Sacrum, SI, Pelvis Flashcards
What is the common pain pattern for sacroiliac joint (SIJ) pain?
Pain is usually over the posterior SI joint and buttock.
- may be unilateral or bilateral
- can refer to lumbar spine, abdomen, groin, thigh, foot, and ankle
- Rarely midline or above L5
What are some causes of pelvic pain that can refer to the groin or thigh?
Musculoskeletal, neuromuscular, gynecological, infectious, vascular, cancer, or gastrointestinal causes.
What are the red flags when screening for sacral or pelvic pathology?
- insidious onset
- lack of objective findings
- no definitive MOI
What is the sacroiliac joint (SIJ) pain pattern in standing vs. sitting?
- Unilateral pain with standing after sitting suggests SIJ
- Central pain is likely discogenic.
Sacral fracture should be considered when…
Clinical presentation = ?
- Pain on palpation
- Antalgic gait
- LLD
What are constitutional symptoms to watch for in systemic pelvic disorders?
- fatigue
- weight loss
- night sweats
- fever
What are red flags for reproductive system-related pelvic pain?
History of reproductive, colon, or breast cancer, endometriosis, or trauma.
What are the most common causes of pelvic pain in descending order?
- MSK
- neuromuscular
- gynecological
- infectious
- vascular
- cancer
How does musculoskeletal pelvic pain typically present?
Pelvic pain of MSK origin may be referred from the hip, sacrum, SI joint, or lumbar spine.
What are key characteristics of pelvic pain from endometriosis?
Pain worsens with hormonal fluctuations, resolves after menstruation, and can refer to the low back and coccyx.
What systemic causes should be screened for in cases of pelvic pain?
Screen for GI, reproductive, and urogenital systems.
What are signs of a stress fracture in the anterior pelvis?
Stress fractures present with localized anterior pelvic pain, especially in endurance athletes.
What is the typical pain pattern for sacroiliac joint dysfunction?
Pain is experienced over the posterior SI joint and buttock, with or without lower extremity pain.
What are common aggravating factors for sacroiliac joint pain?
Worse with sitting, lying, weight-bearing on the affected side, prolonged driving, Valsalva, or trunk flexion.
What pain pattern is suggestive of discogenic pain rather than SIJ pain?
Central pain with Valsalva or trunk flexion suggests discogenic origin.
What are common signs of coccyx pain (coccydynia)?
Localized tailbone pain, worse with sitting, sit-to-stand, or bowel movements.
What are the signs of pelvic pain from neuromuscular causes?
Pain is worse with exercise, weight-bearing, and trunk rotation.
What conditions are associated with sacroiliac pain and psoriatic arthritis?
Psoriatic arthritis often presents with skin lesions and joint pain.
What are key signs of ankylosing spondylitis with SIJ pain?
Morning stiffness, pain that improves with activity, and restricted spinal mobility.
What inflammatory condition often presents with a triad of symptoms including arthritis and urethritis?
Reactive arthritis often presents with arthritis, non-specific urethritis, and conjunctivitis.
What systemic condition is linked with sacroiliac pain and a skin rash?
Crohn’s disease often presents with skin rashes and joint pain.
What are key signs of pelvic pain from Crohn’s disease?
Moderate to severe LLQ and L pelvic pain concurrent with bowel symptoms.
What are the risk factors for sacral fractures?
Female, endurance athlete, prolonged corticosteroid use, trauma.
What are typical signs of a metabolic bone disease-related sacral fracture?
Pain on palpation, antalgic gait, leg length discrepancy > 10mm.
What red flag is associated with a new onset of sacral pain following multi-level L/S fusion?
Insufficiency fracture should be suspected.
What are clinical signs of sacral fractures?
Hip, low back, groin, and buttock pain with antalgic gait.
What cancers commonly metastasize to the sacrum?
Breast, lung, colon, and prostate cancers are common sources of metastasis to the sacrum.
What systemic signs indicate potential GI involvement with pelvic pain?
GI pain increases with coughing, sneezing, or lifting; associated with changes in bowel patterns.
What symptoms suggest the presence of a pelvic neoplasm?
Persistent pelvic pain not relieved by PT, accompanied by unexplained weight loss or fatigue.
What are the red flags for ovarian cancer presenting as pelvic pain?
History of nulliparity, BMI > 30, family history, and pelvic pain that mimics renal back pain.
What symptoms are linked to cervical cancer causing pelvic pain?
Late-stage symptoms may include hemiparesis and headache.
What are common signs of bladder/urethral involvement in pelvic pain?
Painful urination and changes in bladder function, associated with pelvic pain.
What are common signs of rectal or bladder lesions causing coccydynia?
Coccydynia accompanied by deep pelvic pain and unexplained bladder issues.
What is the typical presentation of pain from appendicitis in pelvic disorders?
RLQ pain, rebound tenderness (Blumberg’s sign), and possible McBurney’s point tenderness.
What signs suggest endometrial cancer as a cause of pelvic pain?
History of estrogen-related risk factors, pelvic pain, and unexplained weight loss.
What are red flags for sacral tumors as a cause of SIJ pain?
Red flags include unexplained weight loss, fatigue, and recent history of cancer.
What are signs of a sacral fracture that mimic sciatica or LBP?
Pain may resemble sciatica or low back pain, often following a trauma or injury.
What reported symptoms would make you think patient’s pelvic pain is GI related?
- Worse with increased intra-abdominal pressure
- GI symptoms
- Positive McBurney’s point
- Rebound tenderness (Blumberg’s sign)
