Sacrum Flashcards
Sign of the Buttock test
Position: supine
Test: a straight leg raise is performed passively by the examiner
Positive Findings: if the SLR is positive, the end-feel is usually spasm or capsular but definitely painful. passively flex the patient hip but this time with the ipsilateral knee flexed to end-range. assess for further hip flexion was achieved, if none, the pathology is within the hip or buttock and not the hamstrings or sciatic nerve.
To be positive is must have all of these present: restriction of SLF concurrently with limited hip flexion and a non-capsular pattern of restriction of hip joint ROM
Seated Flexion Test
Position: seated
Stabilization: Place thumbs on the undersurface of the PSIS of the seated pt. taking care to keep both thumbs horizontal
Force: ask pt. to bend forward into flexion with their feet on the floor and allow your thumbs to follow PSIS movement, taking care to maintain both thumbs underneath the PSIS
First and Furthest
Sacral Extension Test
Position: standing with weight equally distributed on both legs
Examiner: sits behind pt. and palpates both PSISs
Test: the pt. is asked to bend backwards while the examiner notes any asymmetry
Interpretation: PSISs fail to move posteriorly and inferiorly. during bending backwards the innominate bones and sacrum remain in the same position so there should be no change in relationship
Valsalva Test
Position: sitting or standing, hand forming a fist right in front of their mouth
Pressure: pt. takes a deep breath and blows air out into their hand as hard as they can.
Positive sign: pain upon forced exhale as pressure builds internally
Implications: Posterior pain along spine with radiating symptoms implies a herniated disc compressing a nerve. (anterior pain implies a hernia)
Babinski Test
Position: long-sitting with feet off the edge of the table
Pressure: drag pointed object from the heel towards the head of the fifth metatarsal, and then along the metatarsal heads to the first metatarsal.
Positive Sing: spreading of the toes and possibly pushing foot into pointed object as it runs along the foot
Implications: nerve dysfunction or CNS disorder
Standing Flexion Test (Sacral Flexion Test)
Position: Standing
Stabilization: place thumbs on the undersurface of the PSIS of the pt.
Force: ask pt. to bend forward into flexion with their leg straight and allow your thumbs to follow PSIS movement
Interpretation: a positive test if greater superior motion is felt on one PSIS compared to the other. the side of the last PSIS movement is the side of pelvis restriction.
Brudzinski-Kernig Test
Brudzinski - pt. lies supine and elevates the head from the table. when the head is lifted the pt. complains of neck and low back discomfort and attempts to relive the meningeal irritation by involuntarily flexion of the knees and hips
Positive sign: when the head is lifted the patient complains of neck and low back discomfort and attempts to flex knees and hips
Kernig - pt. lies supine with the hip and knee flexed to 90. The patient then extends the knee. if the pt. complains of pain in the lower back, neck or head on knee extension, it is suggestive of meningeal irritation. returning to knee flexion will relieve pain
Straight Leg Raise (Lasegue’s)
Position: supine
Fixation: examiner places hand on anterior thigh and hold foot-lift
Test: examiner passively raises the leg until symptoms are reproduced leg is then lowered to no pain, and examiner dorsiflexes the foot
Interpretation: if the patient experiences sciatic pain when the straight leg is at an angle of between 30 and 70 degrees the the test is positive and a herniated disc is likely to be the cause of the pain.
Slump Test
Position: seated
Test: Patient is seated upright with hands held together behind his/her back. the examiner instructs the patient to flex/slump followed by neck flexion. the examiner then places their hand on top of the head and has the patient perform knee extension and dorsiflex the foot.
Pressure: apply overpressure to head
Interpretation: test is considered positive if symptoms are increased in the slumped position and decreased as the patient moves out of neck flexion
Bowstring (Cram) Test
Position: supine
Force: examiner carries out a SLR and pain results. While maintaining the thigh in the same position the examiner flexes the knee slightly 20 degrees reducing symptoms. thumb or finger pressure is then applied to the popliteal area to reestablish the painful radicular symptoms.
Positive Findings: pain results from pressure or tension on the sciatic nerve
Gillet Test
Position: stands, examiner palpates the PSIS bilaterally
Force: Subject flexes one hip and brings knee to chest while the examiner maintains palpation to each PSIS and Assesses overall SI movement
Findings: if the PSIS on the ipsilateral side of the knee being flexed does not move or moves minimally in the inferior direction
SI joint stress Test 1
Position: supine
Action: the examiner applies outward and downward pressure with the heel of the hands. examiner has hands crossed
Positive finding: unilateral pain at the SI joint or in the gluteal or leg region indicates anterior SI ligament sprain. joint compression
SI joint stress test 2
Position: sidelying
Action: examiner applies downward pressure. one hand over the other on iliac crest
Positive finding: increase pain or pressure is indicative of SI joint pathology possibly involving the posterior SI ligaments. distraction or gapping
SI joint stress test 3
position: supine. examiner places both hands on the lateral aspect of the subjects iliac crests
Action: examiner applies an inward and downward pressure
Positive finding: increased pain or pressure is indicative of SI joint pathology, possibly involving the posterior SI ligaments. distraction or gapping.
SI joint stress test 4
position: prone. examiner places both hand one on top of the other over the subjects sacrum
Action: examiner applies downward pressure, creating a shear of the sacrum on the ilium
Positive finding: pain at the SI joint is indicative of pathology that could be SI joint compression
