Screening for Sacrum, Pelvis, SI

Question 1

For patients with sacral pain what is most important factor to rule in mechanical pain?

Answer 1

needs to be some sort of trauma like MVA, fall, childbirth bc the sacrum is a very stable joint so little things won’t cause a big problem

Question 2

What are two common sacral issues in males?

Answer 2

Reiters and Ankylosing Spon.

Question 3

What are characteristics of Reiter’s?

Answer 3

can’t pee, can’t see can’t climb a tree

20-40 y/o from some type of infection

Question 4

What are characteristics of Anky spon?

Answer 4

men under 40 with Sacral pain with no hx of trauma you should suspect AS

also fever, morning stiffness, fatigue

Question 5

What are the three types of sacral fx?

Answer 5

1. traumatic- MVA,stress fx
2. insufficiency - osteopo, radiation, steriods
3. pathologic- cancer

Question 6

What is coccygodynia?

Answer 6

coccyx main almost always caused by trauma or child birth, present with 10/10 pain

tx- manip can reset coccyx

Question 7

How can you DD for coccygodynia?

Answer 7

if pain persists after manip longer than 2-3 sessions probably medical and refer out

Question 8

What are the two different regions for pelvic pain?

Answer 8

1. anterior- rectus, trasverse, obliques

2. lateral- iliopsoas, obturator, levator ani (pelvic floor)

Question 9

What is the Kegel procedure post birth for women?

Answer 9

10 sec hold, 10 sec rest repeat 10 reps several times a day to train ms for endurance

Question 10

What are risk factors for medical level pain?

Answer 10

IUD use, menopause, STD, pregnancy

Question 11

What hx should lead you to think of pelvic problems?

Answer 11

colon or breast CA, painful periods, STD, parity vs gravida, sexual assault, difficult labor, multiple births, varicose veins

Question 12

How can you tell if pelvic pain is MS?

Answer 12

aggravated by exercise, trunk rotation, lifting objects, relieved by stretching,

Question 13

What are different issues causing anterior pelvic pain?

Answer 13

1. psoas abcess- recent ab surgery
2. stress fx- runner, volleyball
3. instability - SLS will increase sx
4. femoral hernia- finger will sink in

Question 14

What are reasons for posterior pelvic pain?

Answer 14

1. associated lumbar or sacral dysfunction
2. proximal HS injury
3. levator ani syndrome- usually with GI issues

Question 15

What are gynecological reasons for pelvic pain?

Answer 15

pregnancy, multiple births, complicated labor, endometrosis, PID, pelvic congestion

Question 16

What is rectocele and cystocele?

Answer 16

recto- bulging of anterior wall of the rectum -can lead to fecal incontinence

cysto- bulging of mm wall between bladder and vaginal canal- urinary incontinence (females only)

Question 17

What are signs and symptoms of endometriosis?

Answer 17

LBP, pelvic pain and is usually cyclical with menstrual cycle

Question 18

What is PID?

Answer 18

pelvic inflammatory disease, general term for pelvic infections

Question 19

What are examples of bacterial infections of the uterus?

Answer 19

STD (2/3 of PID), childbirth, acute or chronic

Question 20

What are most common STD associated with PID?

Answer 20

chlamydia and gonorrhea

Question 21

What can PID lead to?

Answer 21

ectopic pregnancy which is a MED EMERGENCY- any pt with history of PID and pelvic pain should be sent immediately

Question 22

What is pelvic congestion syndrome?

Answer 22

varicose veins of pelvis

pain worse with prolonged standing, better with rest

Question 23

What are 3 most common cancers associated with pelvic pain?

Answer 23

1. endometrial (most common)
2. ovarian
3. cervical

Question 24

What are characteristics of endometrial?

Answer 24

women 50-70, postmenopausal, associated with tamoxifen (breast cancer med)

Question 25

What are characteristics of ovarian cancer?

Answer 25

poor prognosis due to hard to screen, women 40-70, no births or births over 35, early periods, obesity BMI over 30

Question 26

What are characteristics of cervical cancer?

Answer 26

women 30-40 screened with papsmere, HPV related

Question 27

What can be a missed cause of pelvic pain?

Answer 27

psychogenic origin if history of sexual abuse

ask questions about anxiety

Question 28

What is a red flag for sacral etc?

Answer 28

is you suspect a fx, cancer, ectopic pregnancy with PID

Question 29

What is a yellow flag for sacral etc?

Answer 29

failure to respond to PT, cancer

Question 30

When should a girl have a papsmere?

Answer 30

start at 21 and have bi annually if negative, annually if positive