SACRAL AND PELVIS CS - SRS

Question 1

Where would you find a TP for the anterior lateral trochanter?

Answer 1

5-7 cm lateral and inferior to the ASIS but anterior and superior to the greater trochanter

Question 2

With the patient prone, how would you treat the TP for the posterior medial trochanter?

Answer 2

1. Grasp leg on tender side and place knee under the thigh
2. slightly extend the leg
3. moderately externally rotate it
4. bring leg across midline with adduction until the TP resolves
5. Hold 90 sec
6. recheck

Question 3

Where would you find the TP for the high ilium sacroiliac (HISI)?

Answer 3

4-5 cm lateral to PSIS

Question 4

Where would you find the tender point for the lateral trochanter?

Answer 4

LAteral surface of the femur, 0-15cm distal from the great trochanter in the IT band

Question 5

With the patient prone, how would you treat the piriformis TP you just located?

Answer 5

1. Doctor is seated on side of TP
2. suspend patients leg off table and rest the leg on the thigh
3. flex hip to about 135 degrees
4. abduct slightly via the knee
5. internally or externally rotate the knee until the TP resolves
6. Hold 90 sec
7. recheck

Question 6

Where is the tender point for the inguinal ligament?

Answer 6

Superior surface of pubic tubercle

Question 7

With the patient supine, how would you treat the TP for the anterior lateral trochanter?

Answer 7

1. Stand ipsilateral
2. flex hip between 70-90 degrees
3. add abduction
4. add external rotation until TP resolves
5. hold 90 sec
6. recheck

Question 8

Where is the iliacus tender point?

Answer 8

2 inches inferior and 2 inches medial from the ASIS (press posterolaterally)

Question 9

High Ilium outflare (HIFO) is seen in what conditions?

Where is the tender point located?

Answer 9

Seen in coccydynia

TP is at sacrococcygeal joint or on the coccyx

Question 10

Where are the sacral tenderpoints found?

Answer 10

Found along the median crest of the sacrum. Would be on the spinous and transverse processes of the sacrum if it were not fused. (note the sacrum fuses around 25, so if younger TPs will be on corresponding transverse and spinous processes)

Question 11

How would you treat the tender point you just found for the lateral trochanter?

Answer 11

1. patient prone
2. doctor seated on a stool, supporting the thigh with the tender point
3. slightly flex the hip
4. add abduction (generally more than flexion)
5. add internal rotation if needed for resolution of TP
6. hold 90 seconds
7. recheck

Question 12

With the patient supine, and your finger on the tender point you found at the superior surface of the pubic tubercle, what is the setup/technique for treating this inquinal ligament tender point?

Answer 12

1. Flex both patients legs and place them on your thigh.
2. move leg on tender side under the opposite leg.
3. adduct the femur
4. internally rotate the foot towards yourself until the TP resolves
5. Hold for 90 seconds
6. Recheck

Question 13

With the patient supine, and standing on the ipsilateral side to the iliacus (psos) tenderpoint, how would you treat?

Answer 13

1. as mentioned, stand on tender side
2. flex patients legs
3. externally rotate the legs and place them on your thigh
4. flex, sidebend toward the TP until resolution
5. Hold 90 seconds
6. recheck

Question 14

With the patient supine, how would you go about treating the tender point you found at the low ilium?

Answer 14

1. Flex the tender side only (90degrees)
2. add abduction if needed for resolution
3. hold 90 seconds
4. Recheck

Question 15

Where would you find a tender point for the posterior medial trochanter?

Answer 15

3-5mm inferior to the greater trochanter between the posterior medial surface of the shaft of the femur and the posterior lateral surface of the ischial tuberosity.

Question 16

With the patient prone, how would you treat the posterior lateral trochanter TP?

Answer 16

1. doctor stands with knee on table under patients thigh.
2. add moderate extension
3. add some abduction
4. add significant external rotation until TP resolves
5. hold 90 seconds
6. recheck

Question 17

Where is the low ilium (SI) tender point located?

Answer 17

Lateral ramus of the pubic bone anterior surface

Question 18

Where is the TP for the piriformis?

Answer 18

In the belly of the piriformis, 8-9 cm medial and slightly superior to the greater trochanter (but can be anywhere along the track of the muscle)

Question 19

Now that you have located a sacral tender point, how would you treat it?

Answer 19

1. Patient prone
2. doctor is standing and will apply gentle pressure to the opposite part of the sacrum where TP is located
   
   • For example, if it is a PS1 right point, the doctor will push on the left ILA
3. hold 90 seconds
4. recheck

Question 20

Where is the tender point for the posterior lateral trochanter?

Answer 20

Superior lateral surface of the posterior greater trochanter.

Question 21

With the patient prone (can also be done supine), how would you treat the TP at the HISI?

Answer 21

1. Stand on affected side of patient
2. extend leg
3. slightly abduct leg until TP resolves
4. hold 90 sec
5. recheck

Question 22

How would you treat the HIFO TP you just located?

Answer 22

1. patient prone
2. doctor on affected side
3. raise (extend) the affected side just enough to be able to adduct the leg over the other leg
4. Adduct the leg until the TP resolves
5. hold 90 sec
6. recheck

Question 23

How would you treat a patient with a TP for their MPSI?

Answer 23

1. Stand on affected side
2. slightly flex the hip and knee
3. add in abduction (major component of this treatment)
4. add some external rotation until TP resolves
5. 90 sec
6. recheck

Question 24

Where would you find a TP for the mid pole sacroiliac (ilium in flare superior) (MPSI)

Answer 24

TP is 3-4 cm inferior to the PSIS in the divot in the muscle just lateral to the sacrum. Approach the TP from the lateral side