Pelvis / SIJ Flashcards
What are the roles of the pelvis during gait?
What happens when there is a failure of that system?
Allows for load transfer
Force generator (mid-late stance re-supinates foot)
Failure of load transfer system causes decreased activation of obliques, gluteus Maximus, and Multifidus and increased activation of biceps femoris
What are the intrinsic and extrinsic ligaments of the SIJ?
Intrinsic:
Short posterior SI ligament:
Long posterior SI ligament: restricts anterior rotation of innominate or extension of sacrum (counter nutation)
Posterior interosseous ligament
Extrinsic:
sacrotuberous: restricts nutation of sacrum, posterior rotation of innominate (opposes long posterior ligament)
Sacrospinous: stabilizes SIJ with sacrotuberous ligament, pelvic floor support
Iliolumbar: stabilizes L5 in transverse plane, restricts SIG sagittal plane movement -> provides lumbosacral and SI stability
What are potential nerve entrapments around SIJ?
What are referral of the SIJ?
Long posterior SI ligament potential entrapment site
S2 passes under piriformis for potential entrapment
Upper SIJ refers to upper and mid buttock and sometimes thigh
Lower SIJ refers to mid/lower buttock, thigh, and lower leg
What are the 3 parts of the erector spinae?
What muscles to erector spinae work with to form stability of pelvis?
Lateral to medial (I Love Spaghetti)
Iliocostalis, longissimus, spinalis
Erector spinae, psoas, and QL
What is the cluster of the hyper mobility of pubic joint?
Excessive motion on 3 WB radiographs
+ ASLR
TTP superior pubic ligament, psoas, Iliacus, adductors (esp pectineus)
(5/6)
What are the following tests and how do they relate to testing of SIJ
HABER
Lumbar SB
HABER: hip ABD/ER (prone): detects LBP with SIJ origin
Lumbar SB: R SB should cause R sacrum to come away from finger (rotates away)
What is shear?
When a hypermobile joint gets locked and cannot move or transfer load optimally; causes aberrant movement pattern
What are the characteristics of cauda equina syndrome?
Saddle anesthesia Bladder dysfunction Bowel dysfunction Sexual dysfunction LE Neuro claudication
What are clinical findings for chronic pelvic pain syndrome? (Pelvic floor referral)
Urinary symptoms Psychological dysfunction Visceral organ-specific Infection Neur.systemic conditions Myalgia Sexual dysfunction Intra-pelvic Palpation can refer pain to thorax, pelvic area or LE
What clinical test can be performed to check for pelvic fracture?
What imaging should be used for suspected blunt trauma to pelvis? For stress fracture?
Inability to perform hip flexion with knee extended
CT scan gold standard for blunt trauma fracture of pelvis
Stress fracture diagnosed with MRI
How to rule in lumbar zygopophyseal dysfunction?
How to rule out/in lumbar stenosis
No pain with sneezing/coughing
No pain when arising from flexed sitting posture
Lumbar stenosis:
R/o if no pain with lumbar extension/rotation
R/in stenosis older age, no sxs when coughing, relief of sxs when sitting
What is the CPR for OA of hip?
There are two of them
- Measure hip ADD, flex, ER/IR at 90 and prone extension
If 3/5 limited, think OA - hip pain, IR <15, pain with passive IR, AM stiffness up to 60 min, age >50
If all present, think hip OA
What are the two CPRS for sacroiliitis?
- Thigh thrust, compression, distraction, sacral thrust, Gaenslan (3/5)
- Distraction, compression, FABER, thigh thrust, Gaenslane
(if <3/5 r/o high)
What is the fortin finger test?
What is the sign of the buttock?
- Patient should point 1 finger to pain that is within 1cm of PSIS
- passive SLR to point of pain then flex knee and move hip more; if same restriction, then referral is recommended
What is the lumbar CPR?
What is the subjective CPR to rule in? Rule-out?
B sxs, leg pain>back pain, pain with walking and standing, pain relief with sitting, age >48 (3+ positive tests)
Rule-out if they do not have these things: age >65, pain below buttock, leg sxs worse with walking
Rule-in if: no pain with sitting, sxs alleviated with sitting
