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OS-II CPA 1 > Sacrum > Flashcards

Sacrum Flashcards

1
Q

What two locations of the sacrum are we feeling?

A
  1. Sacral sulci
  2. ILAs
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2
Q

Sacrum TART Eval

A

Palpate:

1. Quadratus lumborum

2. Erector Spinae m.

3. Piriformis m

4. Hamstrings

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3
Q

Posterior and ________ always occur together.

A

Inferior

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4
Q

Anterior and _______ always occur together.

A

Superior

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5
Q

What types of motion does the sacrum perform?

A
  1. Flexion: base moves anterior and apex moves posterior
  2. Extension: base moves posterior and apex moves anterior
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6
Q

What types of flexion SDs can the patient have?

A
  1. LSF (left sacral flexion)
  2. RSF (right sacral flexion)
  3. BSF (bilateral sacral flexion)
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7
Q

What types of extension SDs can the patient have?

A
  1. LSE (left sacral extension)
  2. RSE (right sacral extension)
  3. BSE (bilateral sacral extension)
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8
Q

What types of torsions can the patient have?

A

Two types: forward and backward

Foward:

  1. Right rotation on a R axis sacral torsion (R/R ST)
  2. Left rotation of a L axis sacral torision (L/L ST)

Backward

  1. Left rotation on a right axis sacral torsion (L/R ST)
  2. Right rotation on a left axis sacral torision (R/L ST)
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9
Q
  1. LSF (left sacral flexion)
  2. RSF (right sacral flexion)
  3. BSF (bilateral sacral flexion)

Describe what you would find.

A
  1. LSF= L sacral sulci is anterior; L ILA is posterior.
  2. RSF= R sacral sulci is anterior; R ILA is posterior.
  3. BSF= Sacral sulci: anterior; ILAs: posterior

For L/R; the opposite sides should be opposite.

Sacral sulci are anterior; ILA is posterior

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10
Q
  1. LSE (left sacral extension)
  2. RSE (right sacral extension)
  3. BSE (bilateral sacral extension)

Describe what you would see.

A
  1. LSE: L sacral sulci is posterior; L ILA is anterior
  2. RSE: R sacral sulci is posterior; R ILA is anterior
  3. BSE: both sacral sulci are posterior; both ILA are anterior

sacral sulci are posterior; ILAs are anterior.

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11
Q

Two types of torsion: forward and backward

Foward:

  1. Right rotation on a R axis sacral torsion(R/R ST)
  2. Left rotation of a L axis sacral torision (L/L ST)

Backward

  1. Left rotation on a right axis sacral torsion (L/R ST)
  2. Right rotation on a left axis sacral torision (R/L ST)

Describe what you would see.

A

FWDS:

  1. Right rotation on a R axis sacral torsion(R/R ST): L sacral sulci is anterior; R ILA is posteior
  2. Left rotation of a L axis sacral torision (L/L ST): R sacral sulci is anterior; L ILA is posterior.

BCKWARDS:

  1. Left rotation on a right axis sacral torsion (L/R ST): L sacral sulci is posterior; R ILA is posterior.
  2. Right rotation on a left axis sacral torision (R/L ST): R sacral sulci is posterior; L ILA is anterior
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12
Q

How do I diagnose?

A
  1. Conduct lateralization test (will tell you if a L/R sided problem): seated flexion test.
  2. Conduct: lumbar spring test, backward bending sphinx test, respiratory motion test (will tell if you if F/E)
  • Active (sphinx)
  • Passive (backward bending sphinx, respiratory motion test)
  1. 4-point static sacral eval will tell you exactly. what it is.
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13
Q

What laterization test do we perform?

A

Seated flexion test.

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14
Q

Seated flexion test

A
  1. Have pt seated with feet on floor.
  2. Doc is behind pt at eye level with PSIS.
  3. Put both thumbs on the patients PSIS and ask the pt to bend foward
  4. Look to see which goes superior more;
  • If R moves 1st -> + on right -> R-sided dysfunction
  • If L moves 1st -> + on L -> L sided dysfunction
  • If (-) -> no sacral dysfunction or pt has a bilateral dysfunction
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15
Q

What tests will tell us if it is a forward/backward (flexed/extended) SD?

A

1. Lumbar spring test

2. Backward bending sphinx test

3. Sacral mobility during respiration test

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16
Q

Lumbar Spring Test

A
  1. With patient laying prone, push down on the lumbrosacral junction several times.
  • Positive test: resistance to springing; sacrum is extended (likes to move posterior)
  • Negative test: ease of springing; sacrum is flexed (likes to move anterior)
17
Q

Backward bending sphinx test

A
  1. Patient lays down prone
  2. Put thumbs on the sacral sulci and note which one is deeper.
  3. Tell pt to get in TV watching position and see what thumbs do.
    • test: inequity between L/R increases; sacrum is sitting backwards (posteriorly) extended SD
      - test: sacral sulci even out; sacrum is sitting forward or anterior; pt has a flexed SD.
18
Q

Sacral Mobility During Respiration

A
    1. Cup the sacrum
    1. Push on it.
    1. Ask pt to breath deeply in and out.
    1. Follow with hands.
    1. Sacrum is extended if: it doesnt like to go forward when pt breathes out, but likes to go back when pt breathes in/
      * Sacrum is flexed if: it likes to drop when exhales but does not like to up when inhales.
19
Q

How do you decide which corner is the problem?

A

4 point sacral evaluation test

20
Q

4 point sacral evaluation test

A

Used to diagnose sacral torsion dysfunction

  1. Pt is on stomach
  2. Put 2 index fingers on the sacral sulcus
  3. Put 2 thumbs on the ILA.
  4. Apply pressure
21
Q

Unilateral Sacral Extended MET/ART

A

ON SIDE WITH THE PROBLEM:

  1. Pt is prone; Externally rotate and abduct the leg.
  2. Take palm, but it on part that is sticking out (if L extended, put palm on L sacral sulcus)
  3. ART: spring back and forth
  • MET: have patient breath in and out deeply;
    • Inhalation (breathe in)- resist
    • Exhalation (breathe out) - push
22
Q

Unilateral Sacral FLEXED MET/ART

A

ON SIDE OF DYSFUNCTION:

  1. Pt is prone; Internally rotate and abduct the leg
  2. Place palm on ILA that is sticking out (whatever side you have dysfunction on)
  3. ART: spring until motion improves

MET: have patient breathe deeply;

  • Inhalation (breathes in): push
  • Exhales (breathes out): resist
23
Q

Bilateral Extended Sacrum MET/ART

A
  1. Tell patient to get in TV watching position
  2. Abduct and externally rotate legs.
  3. Put hand over base of the sacrum
  4. Tell pt to breathe deeply in and out.
  5. ART: spring
  • MET:
    • When patient inhales, resist.
    • When patient exhales, push down.
    • Repeat 3-5 times or until no new barriers.
24
Q

Bilateral Flexion Sacrum MET/ART

A
  1. Pt. is prone
  2. Internally rotate and abduct both legs.
  3. Put hand in between ILAs
  4. Tell pt to breathe deeply in and out.
  5. ART: spring
  • MET:
    • When patient inhales, push.
    • When patient exhales, resist
    • Repeat 3-5 times or until no new barriers.
25
Q

Forward torsions MET or ART.

(L on L or R on R)

A
  1. Patients lays on side with axis side down.
  2. Pt puts chest toward the table
  3. Move BOTH thighs off the table at 90 degrees and monitor at S1.
  4. Drop BOTH legs off of the table
  5. ART: spring legs down
  • MET: push down while telling patient to push up for 3-5. seconds. relax for 1-2 seconds. go to next barrier and repeat 3-5 times.
    • RETURN THE PATIENT TO NEUTRAL.
    • FEET SHOULD NOT TOUCH THE FLOOR
26
Q

Backward sacral torsion

L on R

R on L

A
  1. Patients lays on side with axis side down.
  2. Pt puts back toward the table
  3. Move ONE thigh off the table at 90 degrees and monitor at S1.
  4. Drop ONE leg off of the table
  5. ART: spring legs down
  • MET: push down on knee while telling patient to push up for 3-5. seconds. relax for 1-2 seconds. go to next barrier and repeat 3-5 times.
  • RETURN THE PATIENT TO NEUTRAL.
  • DO NOT PUT FEET ON TABLE
27
Q

what do you see in

L unilateral flexion

R unilateral flexion

Bilateral unilateral flexion

A
28
Q

what do you see in

L unilateral extension

R unilateral extension

Bilateral unilateral extension

A
29
Q

What do you see in

Forward torsions

A
30
Q

What do you see in

backward torsions

A

OS-II CPA 1 (7 decks)

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