Sacrum Flashcards
Instrumentation break for a posteriorly rotated sacrum?
S1 or S2
Fixation finding for a posteriorly rotated sacrum?
On the side of the posterior rotation (P-L, PI-L, P-R, PI-R)
Where is the point tenderness for a posteriorly rotated sacrum?
S1 and/or S2 tubercles
Where is the spongy edema for a posteriorly rotated sacrum?
Posterior superior margin of the SI joint
Where is the prominence that suggests a posteriorly rotated sacrum?
Lateral inferior angle of sacrum
Which side of the ilium is the posteriorly rotated sacrum usually on?
IN or AS
What is the chief complaint in a patient with a BP?
Pain across the lumbosacral junction
Where is the instrumentation break for a BP?
Lower 1/3 of the L5 spinous
Where is the fixation for a BP?
L5
Where is the edema for a BP?
Between L5 and S1
Where is the tenderness for a BP?
Over S1 and S2
Where are sudoriferous changes notes for a BP?
Over L5 and S1
What test relieves the BP sacrum?
Sacral compression test- it may be closing the L5 posterior open disc wedge (flexion malposition)
What test aggravates the BP sacrum?
Sacral distraction test- it is increasing the L5 posterior open disc wedge even more (flexion malposition)
Is L5 in a flexion or extension malposition on the sacral base in a BP?
Flexion
What angle defines a BP?
Less than 36 degrees (0-35)
What radius defines a BP?
More than 24 cm (25+)= hypolordosis
Where does the gravitation stress line fall to suggest hypolordosis of the lumbar spine?
Posterior to the anterior 1/3 of sacral base
With a BP will the sacral base George’s line be anterior or posterior to the L5 George’s line?
Sacral base line will be posterior to L5 line
What is the normal range for sacral base angle?
36-45 degrees
What is the normal range for the lumbar radius?
19-24 cm
LOC for a spondy?
P-A through the L5 disc
TP for a spondy?
S-I
SCP for a spondy?
S2 tubercle
Should you use a drop for a spondy?
NO
What is the chief complaint in a patient with an Apex posterior (AP) sacrum?
Lumbosacral pain due to L5-S1 facet syndrome
Where is the instrumentation break for an AP sacrum?
Lower 1/3 of L5
Where is the fixation for an AP sacrum?
L5
Where is the edema for an AP sacrum?
Between L5-S1
Where is the tenderness for an AP sacrum?
L5 spinous
Where are the sudoriferous changes for an AP?
Over L5 and S1
A positive Kemp’s test may be indicative of what?
Facet syndrome- AP sacrum
What test relieves the AP sacrum?
Sacral distraction test- opens the jammed facets between L5 and S1
What test aggravates the AP sacrum?
Sacral compression test- further jams the L5 and S1 facets
Is L5 in a flexion or extension malposition on the sacral base in an AP?
Extension
What is the sacral base angle seen with an AP?
> 45 degrees
What is the radius seen with an AP?
Normal range for sacral base?
36-45 degrees
A decreased radius is indicative of what?
Hyperlordosis– AP sacrum
An increased radius is indicative of what?
Hypolordosis– BP sacrum
In an AP is the gravitational stress line anterior or posterior to the anterior tip of the sacral base?
Anterior to the anterior tip of sacral base– hyperlordosis– anterior weight bearing
What constitutes a positive McNabb’s line? What misalignment is it seen with?
McNabb’s line is drawn across the inferior plate line of L5- a positive is present when the tip of S1 superior facet is visible above the L5 McNabb’s line
What is it termed when there is vertical stenosis of L5-S1 seen with an AP?
“Facet imbrication”
Any disc angle >15 degrees is a sign of what?
Severe facet syndrome
What is the LOC for an AP?
S-I, P-A arcing thrust
Where is the pain for a coccyx misalignment?
Lumbosacral or SI pain
Moderate to severe pain over sacrococcygeal articulations
What aggravates a coccyx misalignment?
Valsalva maneuver
Sitting
Rising from sitting
Defecation
How does coccyx appear on the lateral with a CAR/CAL?
Apex anteriority
How does coccyx appear on the AP lumbopelvic?
Base inferiority relative to the sacral apex above (open wedge on that side)
An instrumentation break at S1 or S2?
Posteriorly rotated sacrum
An instrumentation break at lower 1/3 of L5?
BP
AP
Tenderness over S1 and/or S2?
Posteriorly rotated sacrum
BP
Edema between L5 and S1?
BP
AP
Edema at posterior superior aspect of SI?
Posteriorly rotated sacrum
Tenderness over L5?
AP
