Sacrum, SI, Pelvis

Question 1

What is the common pain pattern for sacroiliac joint (SIJ) pain?

Answer 1

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

Question 2

What are some causes of pelvic pain that can refer to the groin or thigh?

Answer 2

Musculoskeletal, neuromuscular, gynecological, infectious, vascular, cancer, or gastrointestinal causes.

Question 3

What are the red flags when screening for sacral or pelvic pathology?

Answer 3

• insidious onset
• lack of objective findings
• no definitive MOI

Question 4

What is the sacroiliac joint (SIJ) pain pattern in standing vs. sitting?

Answer 4

• Unilateral pain with standing after sitting suggests SIJ
• Central pain is likely discogenic.

Question 5

Sacral fracture should be considered when…

Clinical presentation = ?

Answer 5

• Pain on palpation
• Antalgic gait
• LLD

Question 6

What are constitutional symptoms to watch for in systemic pelvic disorders?

Answer 6

• fatigue
• weight loss
• night sweats
• fever

Question 7

What are red flags for reproductive system-related pelvic pain?

Answer 7

History of reproductive, colon, or breast cancer, endometriosis, or trauma.

Question 8

What are the most common causes of pelvic pain in descending order?

Answer 8

• MSK
• neuromuscular
• gynecological
• infectious
• vascular
• cancer

Question 9

How does musculoskeletal pelvic pain typically present?

Answer 9

Pelvic pain of MSK origin may be referred from the hip, sacrum, SI joint, or lumbar spine.

Question 10

What are key characteristics of pelvic pain from endometriosis?

Answer 10

Pain worsens with hormonal fluctuations, resolves after menstruation, and can refer to the low back and coccyx.

Question 11

What systemic causes should be screened for in cases of pelvic pain?

Answer 11

Screen for GI, reproductive, and urogenital systems.

Question 12

What are signs of a stress fracture in the anterior pelvis?

Answer 12

Stress fractures present with localized anterior pelvic pain, especially in endurance athletes.

Question 13

What is the typical pain pattern for sacroiliac joint dysfunction?

Answer 13

Pain is experienced over the posterior SI joint and buttock, with or without lower extremity pain.

Question 14

What are common aggravating factors for sacroiliac joint pain?

Answer 14

Worse with sitting, lying, weight-bearing on the affected side, prolonged driving, Valsalva, or trunk flexion.

Question 15

What pain pattern is suggestive of discogenic pain rather than SIJ pain?

Answer 15

Central pain with Valsalva or trunk flexion suggests discogenic origin.

Question 16

What are common signs of coccyx pain (coccydynia)?

Answer 16

Localized tailbone pain, worse with sitting, sit-to-stand, or bowel movements.

Question 17

What are the signs of pelvic pain from neuromuscular causes?

Answer 17

Pain is worse with exercise, weight-bearing, and trunk rotation.

Question 18

What conditions are associated with sacroiliac pain and psoriatic arthritis?

Answer 18

Psoriatic arthritis often presents with skin lesions and joint pain.

Question 19

What are key signs of ankylosing spondylitis with SIJ pain?

Answer 19

Morning stiffness, pain that improves with activity, and restricted spinal mobility.

Question 20

What inflammatory condition often presents with a triad of symptoms including arthritis and urethritis?

Answer 20

Reactive arthritis often presents with arthritis, non-specific urethritis, and conjunctivitis.

Question 21

What systemic condition is linked with sacroiliac pain and a skin rash?

Answer 21

Crohn’s disease often presents with skin rashes and joint pain.

Question 22

What are key signs of pelvic pain from Crohn’s disease?

Answer 22

Moderate to severe LLQ and L pelvic pain concurrent with bowel symptoms.

Question 23

What are the risk factors for sacral fractures?

Answer 23

Female, endurance athlete, prolonged corticosteroid use, trauma.

Question 24

What are typical signs of a metabolic bone disease-related sacral fracture?

Answer 24

Pain on palpation, antalgic gait, leg length discrepancy > 10mm.

Question 25

What red flag is associated with a new onset of sacral pain following multi-level L/S fusion?

Answer 25

Insufficiency fracture should be suspected.

Question 26

What are clinical signs of sacral fractures?

Answer 26

Hip, low back, groin, and buttock pain with antalgic gait.

Question 27

What cancers commonly metastasize to the sacrum?

Answer 27

Breast, lung, colon, and prostate cancers are common sources of metastasis to the sacrum.

Question 28

What systemic signs indicate potential GI involvement with pelvic pain?

Answer 28

GI pain increases with coughing, sneezing, or lifting; associated with changes in bowel patterns.

Question 29

What symptoms suggest the presence of a pelvic neoplasm?

Answer 29

Persistent pelvic pain not relieved by PT, accompanied by unexplained weight loss or fatigue.

Question 30

What are the red flags for ovarian cancer presenting as pelvic pain?

Answer 30

History of nulliparity, BMI > 30, family history, and pelvic pain that mimics renal back pain.

Question 31

What symptoms are linked to cervical cancer causing pelvic pain?

Answer 31

Late-stage symptoms may include hemiparesis and headache.

Question 32

What are common signs of bladder/urethral involvement in pelvic pain?

Answer 32

Painful urination and changes in bladder function, associated with pelvic pain.

Question 33

What are common signs of rectal or bladder lesions causing coccydynia?

Answer 33

Coccydynia accompanied by deep pelvic pain and unexplained bladder issues.

Question 34

What is the typical presentation of pain from appendicitis in pelvic disorders?

Answer 34

RLQ pain, rebound tenderness (Blumberg’s sign), and possible McBurney’s point tenderness.

Question 35

What signs suggest endometrial cancer as a cause of pelvic pain?

Answer 35

History of estrogen-related risk factors, pelvic pain, and unexplained weight loss.

Question 36

What are red flags for sacral tumors as a cause of SIJ pain?

Answer 36

Red flags include unexplained weight loss, fatigue, and recent history of cancer.

Question 37

What are signs of a sacral fracture that mimic sciatica or LBP?

Answer 37

Pain may resemble sciatica or low back pain, often following a trauma or injury.

Question 38

What reported symptoms would make you think patient’s pelvic pain is GI related?

Answer 38

• Worse with increased intra-abdominal pressure
• GI symptoms
• Positive McBurney’s point
• Rebound tenderness (Blumberg’s sign)