SI Joint Exam

Question 1

What are the ways the sacroiliac joint stabilizes itself/force closure

Answer 1

• self locking mechanism
• irregular surface
• ligamentous structures

Question 2

Self assessments for SI dysfunction

Answer 2

• Oswestry Disability Index (ODI)
• Patient Specific Functional Scale
• Fear Avoidance Beliefs Questionnaire (FABQ)
• Pain Catastrophizing Scale (PCS)

Question 3

Dynamic variations of the SI joint

Answer 3

• greater curves in spine
• sacral facets at greater angle
• sacrum more horizontal
• more stable SI

Question 4

Stable variations of the SI joint

Answer 4

• less curves in spine
• sacral facets at smaller angle
• sacrum more vertical
• more mobile SI

Question 5

Define nutation

Answer 5

• sacrum tilts anterior
• ilium tilts posterior

Question 6

Define counter-nutation

Answer 6

• sacrum tilts posterior
• ilium tilts anterior

Question 7

Symptoms of sacroiliac pain

Answer 7

• pain just inferior to PSIS 3 cm wide and 10 cm long
• typically pain is unilateral weight bearing & sit to stand transfers
• must rule out the lumbar spine

Question 8

Palpation and patient identification of pain

Answer 8

• sacral sulcus tenderness
• PSIS is main location of pain
• groin discomfort/pain

Question 9

Sacroiliac pain provocation tests

Answer 9

• 3 positives indicate SI dysfunction
• distraction
• thigh thrust
• Gaenslen
• sacral thrust
• compression

Question 10

Describe distraction

Answer 10

• patient supine
• push through patient’s ASIS

Question 11

Describe thigh thrust/P4

Answer 11

• patient supine
• knee at 90-90
• fixate sacrum against table with one hand
• push through patient’s knee

Question 12

Describe Gaenslen

Answer 12

• patient supine
• have patient hold one knee to chest and let the other leg hang off the side of the table
• push the leg that is off the table down

Question 13

Describe sacral thrust

Answer 13

• patient prone
• place hands on sacrum and push down towards the table

Question 14

Describe compression

Answer 14

• patient in side-lying
• find ASIS and come off of it slightly posterior and push towards table

Question 15

Tests used for treatment decisions

Answer 15

• Gillet test (standing hip flexion)
• Standing flexion test
• Supine long sit test
• Prone knee bend

Question 16

Describe Gillet test

Answer 16

• patient in standing with feet 12 inches apart
• palpate S2 and iliac spine
• have patient flex hip and knee on one side
• positive = no movement of PSIS in a posterior direction compared to S2

Question 17

Describe standing flexion test

Answer 17

• patient in standing
• palpate PSIS bilaterally
• patient forward flexes as far as possible
• positive for hypermobility if one PSIS moves further cranially

Question 18

Describe supine long sit

Answer 18

• patient in supine
• palpate medial malleoli & note leg length
• patient long sits
• note leg length
• positive if leg length changes

Question 19

What rotation causes a change in leg length

Answer 19

• posterior rotation causes functional leg lengthening when sitting but leg shortening when supine

Question 20

Describe prone knee bend

Answer 20

• patient in prone with knees extended
• assess leg length
• passively flex knees to 90 degrees
• assess leg length
• positive if leg length changes

Question 21

Manual treatment

Answer 21

• muscle energy techniques (anterior vs posterior rotation of innominate)
• prone anterior rotation manipulation
• sidelying posterior rotation manipulation
• supine SI manipulation

Question 22

Indications for SI manipulation

Answer 22

• FABQ work sub scale score <18
• duration of symptoms 15 days or less
• no symptoms distal to the knee
• lumbar spine hypomobility at any level
• either hip with greater than 35 degrees of internal rotation

Question 23

Describe SI manipulation technique

Answer 23

• maximally sideband patient ‘s trunk and LEs away from you
• without losing the sideband rotate the trunk towards you
• place one hand on the ASIS and the other on the scapula
• once the ASIS starts to elevate perform a smooth high-velocity, low-amplitude thrust in an anterior to posterior direction

Question 24

Exercise treatment for SI joint pain

Answer 24

• pelvic floor coordination
• hip and lumbar spine assessment