Quiz 2 (pelvis) Flashcards
Symphysis pubis capsular pattern
Pain when joints are stressed
Symphysis pubis resting position
Not applicable
Sacroiliac joint capsular pattern
Pain when joints are stressed
Sacroiliac joint resting pattern
Not applicable
2 joints in the pelvis
Sacroiliac joint
Symphysis pubis
Sacroiliac joint ligaments
Anterior sacroiliac ligament
Posterior sacroiliac ligament
Interosseous membrane
Primary stabilizer of the sacroiliac joint
Interosseous ligament
3 other ligaments related to the sacroiliac joint
Iliolumbar ligament
Sacrospinous ligament
Sacrotuberous ligament
What counteracts forward tiliting of the sacrum at the top end?
Sacrospinous & sacrotuberous ligament
Symphysis pubis ligaments
Superior pubic ligament
Inferior pubic ligament
Posterior pubic ligament
Anterior pubic ligament
What muscles influence the symphysis pubis mobility?
Adductor group & rec ab
Anterior rotation of the innominate
ASIS down, PSIS up
Posterior rotation of the innominate
ASIS up, PSIS down
Outflare of the innominate
ASIS away, PSIS towards
Inflare of the innominate
ASIS towards, PSIS away
Sacral flexion/nutation
Top of sacrum goes anteriorly
Sacral extension/counternutation
Top of sacrum goes posteriorly
Important history questions for pelvis assessment
-Pregnant or recent pregnancy?
-Sleeping position?
-Mechanism of injury? - falling on butt, sudden jarring, lifting/twisting
-Symptoms related to the menstrual cycle?
Pelvis mechanisms of injury (3)
-Falling on butt
-Sudden jarring
-Lifting/twisting
Sacroiliac joint pain referal
-Slightly medial and inferior to the PSIS or in the buttock and/or posterior lateral thigh and upper calf
-Iliac fossa, abdomen and occasionally to groin
Sacroiliac joint pain aggravations
Turning in bed, stepping on a step, getting in and out of bed
Posterior sacroiliac ligament pain referral
Lateral, posterolateral and posterior medial thigh
Posterior sacroiliac ligament pain aggravators
Worsens during ovulation and menstrual period
Anterior sacroiliac ligament pain referral
Buttock and posterior thigh
Symphysis pubis joint pain referral
Local
Symphysis pubis joint pain aggravators
Contraction of rec ab or adductors
4 ways to evaluate innominate bone mobility
- PSIS test
- Standing hip flexion test (observation only)
- Gillet’s test (standing hip flexion test with palpation of S2 and PSIS)
- Standing hip flexion test with palpation of lower sacrum and ischial tuberosity
How to evaluate movement of the sacrum
Sacral sulcus test
PSIS test (patient position, examiner action, normal response, positive response, indicates)
Position: standing
Examiner: Find PSIS by finding dimples, dropping down 2-3 inches pushing in and then up to hook under them. Move thumbs laterally until they are 8-10 inches apart. Ask patient to flex.
Normal response: No movement initially, the both PSIS elevate at the same time
Positive response: If one elevates immediately or one doesn’t elevate as much as the other after the initial lag
Indicates: hypomobility of the innominate bone on that side
Standing hip flexion test observation only (patient position, examiner action, normal response, positive response, indicates)
Patient: standing
Examiner: Ask patient to alternately bring hips to 90* and observe buttock
Normal response: Buttock should be round on side of being lifted
Positive response: Patient’s hip hikes up
Indicates: hypomobility of the innominate bone on that side
Gillet’s test (patient position, examiner action, normal response, positive response, indicates)
Patient: standing
Examiner: Palpate S2 and PSIS, ask patient to bring hip on test side to 90*
Normal response: PSIS drops in relation to S2
Positive response: PSIS goes up in relation to S2
Indicates: hypomobility of the innominate bone on that side
Standing hip flexion test with palpation of bottom of sacrum and ischial tuberosity (patient position, examiner action, normal response, positive response, indicates)
Patient: standing
Examiner: Palpate lower sacrum and ischial tuberosity, ask patient to bring hip on test side to 90*
Normal response: ischial tuberosity moves lateral on test side
Positive response: ischial tuberosity goes up
Indicates: hypomobility of the innominate bone on that side
Sacral sulcus test (patient position, examiner action, normal response, positive response, indicates)
Position: standing
Examiner: Find iliac crests and most posteriorly until thumbs are 6 inches apart. Ask patient to extend then flex
Normal response: On extension both thumbs deepen equally. On flexion both thumbs move posteriorly equally
Positive response: The side that does not deepen or move posteriorly as much is the affected side
Indicates: hypomobility of the sacrum on that side
4 passive movement tests (pelvis)
- Gapping test
- Squish test
- Sacroiliac rocking ligament test
- Superoinferior symphysis pubic stress test
Gapping test (patient position, examiner action, positive response, indicates)
Patient: supine
Examiner: Applies outward pressure to ASIS with crossed arms
PR: Reproduces unilateral gluteal or posterior leg pain
Indicates: Sprain of anterior sacroiliac ligament
Squish test (patient position, examiner action, positive response, indicates)
Patient: supine
Examiner: Place both hands on patient’s ASIS and iliac crests, then push down and in at 45 degree angle
PR: reproduces pain (often lateral, posteriorlateral or posteriormedial thigh pain)
Indicates: Sprain of posterior sacroiliac ligament
Sacroiliac rocking ligament test (patient position, examiner action, positive response, indicates)
Patient: supine
Examiner: Passively flexes patient’s hip to same shoulder, opposite shoulder, then opposite elbow
PR: Reproduces pain
Indicates: Sprain of vertical, oblique or horizontal fibres of the SI ligaments (depending on direction) and/or sprain of sacrotuberous ligament
Superoinferor symphysis pubic stress test (patient position, examiner action, positive response, indicates)
Patient: supine
Examiner: Stands at patient’s side and places heel of one hand over superior pubic ramus on one side and the heel of the other hand under the inferior pubic ramus on other side. Squeeze hands together.
PR: reproduces pain in symphysis pubis
Indicates: sprain of pubic symphysis
Resisted movements for pelvis (Isometrics)
Hip flexion/extension
Hip adduction/abduction
Trunk flexion
How long do you hold pelvic isometrics?
Only long enough to determine if pain is reproduced
Pelvis special tests
Gaenslen’s test
Flamingo test
Baer’s point
Gaenslen’s test (patient position, examiner action, positive response, indicates)
Patient: side lying with lower leg to chest (holding posterior thigh)
Examiner: Stabilize the pelvis while extending the hip. Patient hugs bottom leg
PR: Pain in SI joint, hip joint or along the L4 nerve root distribustion (lateral thigh, anterior and posteriomedial lower shin, medial malleolus to anterior big toes)
Indicates: Ipsilateral sacroiliac joint lesion, hip pathology or L4 nerve root lesion
L4 nerve root distribustion
Lateral thigh, anterior and posteriomedial lower shin, medial malleolus to anterior big toes
Flamingo test (patient position, examiner action, positive response, indicates)
Patient: standing
Examiner: Ask patient to stand on one leg. May ask patient to hop on test side.
PR: pain in symphysis pubis or sacroiliac joint
Indicates: Lesion in symphysis pubis or sacroiliac joint
Baer’s point (patient position, examiner action, positive response, indicates)
Patient: supine
Examiner: Ask patient to take a deep breath, the exhale. On exhalation press in the iliac fossa, anterior to SI joint
PR: tenderness
Indicates: spasm of the iliacus muscle (due to SI joint infection or sprain of the anterior sacroiliac ligament)
Causes of Iliacus muscle spasm
SI joint infection or sprain of the anterior sacroiliac ligament
Piriformis strain/syndrome signs/symptoms
-Localized tenderness
-Low back and hip pain
-Pain on resisted hip extension, lateral rotation and abduction
-If spasm, will have deep sulcus on affected side
-Positive piriformis test
-May have lateral rotation of hip in standing/gait
Piriformis syndrome additional signs/symptoms
-Radiation down post. thigh to popliteal space when sciatic nerve compressed
-May have poorly defined tingling or numbness in buttock and/or posterior thigh
-If active TrP, may have pain in mid-calf and/or bottom of foot
Osteitis pubis signs/symptoms
-Local tenderness
-Local swelling
-Pain on resisted hip adduction and trunk flexion
-Aggravated by coughing/sneezing
-Positive flamingo test
-Positive superoinferior symphysis pubis stress test
Posterior SI ligament sprain signs/symptoms
-Local tenderness
-Positive squish test
-Positive sacroiliac rocking ligament test for affected fibres
-Pain referred to lateral/posteriorlateral/posteriomedial thigh
-Aggravated by side lying with top leg dropped in front of bottom leg
Anterior SI ligament sprain signs/symptoms
-Positive gapping test
-Positive transverse anterior shear test
-Positive sacroiliac rocking ligament test for affected fibres
-Positive Baer’s point if anterior SI ligament causes iliacus spasm
-Referral into buttock/posterior thigh
Ankylosing spondylitis signs/symptoms
-Initially has vague discomfort and stiffness in lower back, worse on awakening, eased by exercise
-Breathing becomes restricted
-Marked thoraco-cervical kyphosis and flattening of lumbar lordosis
