difference or differences in height upslip/downslip

Question 26

pelvic torsion

Answer 26

compare anteriorly and posteriorly in horizontal plane - in rotation if there is = more exam to see if its on the left or right

Question 27

classic torsion

Answer 27

PSIS lower on the left than right ASIS higher on the left than on right positional palpation tests may NOT be able to determine SI-jt

Question 28

palpation

Answer 28

a sensory challenge since we're only touching the skin since actual SIJ is deep

Question 29

subj considerations

Answer 29

identifying nonmechanical sx or risk factors that is associated with infections adn inflammations and metabolic conditions

Question 30

common subj complains

Answer 30

unilateral pain lateral buttock pain pain can radiate down to posterior thigh or LE in general can be traumatic onset (fall, MVA with foot depressed on brake) long term positioning - crossing legs, slumping

Question 31

diff dx

Answer 31

ovaries, IUD, urinary hip pathology - labral tear, transient osteoporosis of hip (common in prego) lumbar radiculopathy lumbar facet referral myofascial - TrPs = all glutes, QL, piriformis - piriformis syndrome, piriformis shorterning of SIJ

Question 32

sign of the buttock

Answer 32

deep gluteal pain of non-msk origin - buttock large + swollen + TTP - SLR limited and painful - hip + knee flexion limited and pain - empty end feel on hip flexion - limited trunk flexion - non-capsular pattern of restriction @ hip (flex, abd, IR) - resisted hip movt painful and weak = extension

Question 33

sign of the buttock dx

Answer 33

rheumatic bursitis osteomyelitis of upper femur neoplasm of upper femur + ilium fx sacrum ischorectal abcess septic sacroilitis septic gluteal bursitis

Question 34

SIJ pain + s/s

Answer 34

unilateral WB STS can't stand on one leg increase pain when running or stairs centralization during lumbar exam = DO NOT HAVE SIJ

Question 35

Pain maps

Answer 35

fortin: "fortin finger" - pain around 3 cm wide and 10 cm long just inferior to PSIS

Question 36

strength testing

Answer 36

side lying hip adduction = sx with pt's having hypermobility of SI and pelv