SacroIliac Joint and Pelvis Flashcards
What are Form and Force Closure as related to the SI Joint?
- Form Closure- Congruity and Interlocking mechanisms of the SIJ based on Osteology
- Force Closure- Mechanism by which muscles and ligaments within the joint
What is the Pain referral pattern of the SI Joint?
- Approx 3-10 cm directly Inferior to the PSIS
What are the pain provocation tests used in the Laslett Test Item Cluster?
- Distraction
- Compression
- Thigh Thrust
- Gaenelens
What are the tests used in the Cibulka Test Item Cluster?
- Standing Flexion Test
- Supine Long Sitting Test
- Sitting PSIS Palpation
- Prone Knee Flexion Test
Discuss some Bony Landmark and Leg Length changes with Posterior Iliac Rotation (left)
- Left PSIS Inferior, ASIS Superior
- Left Leg Short
Discuss some Bony Landmark and Leg Length changes with Anterior Iliac Rotation (left)
- Left PSIS Superior, ASIS Inferior
- Left Leg Long
Discuss some Bony Landmark and Leg Length changes with Iliac Outflare (left)
- Left ASIS Lateral, PSIS Medial
- No Leg Length Change
Discuss some Bony Landmark and Leg Length changes with Iliac Inflare (left)
- Left ASIS Medial, PSIS Lateral
- No Leg Length Change
Discuss some Bony Landmark and Leg Length changes with Iliac Upslip (left)
- Left ASIS and PSIS Superior
- Left Leg Short
Discuss some Bony Landmark and Leg Length changes with Iliac Downslip (left)
- Left ASIS and PSIS Inferior
- Left Leg Long
Discuss some Bony Landmark and Leg Length changes with Sacral Torsion Anterior (Left on Left)
- Right Sacral Base Deep, Left ILA Prominent
- Left Leg Short
Discuss some Bony Landmark and Leg Length changes with Sacral Torsion Posterior (Left on Right)
- Left Sacral base prominent, Left ILA Prominent
- Left Leg Short
Discuss some Bony Landmark and Leg Length changes with Unilaterally Flexed Sacrum (left)
- Left Sacral base Deep, Right ILA inferior
- Left Leg Long
Discuss some Bony Landmark and Leg Length changes with Unilaterally Extended Sacrum (left)
- Left Sacral base prominent, Left ILA Superior
- Left Leg Short
Discuss some Bony Landmark and Leg Length changes with Bilaterally Flexed Sacrum
- Bilateral Bases of Sacrum Deep
- No Leg Length Change
Discuss some Bony Landmark and Leg Length changes with Bilaterally Extended Sacrum
- Bilateral Bases of Sacrum Prominent
- No Leg Length Change
What test is good at determining SIJ Laxity in PostPartum Patients?
- Active Straight Leg Raise
What are some common medical conditions that affect the SI Joint?
- Seronegative Arthropathies
- RA
What are Radiologic Signs of Pubic Symphysis Instability?
- Pubic Symphysis Separation > 10 mm
- Vertical Displacement > 2 mm with Single Leg Stance
In patients with SIJ pain, delayed activation of what muscles is likely to be present on the symptomatic side?
- Internal Oblique
- Gluteus Maximus
- Multifidus
The Long Posterior (Dorsal) Ligament of the SIJ restricts what movements?
- Anterior Rotation of the innominate
- Extension (Counternutation) of the Sacrum
What is the function of the Sacrospinous ligament?
- Assisting the Sacrotuberous ligament in stabilizing the SIJ
What is the role of the Gluteus Maximus in SIJ Function?
- Contraction of the Gluteus Maximus add stiffness (stability) to the SIJ
What is the role of the Gemelli, Quadratus Femoris, and Obtuator Internus about the Pelvis and SIJ?
- Likely more important as postural stabilizers than as prime movers
Describe Ilial Flares
- Movement defined by position of ASIS
- Inflare- ASIS moves medially and PSIS moves laterally, coupled with internal rotation
- Outflare- Opposite, coupled with external rotation
Describe Sacral Flexion and Extension
- Sacral Flexion (Nutation)- Superior portion of Sacrum moves Anteriorly
- Sacral Extension (Counternutation)- Superior portion of Sacrum moves posteriorly
Describe Ilial Rotation
- Anterior Rotation of Ilia- ASIS Moves Anteriorly
- Posterior Rotation- ASIS moves Posteriorly
What is the Fortin Finger Test?
- When asked to localize pain, patient points with one finger near the PSIS
- Positive for SIJ Pathology
Describe the Iliofemoral Ligament and Explain its role
- Two Branches
- Pars Inferioris- Constrains Hip Extension
- Pars Superioris- Constrains Hip Extension, Adduction, and External Rotation
What motions does the Pubofemoral Ligament Constrain Primarily?
- Extension, ABduction, External Rotation
What is the role of the Ischiofemoral Ligament?
- Reinforce the CFJ Capsule
When pain experienced at night and pain is temporarily relieved by Aspirin, what is a possible cause?
- Osteoid Osteoma
Swelling in the groin suggests what?
- Inguinal Hernia
- Lymphangitis
- Other Serious Pathology
When a younger patient presents with nontraumatic onset of painful capsular pattern loss, what is a possible cause?
- Legg Calve Perthes
- SCFE
- Seek further testing
Describe SCFE
- Femoral Head Epiphysis slides off the femoral neck
- affects males > females
- Age 13-15
- Groin pain in weight bearing, possible Anterior knee pain
Describe Legg Calve Perthes
- Aseptic bone necrosis of the femoral head
- Related to imperfect vascularization and is self limiting
- Ages 3-10
- Presents with groin pain or anterior knee pain, antalgic gait
- Frog Leg views helpful
- Possible Drehmann Sign
What is a Drehmann Sign?
- Due to slippage of femoral head
- Patient has increased muscle guarding, limited IR, Increase ER, Obligator ABduction and ER during passive flexion
What is the Clinical Triad for presentation of Loose Body in the Coxafemoral Joint (CFJ)?
- Non Capsular Pattern of Limitation
- Pathological End Feel and Sharp Shooting Pain
- Feeling of giving way in the Lower Extremity that immediately follows the pain
Describe Snapping Hip Syndrome or “Coxa Saltans”
- Classified as either Intra Articular and Extra Articular
- Intra - Snapping off the iliopsoas tendon over the iliopectineal eminence
- Extra- Related to thickening of the iliotibial tract at the greater trochanter
What is Hamstring Syndrome?
- Nerve Entrapment and potential irritation of the epineurium of the nerve as it passes around the ischial tuberosity
- preceded by episodic hamstring injury or low back pain
- Associated with active individuals
- pain localized to ischial tuberosity
What is the Clinical Triad for Hamstring Syndrome?
- Increased pain with sitting
- Pain with resisted knee flexion with the hip flexed to 90 and knee extended
- Pain then worsened when ankle and foot dorsiflexion added
- Additionally, resisted knee flexion with hip extended is pain free
Describe Piriformiis Syndrome
- Can begin with blunt trauma to buttock or overuse activities that place sciatic nerve under tension, such as running
- Increased pain in buttock with walking while sitting may decrease pain
Describe Greater Trochanteric Bursitis
- Lateral Buttock (hip) Pain
- Confirm diagnosis with palpation
- Treat with RICE, NSAIDS, Tape the Glut Med off the bursa
- Occasionally treated with injection
Describe Ischiogluteal Bursitis
- Buttock pain that is centrally located
- Usuallly in response to increased sitting, blunt trauma, or Glut Med Tear
What may be the cause of sharp burning pain in the buttock?
- Radiculopathy
- Pudendal Nerve Entrapment - elicited by activities such as bicycling with narrow seat
- Treatment should be to minimize compression of the nerve (wider seat)
Describe Pubic Symphysis Insability pain
- Worsened with Resisted ADduction, especially with hip at 45 deg flexion
- made better with use of Stabilization belt around pelvic ring
Describe a Sportsmans Hernia
- Weakening or tearing of the Transversalis Fascia, Conjoined Tendon, and/ or Internal Oblique Fibers
- Creates an Inside Out Hernia
- Pain in lower abdominal, inguinal and groin regions
- Worsened with Exertion or Valsalva
What are the three sub types of FAI?
- Cam Impingement- Non Spherical Femoral Head and Neck Relationship
- Pincer- Acetabulum too deep and too much coverage around the femoral head
- Mixed
- Pincer typically secondary to retroversion or turning back of the acetabulum
What Symptoms are typical in the patient with a Acetabular Labral Tear?
- Pain with Sitting and Climbing Stairs
- Possible Clicking, Locking, Giving Way during Weight Bearing Activities
- Possible Limitation during passive internal rotation with hip flexed but not with hip extended
What Symptoms are typical in the patient with stress fractures?
- Pain with weight bearing
- Sx Reproduced with Unipodal Hop
- (+) Fulcrum Test
What can cause Hip pain to occur in passive hip external rotation in fully flexed position?
- Iliopectineal Bursitis
Describe Myositis Ossificans in the Iliopsoas
- Extremely Rare
- Groin Pain, Hip Flexion Contracture, Abdominal Tenderness, Parasthesias in distribution of femoral nerve
