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OS II Sacrum/Innominate > Sacral Dx and Tx > Flashcards

Sacral Dx and Tx Flashcards

1
Q

If my patient has a Bilateral Flexion what would be findings be?

A
  • seated flexion/pelvic compression= NEG
  • lumbar lordosis= increased
  • sacral sulcus= deep bilaterally
  • ILA= posterior bilaterally
  • lumbar spring test= NEG
  • respiratory motion= restricted to inhalation
  • side bending passive and 4 point passive= no restriction
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2
Q

If my patient had a Bilateral Extension what would my findings be?

A
  • seated flexion/pelvic compression= NEG
  • lumbar lordosis= decerased (flat)
  • sacral sulcus= shallow bilaterally
  • ILA= anterior bilaterally
  • lumbar spring= POS
  • respiratory motion= restricted to exhalation
  • side bending passive and 4 point passive= no restriction
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3
Q

If my patient had a Right Unilateral Sacral Flexion what would my findings be?

A
  • seated flexion/pelvic compression= POS R
  • sacral sulcus= deep on R
  • ILA= posterior and inferior on R
  • lumbar spring= NEG
  • SB passive= resricted to SB L (likes to be SB R)
  • 4 point passive= no restriction
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4
Q

If my patient had a Left unilateral flexion what would my findings be?

A
  • seated flexion/pelvic compression= positive on L
  • sacral sulcus= deep on L
  • ILA= posterior and inferior on L
  • Lumbar spring= NEG
  • SB passive= restriced to SB R (like to be SB L)
  • 4 point passive= no restrictions
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5
Q

If my patient had a R Unilateral Extension what would my findings be?

A
  • seated flexion/pelvic compression= POS on R
  • sacral sulcus= shallow on R
  • ILA= anterior and superior on R
  • lumbar spring= POS
  • SB passive= restricted toward SB R (likes to be SB L)
  • 4 point passive= no restriction
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6
Q

If my patient had a Left Unilateral Extension what would my findings be?

A
  • seated flexion/pelvic compression= POS on L
  • sacral sulcus= shallow on L
  • ILA= anterior and superior on L
  • Lumbar spring= POS
  • SB passive= restricted to SB L (likes to be SB R)
  • 4 point passive= no restriction
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7
Q

If my patient had a R on R Foward Torsion what would my findings be?

A
  • seated flexion= POS on L
  • pelvic compression= POS on R
  • sacral sulcus= deep on the L
  • ILA= posterior on R
  • lumbar spring= NEG
  • 4 point passive= restricted to rotating left around right oblique axis, hard end feel on R ILA
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8
Q

If my patient had a Left on Left Foward Torsion what would my findings be?

A
  • seated flexion= POS on R
  • pelvic compression= POS on L
  • sacral sulcus= deep on the R
  • ILA= posterior on L
  • lumbar spring= NEG
  • 4 point passive= restricted to rotating right around left oblique axis, hard end feel on L ILA
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9
Q

If my patient had a Right on Left Backward Torsion what would my findings be?

A
  • seated flexion= POS on R
  • pelvic compression= POS on L
  • sacral sulcus= deep on L
  • ILA= posterior on R
  • lumbar spring= POS
  • 4 point passive= restricted to left rotation around left oblique axis, hard end feel on L ILA (hard end feel R sulcus!)
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10
Q

If my patient had a Left on Right Backward Torsion what would my findings be?

A
  • seated flexion= POS on L
  • pelvic compression= POS on R
  • sacral sulcus= deep on R
  • ILA= posterior on L
  • Lumbar spring= POS
  • 4 point passive= restricted to right rotation around right oblique axis, hard end feel on R ILA (hard end feel on L sulcus!)
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11
Q

What is important to remember about pelvic/ASIS compression test?

A
  • press down posterior medially on ASIS
  • side of hard end feel= POS side
  • does NOT discriminate between iliosacral and sacrolilial motion
  • indicates SI joint dysfunction on side of restricted motion
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12
Q

Lumbar spring test

A
  • pt prone
  • springing force applied anteriorly into lumbosacral junction with heel of hand
  • NEGATIVE= normal spring
  • POSITIVE= no spring, increased resistance to pressure
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13
Q

What is sphinx test used for?

A
  • backward bending test *confirm lumbar spring test
  • backward bending increase lumbar lordosis and brings scarum into flexed position
  • If sulci more symmetric= Anterior torsion/unilateral flexion
  • If sulci more asymmetric= Posterior torsion/unilateral extension
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14
Q

What is 4 point passive test used for?

A
  • finger monitoring at sacral sulcus and heel of hand on opposite side ILA
  • apply anterior pressure on L ILA and monitor posterior motion at R sulcus
  • apply anterior pressure on R ILA and monitor for posterior motion at L sulcus
  • looking for restriction around oblique axes
  • used to dx torsion
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15
Q

Respiratory motion of sacrum

A
  • if restricted to inhalation (sacral base moves posterior)= bilateral flexion
  • if restricted to exhalation (sacral base moves anterior)= bilateral extension

**all unilaterals will have asymmetric respiratory motion, not fully restricted

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16
Q

After all treatments you have to do what?

A

REASSESS!!

  • bilateral dysfunction= sphinc test, lumbar spring, respiratory motion
  • unilateral dysfunction= sidebending
  • torsion= 4 point passive
  • all do static symmetry
17
Q

If a patient had Bilateral Sacral Flexion how would you treat them?

A
  • pt prone
  • place caudad hand on ILAs (sacrum apex)
  • cephalad hand on top of caudad
  • apply anterior/superior force on ILAs
  • exaggerate force during inhale and resist anterior motion during exhale
  • 3-5 respiratory cycles or until no new barriers
  • HVLA= after a few rounds of ME as patient INHALES on last cycle apply quick anterior/superior thrust to sacral apex
18
Q

If a patient had a Bilateral Sacral Extension how would you treat them?

A
  • pt prone/ sphinx position
  • index/middle finger caudad hand on sacral sulcus (base of sacrum)
  • cephalad hand on top
  • pt inhales resist posterior motion, exaggerate motion during exhale by applying anterior and inferior force
  • repeat 3-5 breath cycles or until no new barriers
  • HVLA= apply a few round of ME and as patient EXHALES on last cycle apply quick anterior/inferior thrust to sacral base
19
Q

How would you treat a patient with a Right Unilateral Sacral Flexion?

A
  • pt prone, doc on R side
  • palpate sacral sulcus/base with cephalad hand
  • caudad hand abduct and internally rotate R hip
  • place heel caudad hand on ILA on R and cephalad hand on top
  • apply anterior/superior force on ILA
  • as patient inhales exaggerate force and as pt exhales resist anterior motion
  • repeat until no new barriers
20
Q

How would you treat a patient with a Left Unilateral Sacral Extension?

A
  • pt prone, IN SPHINX, doc on L side
  • palpate sacral sulcus/base with cephalad hand and caudad hand abduct and internally rotate hip of L leg
  • place cephalad hand on L sacral sulcus and caudad hand on top
  • apply anterior/inferior force on sulcus
  • patient inhale resist motion, as exhale exaggerate motion
  • repeat 3-5 cycles or until no new barriers
21
Q

How would you treat a patient with a L on L Foward Torsion?

A
  • pt modified SIMS with (axial side) L side down
  • hips and knees flex 90 with chest down on table arms hanging off
  • monitor L5/S1 flex hips/knees until motion felt
  • pt inhales and exhales deeply 3 times induce axial rotation
  • rest pt knees on your thigh caudad hand grasp pts heels to flex until L5 neutral relative to S1
  • caudad hand lower pt legs toward floor by pushing at feet
  • pt lift feet upwards toward ceiling for 3-5 sec against your counterforce
  • pt relax and doc engage new barrier pushing feel further to floor
  • repeat until no new barriers
22
Q

How would you treat and R on L Backward Torsion with ME?

A
  • pt at edge of table lateral recumbant with (axis side down) L side down
  • flex top hip and knee to 90 and pull lower arm to induce posterior rotation so pt back closer to table
  • monitor at L5/S1 and place top foot further into flexion until motion felt
  • apply gentle force on pts knee toward floor (adducting top hip)until motion felt at L5/S1
  • pt lift knee against your counterforce (toward ceiling) 3-5 sec then relax
  • move pt into next barrier by pushing knee toward floor and repeat until no new barriers met
23
Q

How would you treat a L on R Backward Torsion with HVLA?

A
  • pt supine with doc on side of involved axis (deep sulcus), R side
  • sidebend pt LE and torso away from R creating C shape
  • pt clasp hands behind neck
  • doc place caudad hand on L ASIS
  • plce cephalad hand over opposite shoulder and through space resting dorsum of hand on manubrium (this is rotational lever)
  • using cephalad hand induce rotation of upper torso into barrier by pulling opposite shoulder toward itself and preventing motion at ASIS
  • pt take a deep breath and on exhale apply axial rotation thrust of pt upper body with cephalad hand on rotation level and applying posterior thrust simultaniously on opposite ASIS

OS II Sacrum/Innominate (2 decks)

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