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OCS > SacroIliac Joint and Pelvis > Flashcards

SacroIliac Joint and Pelvis Flashcards

1
Q

What are Form and Force Closure as related to the SI Joint?

A
  • Form Closure- Congruity and Interlocking mechanisms of the SIJ based on Osteology
  • Force Closure- Mechanism by which muscles and ligaments within the joint
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2
Q

What is the Pain referral pattern of the SI Joint?

A
  • Approx 3-10 cm directly Inferior to the PSIS
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3
Q

What are the pain provocation tests used in the Laslett Test Item Cluster?

A
  • Distraction
  • Compression
  • Thigh Thrust
  • Gaenelens
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4
Q

What are the tests used in the Cibulka Test Item Cluster?

A
  • Standing Flexion Test
  • Supine Long Sitting Test
  • Sitting PSIS Palpation
  • Prone Knee Flexion Test
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5
Q

Discuss some Bony Landmark and Leg Length changes with Posterior Iliac Rotation (left)

A
  • Left PSIS Inferior, ASIS Superior

- Left Leg Short

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6
Q

Discuss some Bony Landmark and Leg Length changes with Anterior Iliac Rotation (left)

A
  • Left PSIS Superior, ASIS Inferior

- Left Leg Long

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7
Q

Discuss some Bony Landmark and Leg Length changes with Iliac Outflare (left)

A
  • Left ASIS Lateral, PSIS Medial

- No Leg Length Change

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8
Q

Discuss some Bony Landmark and Leg Length changes with Iliac Inflare (left)

A
  • Left ASIS Medial, PSIS Lateral

- No Leg Length Change

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9
Q

Discuss some Bony Landmark and Leg Length changes with Iliac Upslip (left)

A
  • Left ASIS and PSIS Superior

- Left Leg Short

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10
Q

Discuss some Bony Landmark and Leg Length changes with Iliac Downslip (left)

A
  • Left ASIS and PSIS Inferior

- Left Leg Long

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11
Q

Discuss some Bony Landmark and Leg Length changes with Sacral Torsion Anterior (Left on Left)

A
  • Right Sacral Base Deep, Left ILA Prominent

- Left Leg Short

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12
Q

Discuss some Bony Landmark and Leg Length changes with Sacral Torsion Posterior (Left on Right)

A
  • Left Sacral base prominent, Left ILA Prominent

- Left Leg Short

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13
Q

Discuss some Bony Landmark and Leg Length changes with Unilaterally Flexed Sacrum (left)

A
  • Left Sacral base Deep, Right ILA inferior

- Left Leg Long

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14
Q

Discuss some Bony Landmark and Leg Length changes with Unilaterally Extended Sacrum (left)

A
  • Left Sacral base prominent, Left ILA Superior

- Left Leg Short

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15
Q

Discuss some Bony Landmark and Leg Length changes with Bilaterally Flexed Sacrum

A
  • Bilateral Bases of Sacrum Deep

- No Leg Length Change

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16
Q

Discuss some Bony Landmark and Leg Length changes with Bilaterally Extended Sacrum

A
  • Bilateral Bases of Sacrum Prominent

- No Leg Length Change

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17
Q

What test is good at determining SIJ Laxity in PostPartum Patients?

A
  • Active Straight Leg Raise
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18
Q

What are some common medical conditions that affect the SI Joint?

A
  • Seronegative Arthropathies

- RA

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19
Q

What are Radiologic Signs of Pubic Symphysis Instability?

A
  • Pubic Symphysis Separation > 10 mm

- Vertical Displacement > 2 mm with Single Leg Stance

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20
Q

In patients with SIJ pain, delayed activation of what muscles is likely to be present on the symptomatic side?

A
  • Internal Oblique
  • Gluteus Maximus
  • Multifidus
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21
Q

The Long Posterior (Dorsal) Ligament of the SIJ restricts what movements?

A
  • Anterior Rotation of the innominate

- Extension (Counternutation) of the Sacrum

22
Q

What is the function of the Sacrospinous ligament?

A
  • Assisting the Sacrotuberous ligament in stabilizing the SIJ
23
Q

What is the role of the Gluteus Maximus in SIJ Function?

A
  • Contraction of the Gluteus Maximus add stiffness (stability) to the SIJ
24
Q

What is the role of the Gemelli, Quadratus Femoris, and Obtuator Internus about the Pelvis and SIJ?

A
  • Likely more important as postural stabilizers than as prime movers
25
Q

Describe Ilial Flares

A
  • Movement defined by position of ASIS
  • Inflare- ASIS moves medially and PSIS moves laterally, coupled with internal rotation
  • Outflare- Opposite, coupled with external rotation
26
Q

Describe Sacral Flexion and Extension

A
  • Sacral Flexion (Nutation)- Superior portion of Sacrum moves Anteriorly
  • Sacral Extension (Counternutation)- Superior portion of Sacrum moves posteriorly
27
Q

Describe Ilial Rotation

A
  • Anterior Rotation of Ilia- ASIS Moves Anteriorly

- Posterior Rotation- ASIS moves Posteriorly

28
Q

What is the Fortin Finger Test?

A
  • When asked to localize pain, patient points with one finger near the PSIS
  • Positive for SIJ Pathology
29
Q

Describe the Iliofemoral Ligament and Explain its role

A
  • Two Branches
  • Pars Inferioris- Constrains Hip Extension
  • Pars Superioris- Constrains Hip Extension, Adduction, and External Rotation
30
Q

What motions does the Pubofemoral Ligament Constrain Primarily?

A
  • Extension, ABduction, External Rotation
31
Q

What is the role of the Ischiofemoral Ligament?

A
  • Reinforce the CFJ Capsule
32
Q

When pain experienced at night and pain is temporarily relieved by Aspirin, what is a possible cause?

A
  • Osteoid Osteoma
33
Q

Swelling in the groin suggests what?

A
  • Inguinal Hernia
  • Lymphangitis
  • Other Serious Pathology
34
Q

When a younger patient presents with nontraumatic onset of painful capsular pattern loss, what is a possible cause?

A
  • Legg Calve Perthes
  • SCFE
  • Seek further testing
35
Q

Describe SCFE

A
  • Femoral Head Epiphysis slides off the femoral neck
  • affects males > females
  • Age 13-15
  • Groin pain in weight bearing, possible Anterior knee pain
36
Q

Describe Legg Calve Perthes

A
  • 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
37
Q

What is a Drehmann Sign?

A
  • Due to slippage of femoral head

- Patient has increased muscle guarding, limited IR, Increase ER, Obligator ABduction and ER during passive flexion

38
Q

What is the Clinical Triad for presentation of Loose Body in the Coxafemoral Joint (CFJ)?

A
  • 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
39
Q

Describe Snapping Hip Syndrome or “Coxa Saltans”

A
  • 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
40
Q

What is Hamstring Syndrome?

A
  • 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
41
Q

What is the Clinical Triad for Hamstring Syndrome?

A
  • 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
42
Q

Describe Piriformiis Syndrome

A
  • 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
43
Q

Describe Greater Trochanteric Bursitis

A
  • Lateral Buttock (hip) Pain
  • Confirm diagnosis with palpation
  • Treat with RICE, NSAIDS, Tape the Glut Med off the bursa
  • Occasionally treated with injection
44
Q

Describe Ischiogluteal Bursitis

A
  • Buttock pain that is centrally located

- Usuallly in response to increased sitting, blunt trauma, or Glut Med Tear

45
Q

What may be the cause of sharp burning pain in the buttock?

A
  • Radiculopathy
  • Pudendal Nerve Entrapment - elicited by activities such as bicycling with narrow seat
  • Treatment should be to minimize compression of the nerve (wider seat)
46
Q

Describe Pubic Symphysis Insability pain

A
  • Worsened with Resisted ADduction, especially with hip at 45 deg flexion
  • made better with use of Stabilization belt around pelvic ring
47
Q

Describe a Sportsmans Hernia

A
  • 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
48
Q

What are the three sub types of FAI?

A
  • 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
49
Q

What Symptoms are typical in the patient with a Acetabular Labral Tear?

A
  • 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
50
Q

What Symptoms are typical in the patient with stress fractures?

A
  • Pain with weight bearing
  • Sx Reproduced with Unipodal Hop
  • (+) Fulcrum Test
51
Q

What can cause Hip pain to occur in passive hip external rotation in fully flexed position?

A
  • Iliopectineal Bursitis
52
Q

Describe Myositis Ossificans in the Iliopsoas

A
  • Extremely Rare

- Groin Pain, Hip Flexion Contracture, Abdominal Tenderness, Parasthesias in distribution of femoral nerve

OCS (13 decks)

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