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SACRUM Flashcards

1
Q

Standing: what influences pelvis?

A

pelvis influenced by both structures and functional asymmetry of LE’s

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2
Q

Seated: what influences pelvis?

A

Innominate stabilized by weight on ischial tuberosity, influenced by position of spine and tension in trunk

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3
Q

Prone: what influences pelvis?

A

pelvis supported by pubic symphysis and ASIS, sacrum responds to trunk

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4
Q

Supine: what influences pelvis?

A

stabilized by WB on table, innominate respond to tension from below

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5
Q

Superior pub

A

R one that is higher = R superior pub

L one that is higher = L superior pub

we expect 2 superior pubic ramus to be equal in supine and in standing position

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6
Q

inferior pub

A

L one that is lower = L inferior pub

R one that is lower = R inferior pub

we expect 2 superior pubic ramus to be equal in supine and in standing position

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7
Q

Anterior innominate

Right:

Anterior view
ASIS/ASIS
PSIS/PSIS

Lateral view on the right
ASIS/PSIS

Lateral view on the left
ASIS/PSIS

A

= anterior rotation: if the right side rotates forward, there is an anterior rotation of the right innominate bone

Viewing from anterior view the right ASIS is inferior to ASIS on the left

PSIS on the right is supserior to left PSIS

Lateral from right: ASIS is inferior to PSIS

Lateral from left:
ASIS and PSIS are equal

If it were anterior pelvic tilt then the PSIS would be higher than ASIS from both lateral views: we need to look from both sides to see if it is a unilateral dysfunction

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8
Q

Posterior innominate:
R

Anterior view:
Posterior:

Lateral right:

Lateral Left:

A

Anterior view: Right ASIS superior

Posterior: right PSIS is lower

Lateral right: ASIS higher than PSIS

Lateral Left: ASIS and PSIS are even

Opposite of an anterior innominate
This can occur on either side (can get an anterior or posterior innominate on R or on L)

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9
Q

Where should the ASIS and PSIS be aligned?

A

2 ASIS should be equidistant from umbilicus

2 PSIS should be equidistant from center point of sacrum, SP of sacrum

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10
Q

Inflare

anterior view

posterior view

lateral view

A

medial rotation around the Y axis

Anterior View: we look at ASIS from anterior view on the side of the rotation is closer to the umbilicus than the ASIS of contralateral side

Posterior View: If turn the person around, PSIS is lateral to center of sacrum compared to the PSIS on the contralateral side.

Lateral view wont show anything

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11
Q

Outlfare

anterior view

posterior view

A

Lateral rotation around the y axis

Anterior view – ASIS is laterally displaced from umbilicus compared to other side

Posterior view – PSIS medially displaced from sacrum

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12
Q

Upslip

anterior view

posterior view

lateral view

Crest heights (WB vs NWB)

Ischial tuberosity

A

“superior ilial sheer” or “superior innominate sheer”

: entire right hemipelvis becomes superiorly displaced

Anterior view – ASIS superior

Lateral view – unless there is a rotation coupled with it – it wont look different because it’s level

Posterior view – PSIS is superior

Crest heights in NWB: the iliac crest will be high on the side of the superior displacement
(Not in WB because if your leg lengths are the same, and the leg is planted on the ground, the pelvis will level out and your spine will take up the slack (back accommodates for it)

Ischial Tuberosity: When you look at this, and examine the patient in prone, their ischial tuberosity will also be superiorly displaced because entire hemipelvis will be superiorly displaced

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13
Q

Downslip

  1. Anterior view
  2. Posterior view
  3. Iliac crests
  4. IT’s
A

Inferior ilial sheer or inferior innominate sheer

  1. Anterior view – ASIS inferior
  2. Posterior view – PSIS inferior
  3. Iliac crests – iliac crest inferior
  4. Look at relationships of IT’s – R would be inferior
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14
Q

Where is middle transverse axis located?

A

L3

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15
Q

Where is Right oblique axis?

A

diagonal axis: Right promontory and travels obliquely across sacrum and comes out on L ILA

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16
Q

Where is Left oblique axis?

A

diagonal axis: Left promontory (sacral base) and travels to right ILA

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17
Q

Inhalation: how it affects sacrum?

A

sacrum is going to come backwards

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18
Q

Exhalation: how it affects sacrum?

A

sacrum is going to come forward

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19
Q

which axis at which we find motion related to sacrum that is connected to respiration?

A

Superior Transverse Axis:

inhale: sacrum goes posterior
exhale: sacrum comes anterior

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20
Q

which axis nutation and counternutation?

A

middle transverse axis

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21
Q

Nutation

  • what motion/axis
  • what widens/narrows
A

1) Anterior rotation around middle transverse axis, S2,3, where promontory moves anteriorly and inferiorly

2) Pelvic brim is decreased and pelvis outlet is increased
- –Movement anteriorly around Middle transverse axis: promontory/sacral base moves anteriorly, apex (cornu) moves posteriorly

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22
Q

Counternutation:

A

1) Promontory moves superiorly and posteriorly
2) Pelvic brim is increased and pelvic outlet is decreased
- 1. Sacral base – posterior superior/Cornu – anterior inferior

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23
Q

Are Nutation and Counternutation are normal movements?

A

happen when you breathe

  1. Bring both legs up together to chest– counternutation
  2. Extension – nutation

Normal physiological movements

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24
Q

Right on Right

what is it

is it bad?

A

right rotation around a right oblique axis

Considered to be a normal physiological movement–ie during gait: HS = anterior torsion

**With any movement in the innominate bone or the sacrum the problem is when get stuck in the position whether it is a normal or abnormal movement. So even if the right on right moves right on right and return to neutral is no problem, but if get stuck in right on right and have trouble getting back to neutral, it is still a problem. It is more painful and problem if it is an abnormal movement and it will be more painful and a more significant finding.

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25
Q

Left on Right

A

left on right: left rotation around the right oblique axis

This is a posterior torsion and is a non physiological movement, it does not take place normally -due to trauma

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26
Q

Left on Left

A

Rotate anteriorly around the left oblique axis: rotate towards the left

Left rotation around the left oblique axis which is referred to as an ANTERIOR TORSION and it is a normal physiological movement

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27
Q

Right on Left

A

Right rotation around left oblique axis is a POSTERIOR TORSION, and it is a non physiological movement

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28
Q

Sacral Extension

where does sacral base go? ILA?

A

unilateral superior sacral shear

  1. Hemisacrum slides along side of facet in superior direction
  2. Sacral promontory moves posteriorly and superiorly
  3. ILA moves superiorly
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29
Q

Sacral Flexion

where does sacral base go? ILA?

A

Inferior Unilateral Sacral Sheer

Sacrum sheers in an inferior direction, it slides along the facet joint

Sacral base goes forward and inferiorly

ILA: moves inferiorly

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30
Q

GAIT: Iliosacral Movement:

A

each innominate rotates anteriorly and posteriorly during the walking cycle

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31
Q

GAIT: Sacral Movement

A

The axis of rotation originates on the side of the weight bearing leg

L on L, return to neutral, then R on R, then return to neutral

At midstance of gait cycle the axis of rotation of sacrum is on the side of the weight bearing leg and it is always an anterior torsion.
i. The axis of rotation originates on the side of the weight bearing leg

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32
Q

when the sacrum rotates to the right, simultaneously what sidebending does it do?

A

when the sacrum rotates to the right, simultaneously it does left side bending

When sacrum rotates it also does contralateral side bending

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33
Q

how lumbar spine moves in relation to sacrum?

A

When sacrum rotates, the lumbar spine rotates to the opposite side/ when sacrum sidebends, lumbar spine sidebends to the opposite side

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34
Q

Baer’s Point

dutton

A

1/3 of the way down on the diagonal that goes between ASIS and the pubic symphysis

Gives more a superior part of the SI joint

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35
Q

Baer’s Point

Minel

A

2 inches from umbilicus (more medially) between umbilicus to ASIS

Gives you more inferior part of joint

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36
Q

sacral sulcus

A

Space between sacral base and PSIS:

tells us about relationship between innominate and sacrum

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37
Q

Piriformis muscle

palpation

A

Attaches from the anterior inferolateral aspect of the sacrum to greater trochanter

Trace along length to palpate

Piriformis is over the sciatic nerve (15% of population, sciatic nerve goes through but most of the time is goes under)

You will only feel it if it is in spasm

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38
Q

Sacral hiatus

palpation

A

Travel down sacrum and in area of S5 there is an indentation before the coccyx

S5 – feel an indentation

39
Q

Pain with prolonged sitting, standing, walking or transitions of positions

A

Classic SI complaints

40
Q

Typical Pain Patterns

A
  1. Pain centered over the SI joint
    One finger test i
  2. Pseudo S1 pattern
  3. Diffuse pain from buttock radiating to posterior LE

[Rarely see pain go below knee joint, usually jus buttock and if it does radiate it goes down posterior aspect of thigh]

41
Q

Fortin finger test

A

One finger test in literature

42
Q

Mobility Tests and Examination:

A
  1. Standing
    - asymmetry
    - forward flexion test
    - backwards bending test
    - marching test
    - weight bearing provocation
    - lumbar movement
  2. Sitting
    -asymmetry in static siting
    -seated forward flexion test
    -
    R/O fx
  3. Supine: PUBIC SYMPHYSIS DYSFUNCTION
    - iliac crests
    - pubic symphysis
    - inguinal ligament
    - SI provocation test
  4. prone: SACRAL DYSFUNCTION
    - sacral position
    - ILA
    - LLD
    - gluteal tone
    - ITs
    - tension sacrotuberous ligament
    - palpate PSIS
    - evaluate lumbar curve
    - spring lumbar curve
    - spring sacrum
  5. supine: IS DYSFUNCTION
    - ASIS
    - LLD
    - long sitting test
43
Q

Assess:

PUBIC SYMPHYSIS DYSFUNCTION

A

Supine: PUBIC SYMPHYSIS DYSFUNCTION

  • iliac crests
  • pubic symphysis
  • inguinal ligament
  • SI provocation test
44
Q

Assess

SACRAL DYSFUNCTION

A

prone: SACRAL DYSFUNCTION
- sacral position
- ILA
- LLD
- gluteal tone
- ITs
- tension sacrotuberous ligament
- palpate PSIS
- evaluate lumbar curve
- spring lumbar curve
- spring sacrum

45
Q

Assess

IS DYSFUNCTION

A

Supine: IS DYSFUNCTION (position of the innominate bone)

  • ASIS
  • LLD
  • long sitting test
46
Q

Standing: Forward flexion test:

A

innominate rotation round the sacrum and it is an IS problem.

  • eyes level with PSIS, do not stabilize pelvis because we want it to move: , fingers must be under the PSISs
  • pt stands knees extended: roll down as though going to touch your toes
  • normal: both PSIS rise forward simultaneously and equally

-Positive finding: one side (PSIS) moves first and further
(innominate bone grabbed by sacrum + pulled up faster while other side taking up slack between sacrum and innominate bone as normal)

47
Q

Backward bending test

A

SI Issues= sacrum moving on the innominate bone

PT hands on sacral base: Drop of medially on both sides to PSIS

pt hands on butt. pt backward bend, should have increase in lordosis
(sacrum moves in opposite direction of the lumbar spine, sacral base will drop forward into kyphosis

Normal: should feel both of PT’s thumbs dip forward simultaneously and symmetrically

Positive: problem of movement btwn innominate bone and sacrum on one side, sacrum will not be able to drop forward because it is caught on innominate, and on that side the sacral base will remain back and not drop forward

  • one side will drop forward, the other side will not
  • PT will feel one side relatively posterior: involved side
48
Q

Stork (marching) test:

A

innominate rotation round the sacrum (IS problem)

On NWB side: PT has one thumb on PSIS and other thumb on ipsilateral sacral base
–Must have thumb underneath PSIS and it must stay underneath to follow the PSIS and not let it slip from your finger.

Instruct patient to march in place: 90-90 hip-knee flexion

Normal: expect to feel innominate bone rotating posteriorly in relation to the sacrum:
=should feel PSIS drop down and back under PT thumb as the pt comes up into hip and knee flexion.
As put foot back down should come back into normal alignment.

Positive finding:
= one side does not have appropriate mobility, innominate bone will not drop back and the whole pelvis will shear up
and PT feel a stiffness in pelvis and finding will be that PSIS grabbed cranially and will not drop down and whole unit will come up because innominate cannot rotate normally around the sacrum [it almost looks like a hip hike]

49
Q

Weight bearing provocation

A

Patient stand centered with equal distribution of weight on both LE’s

Ask patient to shift weight over one LE and go back to neutral and shift weight over to opposite LE

Caution: no lumbar side bending or rotation which can cause pain

i. If they sideband and get pain = problem distinguishing between lumbar and SI – so keep in neutral to r/o lumbar spine

Don’t allow lumber spine to move in order to rule out lumbar spine, it is a pure weight shift, discomfort is coming from the pelvis if reproduction of the symptoms on a particular side

Positive finding: reproduction of pain

50
Q

Lumbar movement

A
  1. Already done this as a part of lumbar exam
  2. Flexion, extension, sidebending, rotation
  3. Incorporate findings into differential diagnosis to figure out patient problem
51
Q

Which test for IS issues?

A

innominate rotating around sacrum

When looking at forward bending test and a marching test we are looking at innominate rotation around the sacrum and it is an IS problem.

52
Q

Which test for SI Issues?

A

sacrum moving on the innominate bone

When we’re looking at backward bending in standing we are looking at sacrum, either moving forward or its inability to move forward and its an SI problem.

53
Q

Sitting forward flexion test

A

indicative of issues in the SI JOINT

seated with feet supported, roll fingers underneath PSISs, PSIS eye level

sitting on ITs: movement first in lumbar spine as it reverses lordosis/ then sacrum: innominate bone will move simultaneously if there is an equal amount of slack on both sides for the two SI joints

Normal Finding: PSIS will rise in a cranial direction simultaneously – same finding as the standing forward bending test

Positive: one PSIS will move first and further
dysfunction on one side: sacrum stuck on the side with the innominate bone

54
Q

Difference in what we learn from sitting and standing forward bending test:

A

Sitting position: positive finding is indicative of issues in the SI Joint (sacrum moving on the innominate bone)

Standing position: positive findings in standing are indicative of ilium moving on the sacrum (innominate rotating around sacrum)

55
Q

Standing flexion test

rosen

A

This is a mobility test for the ilium moving on the sacrum.

Instruct the patient to stand with the feet approximately 6 in. apart.

Stand behind the patient to observe the movement. Remember to use your domi- nant eye.
Locate the PSISs and place your thumbs under them. Maintain contact with the PSISs throughout the movement.

Ask the patient to bend as far forward as he or she can. Observe the movement of the PSISs in relation to each other.

They should move equally. If there is a restriction, the side that moves first and furthest is considered to be hypomobile (Figure 6.33). If the patient presents with tight hamstrings, a false- positive finding can occur (Greenman, 2003; Isaacs et al., 2002).

56
Q

Stork (Gillet, Marching) Test

rosen

A

This is a mobility test for the ilium moving on the sacrum. Instruct the patient to stand with the feet ap- proximately 6 in. apart. Stand behind the patient to observe the movement. Remember to use your dom- inant eye. Locate the PSIS on the side that you are testing and place one thumb under it. Place your other thumb just medial to the PSIS, on the sacral base.

Ask the patient to raise the lower extremity on the side being tested so that the hip and knee are flexed to 90 degrees. Note the movement of the PSIS in rela- tion to the sacrum. This test should be repeated on the contralateral side.

Compare the amount of move- ment from one side to the other. If the PSIS does not
drop down into your thumb on one side, the ilium is considered to be hypomobile (Greenman, 2003) (Figure 6.34).

57
Q

Backward-Bending Test

rosen

A

Instruct the patient to stand with the feet approxi- mately 6 in. apart. Stand behind the patient to observe the movement. Remember to use your dominant eye. Place your thumbs medial to the PSISs bilaterally on the sacral base. Instruct the patient to bend backward. Observe as your thumbs move in an anterior direc- tion.

An inability to move anteriorly demonstrates hy- pomobility of the sacrum moving on the ilium (Green- man, 2003; Isaacs and Bookhout 1992) (Figure 6.35).

58
Q

Seated Flexion Test

rosen

A

This is a mobility test for the sacrum moving on the ilium. This test eliminates the influence of the lower extremities. Instruct the patient to sit on a stool with the feet firmly on the ground for support. Stand be- hind the patient to observe the movement. Remember to use your dominant eye. Locate the PSISs and place your thumbs under them. Maintain contact with the PSISs throughout the movement. Ask the patient to bend as far forward as he or she can with their arms between their knees. Observe the movement of the PSISs in relation to each other. The side that moves first and furthest is considered to be hypomobile (Greenman, 2003; Isaacs and Bookhout 1992) (Figure 6.36).

59
Q

Posteroanterior Spring of the Sacrum

rosen

A

This a test for posterior to anterior mobility of the sacrum. Place the patient in the prone position with the neck in neutral rotation. Stand on the side of the patient that is on the side of your dominant eye, with your body turned so that you are facing the patient’s head. Place your hands over the central aspect of the posterior sacrum using the palm as the contact point. Press directly over the sacrum in an anterior direction until all the slack has been taken up (Paris, 1991) (Figure 6.37).

60
Q

R/O fracture

A

positive finding: localized point tenderness

send for xray

61
Q

Mobility Tests

1st Supine

(4)

A

PUBIC SYMPHYSIS DYSFUNCTION

  • iliac crests
  • pubic symphysis
  • inguinal ligament
  • SI provocation test
62
Q

Mobility Tests

prone
10

A

SACRAL DYSFUNCTION

  • sacral position
  • ILA
  • LLD
  • gluteal tone
  • ITs
  • tension sacrotuberous ligament
  • palpate PSIS
  • evaluate lumbar curve
  • spring lumbar curve
  • spring sacrum
63
Q

Mobility Tests

second supine

A

IS DYSFUNCTION

  • ASIS
  • LLD
  • long sitting test
64
Q

First Supine

Iliac Crests

A

for pubic symphysis dysfunction

upslip will have a change in iliac crest height in an unweighted position
–If upslip where the innominate travels up and when lying down it does not go away and see a high crest in NWB: Get a suspicion that the problem is pelvis (not LLD)

Occasionally you will find muscle contraction /muscle spasm that pull innominate bone upward: not an upslip, just secondary stuff going on. (QL in spasm can pull the crest up )

65
Q

First supine

Pubic Symphysis (pubs):

A

for pubic symphysis dysfunction

Pay attention to symmetry from one side to the other

Rest hand on symphysis, take two thumbs/index/middle fingers and compare the height from one side to the other from a superior- inferior direction

66
Q

First supine:

Inguinal Ligament

A

for pubic symphysis dysfunction

In groin line, looking for tenderness/tension between sides

May also feel tension from one side to the other but remember the ligament is from two points that don’t change-can have a change in the joint but don’t have a change in the length relationship from the origin and insertion, so wont expect such a tension difference but will find tenderness differences so note which side/ both sides

67
Q

First supine:

SI Provocation Test

A

for pubic symphysis dysfunction

Anterior/Posterior SI joint Stress Test
look to see if discomfort at the SI joint . Can be done 2 different ways:

Compression component: separate ASIS anteriorly to create compression at the SI: cross my arms to push ASIS laterally to compress SI

Distraction component: patient supine, my hands lateral ASIS and press medially on anterior aspect to distract at SI: my elbows are out and push ASIS in medially

68
Q

Prone

Sacral Position

A

sacral dysfunction

Evaluate the sacral base:

take fingers PSISs and place fingers on the base itself (not the sulcus,

the sacral base—two thumbs on the base of the sacrum): compare depth from one side to the other side.

69
Q

PRONE

ILA

A

sacral dysfunction

Look for hiatus and move laterally

Fingers under ILA: posterior to anterior and inferior to superior

Fingers behind ILA to see if rotated posterior to anterior

Put fingers under ILA to see relationship inferior to superior

Rotation on oblique axis:

  • -. If right oblique axis and rotated to right around right oblique axis: the right ILA will move posterior
  • –If there is a unilateral sheer on right and the sacrum goes into flexion on right, ILA will move inferiorly
70
Q

PRONE

LLD

A

sacral dysfunction

Pelvis responds differently in different positions

In prone: pelvis is secured, trunk is an influence on the sacrum on position (stabilized the pelvis):

prone LLD is a function of how the sacrum is located between the two innominate bones

may see a different LLD in supine: -
supine LLD as a function of innominate bone and as a function of anatomical leg length

they don’t have to be the same.

71
Q

PRONE

observe gluteal tone

A

sacral dysfunction

If have a rotation in the innominate bone or a change in sacral alignment there will be a tone difference

May be squishier on one side, fuller on one side, or see atrophy on one side

72
Q

PRONE

tension sacrotuberous ligament

A

sacral dysfunction

Slide medially off IT and feel the ligament next to your hand

If there is an upslip on the side the IT is elevated the sacrutuberous ligament will feel mushy: note the side that is softer and see if it correlates to the height change in the Its

Correlated often with upslip because attach form IT to the sacrum—if there is an upslip more slack on the ligament and perceive it as a mush

73
Q

PRONE:

palpate PSIS

A

sacral dysfunction

Look at the alignment, is one side higher than the other

Don’t know if higher or lower is the significant finding so just note it at this point

74
Q

PRONE:

evaluate lumbar curve

A

sacral dysfunction

look at the lateral view

should see a lordosis

Some people may have a flattening due to spasm or bony alignment changes

75
Q

PRONE:

spring lumbar curve

A

sacral dysfunction

a. Hand on, spring from L5-L1 vertebrae by vertebrae
b. If increase or normal lordosis should feel nice springing
c. If flattened lordosis feel decrease springing and it feels stiff

76
Q

PRONE:

spring sacrum

A

sacral dysfunction

Do the same movement to spring the sacrum: now the hand is sitting over the sacrum

Note: PAIN and if it moves symmetrically on both sides, is there give

77
Q

PRONE

palpate ITs

A

sacral dysfunction

Fingers underneath ITs and note a height difference from one side to the other

If somebody as a true upslip and half of the pelvis has actually slid up: would find IT higher on the side of the upslip

Note: IT that is elevated

78
Q

SUPINE

ASIS

A

position of the innominate bone, IS dysfunction

79
Q

SUPINE

LLD

  1. anterior innominate
  2. posterior innominate
    3.
A

position of the innominate bone, IS dysfunction

  1. If you have an anterior rotation innominate will push the femur inferiorly: functional LLD: LONGER
  2. If posterior innominate: functional LLD: leg shorter

It is a functional change to accommodate for a true anatomical change:
3. True LLD:
Ie right leg is longer, then find a posterior innominate on that side to try to compensate for the longer anatomical leg to make it functionally shorter so it is not as long from one side to the other

So can see combination of anatomical and functional leg length discrepancy on the same side

80
Q

SUPINE

Long Sitting Test

  1. patient position
  2. what to compare
  3. what patient does
  4. False negatives
  5. normal
  6. Positive
  7. why
A

position of the innominate bone, IS dysfunction

1) Patient in a supine position, patient is told to level pelvis: bend knees in hooklying lift pelvis and drop back down to table, allow to straighten out legs.

Look at LLD:
2—fingers by mediall malleolus and inspect
3—Then ask the patient to longsit from supine
Compare LLD supine to longsit

  1. False negatives/positives: Weak abdominals, uneven hamstring length
  2. Normal : leg length equal in supine and remains equal in long sitting position
    - –>Could also be a normal finding if one leg is longer in supine and stays the same amount longer in long sitting (there is NO CHANGE from one side to the other)
  3. Positive: one leg that is either equal or shorter in supine: and then when patient goes into long sitting, the short leg becomes much LONGER
  4. WHY? If you have a patient who starts out with a posterior innominate which creates a functionally short leg, the acetabulum will be cephalically displaced–Then as you go into long sit pelvis evens out and the relative position of acetabulum goes from superiorly displaced position to a more normal neutral position (evens out because the whole thing rotates together )
81
Q

prone vs supine LLD

A

In prone: pelvis is secured by having the _ resting on the table, trunk is an influence on the sacrum on position (stabilized the pelvis):

prone LLD is a function of how the sacrum is located between the two innominate bones

may see a different LLD in supine:

supine LLD as a function of innominate bone and as a function of anatomical leg length

they don’t have to be the same.

82
Q

why supine to longsit LLD test works

A

If you have a patient who starts out with a posterior innominate which creates a functionally short leg, the acetabulum will be cephalically displaced–Then as you go into long sit pelvis evens out and the relative position of acetabulum goes from superiorly displaced position to a more normal neutral position (evens out because the whole thing rotates together )

83
Q

FABERE (Patrick) Test

A

Rationale: differentiate between hip joint and sacroiliac joint pain

Patient is put into a figure of four position, Place one hand on the pelvis and the other hand on the distal femur and create an opening

If figure of four hurts we suspect the hip

If one hand on the pelvis with the other on the knee, putting pressure on the pelvis makes the pain more intense we suspect the SI joint

84
Q

Prone Knee Bending (Nachlas) Test

A

Patient is in prone, flex the patient knee so heel approach buttock

Pain on anterior part of thigh is rectus femoris tightness

Classic Test used for L3:

  • reproduction of symptoms radiation down front of thigh to knee (medial knee)
  • and/or back pain this is correlated with L3 diagnosis.
  • Can also get pain around iliac crest,
  • pain can start at L3 NR in the back.

If patient has very hypomobile SI on ipsilateral side or tight anterior structures—> iliac rim will start to move because it doesn’t tolerate this and get ASIS rotating forward as it gets pulled.

85
Q

Gaenslen’s Test

A

–Flex the leg that you’re not testing to 90 degrees, hold it there-have them hold it from posterior aspect of thigh

–Then extend and abduct the contralateral side that is off the side of the table

–This stresses SI joint, if it is painful probably has sacroiliac joint dysfunction or pathology.

(looks like Thomas but you’re not stabilizing half of the pelvis—in Thomas test at end of table and pelvis flat on table, but in this test half of pelvis on table. Position looks the same )

86
Q

Indications of Gaenslen’s Test (4)

A

1) SI dysfunction
2) Pubic symphysis instability (creating a hemipelvic rotation so if unstable in pubis this would be uncomfortable)

3) Hip pathology
(asking the patients hip to hyperextend and in capsular pattern hip hyperextension is limited)

4) L4 nerve root irritation because of the input into the femoral nerve and you’re hyperextending the anterior structures (can get some stretch on the front, can also reproduce some of the radicular complaints that the patient might have from L4 nerve root)

87
Q

Thigh Thrust

  1. pt
  2. PT
  3. force
  4. positive finding
A

Thrust (POSH test – posterior sheer test): confirm side but ilium pubis vs sacrum

  1. pt: Place patient in supine, Flex painful hip to 90 degrees
  2. PT: Stand on the UNAFFECTED side and lean across, Place my hand under the sacrum
    - –>Slide hand under the patients sacrum to allow space for the innominate to move around the sacrum, this creates a bridging effect
  3. Force: Press towards the table along the line of the femur thorugh SI on that side

don’t compress the patella

  1. Positive finding: reproduction of symptoms
    (creating a posterior shear of the innominate bone through the femur)
88
Q

Squish Test

A

To determine side of dysfunction and also reproduce patients symptoms

Hands on ASIS and push posterior and medial force: apply downward and medial force (adduction and posterior)

Another way to do it is to do one side at a time: so that also a rotational force on the innominate bone on a side to side, to differentiate one side to the other: will probably feel a difference in movement if its positive on one side

Direction of force is towards sacrum and back

Positive finding: reproduction of pain

89
Q

Hamstring SLR

A

Look for symmetry between sides

90
Q

Hip Flexors: Thomas Test

A

Hip flexors
–Sit at edge of table and table up to buttocks and upper thigh and lie back down.

–Take both knees to their chest.
Person holds their R knee, bring the left leg down and see if it can make contact with the table.

1–If it doesn’t come down: there is tightness in the ILLIOPSOAS

2–Now we straighten the knee. If the extended knee is able to drop down then we know there is tightness in the RECTUS FEMORIS because there is now less stretch on the rectus femoris and so the hip was able to drop down when it is cancelled out. (If the hip stays up then it is only the illiopsoas that is tight.)

  1. If he abducts hip then tight TFL
91
Q

Rectus Femoris: Ely’s Test

A

Rectus femoris tightness

–Patient in supine and legs hang off the table. The good leg is flexed to the chest while the other leg hangs off the table. If the knee extends it is a sign of tightness in the rec fem.

(because flexion of the opposite leg rotates the pelvis posteriorly pulling the rectus femoris)

(some people do a prone knee bend test)

rectus vs psoas

92
Q

TFL: Ober’s Test

A

–Patient lays on their side and flexes the bottom leg for stability: Abduct and extend the upper leg with knee flexed to 90, Stabilize pelvis from anteriorly tilting, Slowly lower the upper limb.

Cradle leg that you’re testing, abduct and extend bring it back to a neutral position or slightly extended. Want to see that person goes further than neutral position.

—Positive: TFL tight if they do not adduct to neutral or if drift into hip flexion when you do it.

93
Q

Piriformis Length

A

Large insertion/attachment onto sacrum big player in sacral alignment
Relationship with sciatic nerve it is a causative factor for buttock and leg pain

Option 1: (AIF Test= adduction, IR, flexion)
Supine: flex hip 90 degrees, with combined adduction and internal rotation
–>Normal: at 90 degrees hip flexion expect: 20 degrees adduction; 20 degrees internal rotation

Option 2:
Prone: knee flexion 90 degrees, bilateral internal rotation
Note symmetry of IR, pay attention to what happens to sacral alignment as you allow the legs to come out

גב (9 decks)

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