Sacroiliac joint; low back pain Flashcards
SI joint: what is the difference between hypomobility and instability?
- Hypomobility = limitation of movement
* Instability = lack of control
Which test are included in the Van der Wurf cluster
- distraction/ gapping test
- compression / aproximation test
- thigh thrust test
- Gaenslens test
- patrick sign/ farber’s test
Name 2 tests which are useful to determine iliopsoas related joint pain.
- Gaenslen’s test
Which tests can be used to determine instability?
- Laslet
- Van der Wurf
- ASLR
- CrossSLR
- PPPP
Explain force closure and form closure.
• form closure + force closure = the closing mechanism of the SI joint
• Form closure:
o Stable ring: helps with load transfer from leg to spine / vice versa
o Form of the bones and ligaments in the ring
o joints are uneven/ irregular–> therefore bones can`t slide downwards
• Force closure
o Muscles and thoracolumbar fascia compression the joints
o Stabilising it
Would you perform a mobility test and mobilization for SI joint in case of possible mobility restriction? Explain.
No, mobility tests are of low diagnostic value.
Patients (60+) might have an ossification of the lig. interosseus, therefore usually mobility is restricted. Mobilizations then are not useful.
Explain nutation and counter-nutation.
- Nutation: Tip of the sacrum moves backward making the pelvic outlet bigger and inlet smaller (flexion)
- Counter nutation: the sacrum moves inwards, making pelvic outlet smaller and inlet bigger (extension)
Name 3 causes of wringing in the SI joint.
can be
- artherogenic
- abnormality
- unilateral muscular shortening
What might be causes for pelvic pain?
What does PPPP stand for?
- Consequence of mechanical aspects: instability of pelvis / excessive force closure –>stress on soft tissue
- Psychosocial factors (passive coping, illness beliefs, anxiety and depression)
- Hormonal factors
- Combination
PPPP = Posterior Pelvic Pain Provocation (test)
Which are the most important ligaments ( according to Ronald) in the SI joint?
lig. sacrotuberale
lig. sacrospinale
What are specific pathologies for lower back pain?
- cauda equina syndrome
- M. bechterew
- vertebral osteoporosis/ fracture
- vertebral cancer
What is a triage for?
screening - distinguishing between severe pathology and none (who gets treatment first)
- History
- Physical examination
- Evidence
concerning acute low back pain:
- simple back pain
- radicular-type
- serious pathology
The KNGF guideline divides low back pain patients in different diagnostic groups. Name them.
Profile 1: Normal course (6 weeks)
Profile 2: Abnormal course without dominant psychosocial symptoms
( + SI joint biomechanical reasons)
Profile 3: Abnormal course with dominant psychosocial symptoms
When is a course abnormal for low back complaints?
after 3 weeks with no increase of activities and functions or increasing/persistent pain
What are 4 symptoms for specific radiculopathy in low back pain?
- pain lower than the knee (radiating pain)
- loss of reflex
- loss of strength
- loss of sensitivity
- -> if 3 of those are positive, radix is involved
