Screening Sacrum, SIJ, and Pelvis

Question 1

what is critical when someone tells you they are having sacral pain

Answer 1

a history

Question 2

what about a patient’s hx are you looking for if they have sacral pain

Answer 2

minor trauma in hx to r/i mechanical pain of pelvis

look for medical issues if not able to mechanically recreate pain

Question 3

how can lifting cause sacral pain

Answer 3

twisting

Question 4

what is the most common cause of SIJ pain

Answer 4

referred from back

Question 5

what are 4 ex of minor traumas that can cause sacral pain

Answer 5

trip off curb
fall
childbirth
lifting hx

Question 6

why is sacral pain more common in women than men

Answer 6

anatomy
hormones

leading to inc laxity of certain ligaments and joints

Question 7

what medical issues could explain sacral pain if not able to recreate pain (4)

Answer 7

cancer
gyn issues
rheumatic issues
large intestine issues

Question 8

what rheumatic issues could cause sacral pain (2)

Answer 8

anky spond- in men
reiters

Question 9

what large intestine issues could cause sacral pain (2)

Answer 9

crohns
IBS

Question 10

what medical dx are related to pelvic pain (5)

Answer 10

gyn
infection - pelv inflam dz (PID)
vascular
cancer
GI

Question 11

what types of sacral fx (3)

Answer 11

traumatic
insufficient
pathological

Question 12

what are risk factors for a traumatic sacral fx

Answer 12

younger:
- stress fx
- military
- overtraining
- volleyball
- running

older - falls

Question 13

what are risk factors for an insufficiency sacral fx (3)

Answer 13

radiation
osteoporosis
chronic steroid use

Question 14

why are osteoporosis and chronic steroid use risk factors for an insufficiency sacral fx

Answer 14

poor bone mineralization

Question 15

what is a risk factor for a pathologic sacral fx

Answer 15

cancer related

Question 16

describe the location of pain in a sacral fx and what is an aggravating factor

Answer 16

pain in lower back, buttocks, hips, front thigh and groin

worse w WBing - esp if acute fx

Question 17

what are 4 sx of a sacral fx

Answer 17

1. pain
2. bruising/swelling in sacral area
3. bowel/bladder conditions, sexual problems
4. resultant weakness in lower limbs d/t compression/swelling

Question 18

triage a suspected sacral fx

Answer 18

urgent imaging needed

Question 19

what are risk factors for reiter’s syndrome (2)

Answer 19

men 20-40yo
bacterial infection
- venereal dz or GI infeciton

Question 20

what are 3 sx of reiter’s syndrome

Answer 20

arthritis (LB or sacral pain)
conjunctivitis
urethritis

Question 21

what are 2 risk factors for ankylosing spondylitis

Answer 21

men <40yo, onset 20s
chronic prog inflam dz

Question 22

what are 5 sx of ankylosing spondylitis

Answer 22

SI stiffness
- prog to morning pain >1hr x3mo

fever
fatigue
loss of appetite
red eyes

Question 23

triage suspected reiter’s syndrome

Answer 23

PCP for blood tests and dx
- looking for genetic markers

Question 24

triage suspected ankylosing spondylitis

Answer 24

PCP for blood tests and dx
- looking for genetic markers

Question 25

what are the 7 most common causes of pelvic pain

Answer 25

MSK NM gyn infectious vascular cancer GI

Question 26

what current medical hx inc risk of pelvic pain (4)

Answer 26

IUD use - risk of infection bc foreign body peri or menopause STD pregnancy, parity/gravida

Question 27

what is parity

Answer 27

births

Question 28

what is gravida

Answer 28

pregnancy

Question 29

why do we care ab the amt of parity and gravida

Answer 29

some internal scarring from multiple gravida (pregnancies) but not parity (births) - also scarring from multiple parity (births)

Question 30

what are 8 risk factors from PMH that can lead to pelvic pain

Answer 30

1. reproductive, colon, or breast cancer 2. painful periods - dysmennorhea 3. STD 4. parity vs graivda 5. sexual assault 6. difficult labor (ie tearing of pelvic floor) 7. multiple births 8. varicose veins in LE

Question 31

what are 4 pelvic pain sx that indicate a NM/MS source

Answer 31

1. aggravated by exercise, WB 2. aggravated by trunk rotation 3. relieved by rest or stretching 4. resolution of sx w ms release techniques

Question 32

what are 5 possible causes of ant pelvic pain

Answer 32

1. associated w hip dysfunction 2. psoas abscess 3. stress fx - pubis, ilium 4. instability 5. femoral hernia

Question 33

what populations do you see a stress fx leading to ant pelvic pain in (3)

Answer 33

military runners volleyball

Question 34

what can cause instability leading to ant pelvic pain (3)? how can this be tested?

Answer 34

birth stress fx osteoporosis SLS inc sx

Question 35

where would a femoral hernia be located and what is a risk factor for this

Answer 35

lateral pelvic wall surgery

Question 36

what are 8 reasons for gynecologic pelvic pain (not NM or MSK in nature)

Answer 36

pregnancy multiparity complicated L&D rectocele cystocele endometrosis PID - infections pelvic congestion (vascular)

Question 37

rectocele vs cystocele

Answer 37

rectocele: men & women - bulging of ant wall of rectum - prolapsed rectum cystocele: women - bulging of ms wall b/w bladder and vaginal canal - prolapsed bladder

Question 38

what is endometriosis

Answer 38

uterine tissue outside uterus but w/i pelvic cavity

Question 39

how does endometriosis pain present

Answer 39

cyclical LBP and sacral pain - 1x a mo w period

Question 40

what is pelvic inflammatory dz (PID)

Answer 40

general term for pelvic infections bacterial infection of uterus - STD, childbirth - acute or chronic

Question 41

what is the majority of PIDs

Answer 41

2/3 are STDs - chlamydia or gonorrhea

Question 42

what is a big risk factor for PID

Answer 42

ectopic pregnancy

Question 43

what can PID lead to

Answer 43

scarring fertility issues

Question 44

what is pelvic congestion syndrome (PCS)

Answer 44

varicose veins of ovaries

Question 45

describe pain w PCS

Answer 45

worse w prolonged standing - better w rest

Question 46

what is PCS associated w for risk factors (2)

Answer 46

PVD kidney removal (donor or dz)

Question 47

what is the most common gyn cancer

Answer 47

endometrial - uterine

Question 48

what are 3 risk factors for endometrial - uterine cancer

Answer 48

women 50-70yo post-menopausal tamoxifen use (estrogen blocker used w breast cancer)

Question 49

what are 3 pelvic cancers

Answer 49

endometrial - uterine cervical ovarian

Question 50

what dx tool for cervical cancer

Answer 50

pap smear

Question 51

rank how common the pelvic cancers are

Answer 51

1. endometrial - uterine 2. ovarian 3. cervical

Question 52

what are 2 risk factors for cervical cancer

Answer 52

women 30-40yo HPV related

Question 53

prognosis for ovarian cancer

Answer 53

poor

Question 54

what are 5 risk factors for ovarian cancer

Answer 54

women 40-70yo no birth, birth >35yo family hx - BRCA1 or 2 genes early periods obesity (BMI>31)

Question 55

what are red flags for medical attention when screening the sacrum, SIJ, and pelvis (4)

Answer 55

fx infection cancer ectopic pregnancy - check for PID hx

Question 56

what are yellow flags for medical attention when screening the sacrum, SIJ, and pelvis (3)

Answer 56

pap smear - 21 yo bi annually if neg, annually if pos failure to respond to PT - and other constitutional sx cancer