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OS II Exam 1 > Sacrum > Flashcards

Sacrum Flashcards

1
Q

What common complaints require evaluation of the sacrum

A 
Abdominal pain
Pelvic pain
Dysmenorrhea
Lower back pain
Urinary tract complaints
Lower GI issues
Neuralgia of lower extremities
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2
Q

Anterior sacral landmarks

A

Sacral base
Sacral promontory
Sacral apex

Sacral ala
Coccyx
Anterior sacral foramen
Pelvic brim landmark
Transverse lines
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3
Q

Posterior sacral landmarks

A

Coccyx
Inferior lateral angle

Superior articular facets
Sacral canal
Auricular surface
Posterior sacral foramina
Sacral hiatus
Sacral tuberosities
Spinous tubercles
Sacral cornu
Intermediate sacral crest
Median sacral crest
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4
Q

Lowest portion of spinal column composed of 4 vertebra that are sometimes fused

A

Coccyx

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5
Q

The sacrum is formed by the union of ____ modified vertebra from 35 ossification centers as well as additional centers for ______ elements which develop within a cartilaginous model along with the vertebral arch and centrum

There are two _____ _____ for each lateral surface which separate adjacent segments and fuse sequentially after puberty with the lowest segments first

A

Five; costal

Epiphyseal plates

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6
Q

The dura attaches at the level of the ____ sacral segment

A

Second

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7
Q

Bony articulations of the sacrum

A

Fifth lumbar vertebra superiorly
Coccyx inferiorly
Two os coxae through C shaped SI articulations

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8
Q

Sacral joints AP

A

Right SI joint
Left SI joint
L5-S1 intervertebral disc
Sacrococcygeal joint

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9
Q

SI joint characteristics in males vs. females aftery puberty

A

Males: SIJ ligaments well developed and strong

Females: SIJ ligaments less developed, allowing mobility required during childbirth

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10
Q

SI joint characteristics in the second decade of life

A

Crescent shaped ridge develops along iliac surface that interdigitates with a depression on the sacral side, which adds stability and limits mobility

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11
Q

SI joint characteristics in the 3rd decade of life, particularly in males

A

Crescent shaped ridge becomes more pronounced decreasing ROM

Males: degenerative changes may begin to occur on the iliac side

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12
Q

SI joint characteristics in 4th and 5th devades of life, particularly in males

A

Males: degenerative changes begin on the sacral side

Fibrous ankylosis may further limit joint motion

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13
Q

SI joint characteristics of sacral surface vs. iliac surface

A

Sacral surface: generally smooth, hyaline cartilage, decreases in width inferior and is consequently wedged between 2 ilia

Iliac surface: anteriorly smooth, posteriorly fibrous, giving rise to the interosseous ligaments, fibrocartilage

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14
Q

The SI joint is described as either L or C shaped; contoured with a ______ upper arm and a ______lower arm, with a junction occurring at approximately ____

The apex points _____

A

Shorter; longer; S2

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15
Q

The SI joint is considered to be _____ bc it contains synovial fluid and matching articular surfaces

A

Diarthrodial

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16
Q

What makes the SI joint different from any other joint in the body?

A

One side is hyaline cartilage and the other is fibrocartilage

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17
Q

What ligament has inferior fibers from the third and fourth sacral segments ascending to the PSIS and posterior end of the internal lip of the iliac crest?

A

Posterior sacroiliac ligament

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18
Q

The posterior sacroiliac ligament blends with the _____ and the ____ fascia

A

STL; thoracolumbar

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19
Q

Which is thicker, anterior or posterior SI ligaments?

A

Posterior

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20
Q

What ligament connects the third sacral segment to the lateral side of the preauricular sulcus?

A

Anterior SI ligament

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21
Q

The anterior sacroiliac ligament blends with what other ligament?

A

Iliolumbar ligament

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22
Q

What ligament forms the major bond between the sacrum and ilium, filling the irregular space posterosuperior to the joint?

A

Interosseous sacroiliac ligament

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23
Q

What covers the interosseous sacroiliac ligament posteriorly?

A

Posterior SI ligament

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24
Q

What ligament connects the PSIS to the lateral aspect of the third and fourth sacral segments?

A

Long dorsal SI ligament

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25
Q

The long dorsal SI ligament is in close anatomic relationship with what 3 structures?

A

Erector spinae mm group

Posterior layer of thoracolumbar fascia

Sacrotuberous ligament

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26
Q

What effect does nutation have on the STLs and sacrospinous ligaments?

A

Stretches them

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27
Q

What ligament is stretched in counternutation, such as early stages of pregnancy, aging, or backward torsions or sacral extensions?

A

Long dorsal SI ligament

28
Q

What ligaments are stretched by nutation?

A

STLs

Sacrospinous

29
Q

What small muscle runs and blends with the STL and sacrospinous ligaments?

A

Coccygeus m

30
Q

What ligament extends from ischial spine to lateral margins of the sacrum where it blends with the sacrotuberous ligament and forms part of the origin of the coccygeus m?

A

Sacrospinous L

31
Q

What ligament runs from lower sacral tubercles to ischial tuberosity and forms part of gluteus maximus attachement, tendon of biceps femoris attachment, and connects with the fascia of the pelvis?

A

STL

32
Q

What ligaments stabilize to limit posterior-superior rotation of the sacral apex around a transverse axis?

A

Sacrospinous

Sacrotuberous

33
Q

Origin/insertion/innervation/action of piriformis m

A

Origin from anterior surface of 2-3-4 lateral masses of the sacrum and sacrotuberous ligament

Insertion upon superior border of greater trochanter

Innervation: ventral rami of 1 and 2 sacral plexus

Action: externally rotates thigh when hip joint is extended; abducts thigh when hip joint is flexed; assists in holding femoral head in acetabulum

34
Q

Hypertonicity of the piriformis may lead to what condition?

A

Sciatica

35
Q

What muscles make up the pelvic diaphragm?

A

Levator ani (puborectalis, pubococcygeus, ileococcygeus)

Obturator internus

Ischiococcygeus

Piriformis

36
Q

What 3 plexuses are associated with the sacrum?

A

Lumbar plexus L1-4

Sacral plexus L5-S4

Coccygeal plexus S5-coccygeal n

37
Q

What 3 ganglia are important in innervation surrounding the sacrum?

A

Inferior mesenteric ganglion

Superior hypogastric ganglion

Ganglion impar

38
Q

What is the significance of the ganglion impar?

A

It joins the 2 sides of ganglia along the sacrum at the apex

39
Q

The self-locking mechanism of the sacrum is critical for resistance against ______, the result of:

______ = the specific properties of the articular surfaces of the SIJ requiring the proper size, shape, and attitude of the articulating surfaces

______ = the compression produced by body weight, muscle action, and ligament force

A

Shear

Form closure

Force closure

40
Q

____ closure is due to how the joint fits together

____ closure is due to gravity and loading forces - muscles, fascia, and ligaments

A

Form

Force

41
Q

How are the 2 oblique axes of sacral motion named?

A

According to the side of the body toward which the superior end of the oblique axis is located

42
Q

What are the 3 transverse axes of motion associated with the sacrum?

A

ST (respiratory) axis - level of S2

MT (postural) axis - level of S2

IT (pelvic/ilial) axis - level of S3

43
Q

Describe movement of the sacrum (including base vs. apex) in counternutation

A

Sacral extension

Base moves posteriorly

Apex moves anteriorly

44
Q

Describe movement of the sacrum (including base vs. apex) in nutation

A

Sacral flexion

Base moves anterior

Apex moves posterior

45
Q

All movements of the sacrum on the ilium are _____ movements including flexion, extension, rotation, SB, and upward/downward motion

A

Gliding

46
Q

Downward force transmitted from the lumbar region glides the sacrum downward and causes ________

Traction applied from above the LS junction glides the sacrum upwards and causes _____

A

Nutation

Counternutation

47
Q

Rotation applied through the lumbar spine causes the sacrum to rotate toward the _____ side and sidebends towards the ____ side

A

Ipsilateral; contralateral

48
Q

Sidebending applied through the lumbar spine causes the sacrum to sidebend towards the ______ side…but rotation during sidebending may be inconsistent

A

Ipsilateral

49
Q

T/F: flexion/extension and gliding upward/downward ROM is less than rotation or sidebending

A

False; greater than rotation or sidebending

50
Q

T/F the ilium always moves in the same direction as the sacrum but to a lesser degree

A

True

51
Q

A restricted inferior occipital condylar part is related to what dysfunction of the sacrum?

A

Lowered sacral base on that side

52
Q

_____ = a transitional segment in which the first sacral segment becomes like an additional lumbar vertebra articulating with the second sacral segment

A

Lumbralization

53
Q

______ = incomplete separation and differentiation of the fifth lumbar vertebra such that it takes on characteristics of a sacral vertebra

OR when transverse proces of the fifth lumbar vertebra are atypically large, causing pseudoarthritis with the sacrum and/or ilia referred to as a batwing deformity if bilateral

A

Sacralization

54
Q

Static testing methods for sacrum

A

Sacral sulcus
L5 rotation
ILA
4 point eval

55
Q

Active motion testing of the sacrum

A

Backward bending test

Respiratory motion test

56
Q

Passive motion testing of the sacrum

A

Lumbosacral spring test

4 point PROM

Oblique axis passive motion

57
Q

In a torsion, the lateralization test will be _____ on the opposite side of the axis

A

Positive

58
Q

The sacral base should move ____ during inhalation and _____ during exhalation

A

Posteriorly; anteriorly

59
Q

Innominate rotation occurs around what sacral axis?

A

Inferior transverse axis (S3)

60
Q

How should rotation of the sacrum relate to rotation of L5?

A

L5 rotates opposite the direction of the sacrum (if not rotated, it is uncompensated and should be tx before the sacral dysfunction)

61
Q

A flexed sacrum means a _____ L5; an extended sacrum means a _____ L5

A

Neutral (type 1); non-neutral (type 2)

62
Q

How does L5 sidebend in relation to an oblique axis of a torsion?

A

L5 sidebends toward the oblique axis of a torsion

63
Q

Which side of the SI joint should be gapped to facilitate flexion?

A

Anterior SI

64
Q

Which side of the SI joint should be gapped to facilitate extension?

A

Posterior

65
Q

For bilateral sacral flexion HVLA, on what respiratory cycle is thrust applied?

A

Inhalation

OS II Exam 1 (4 decks)

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