SI Joint Exam Flashcards
1
Q
What are the ways the sacroiliac joint stabilizes itself/force closure
A
- self locking mechanism
- irregular surface
- ligamentous structures
2
Q
Self assessments for SI dysfunction
A
- Oswestry Disability Index (ODI)
- Patient Specific Functional Scale
- Fear Avoidance Beliefs Questionnaire (FABQ)
- Pain Catastrophizing Scale (PCS)
3
Q
Dynamic variations of the SI joint
A
- greater curves in spine
- sacral facets at greater angle
- sacrum more horizontal
- more stable SI
4
Q
Stable variations of the SI joint
A
- less curves in spine
- sacral facets at smaller angle
- sacrum more vertical
- more mobile SI
5
Q
Define nutation
A
- sacrum tilts anterior
- ilium tilts posterior
6
Q
Define counter-nutation
A
- sacrum tilts posterior
- ilium tilts anterior
7
Q
Symptoms of sacroiliac pain
A
- 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
8
Q
Palpation and patient identification of pain
A
- sacral sulcus tenderness
- PSIS is main location of pain
- groin discomfort/pain
9
Q
Sacroiliac pain provocation tests
A
- 3 positives indicate SI dysfunction
- distraction
- thigh thrust
- Gaenslen
- sacral thrust
- compression
10
Q
Describe distraction
A
- patient supine
- push through patient’s ASIS
11
Q
Describe thigh thrust/P4
A
- patient supine
- knee at 90-90
- fixate sacrum against table with one hand
- push through patient’s knee
12
Q
Describe Gaenslen
A
- 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
13
Q
Describe sacral thrust
A
- patient prone
- place hands on sacrum and push down towards the table
14
Q
Describe compression
A
- patient in side-lying
- find ASIS and come off of it slightly posterior and push towards table
15
Q
Tests used for treatment decisions
A
- Gillet test (standing hip flexion)
- Standing flexion test
- Supine long sit test
- Prone knee bend
16
Q
Describe Gillet test
A
- 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
17
Q
Describe standing flexion test
A
- patient in standing
- palpate PSIS bilaterally
- patient forward flexes as far as possible
- positive for hypermobility if one PSIS moves further cranially
18
Q
Describe supine long sit
A
- patient in supine
- palpate medial malleoli & note leg length
- patient long sits
- note leg length
- positive if leg length changes
19
Q
What rotation causes a change in leg length
A
- posterior rotation causes functional leg lengthening when sitting but leg shortening when supine
20
Q
Describe prone knee bend
A
- patient in prone with knees extended
- assess leg length
- passively flex knees to 90 degrees
- assess leg length
- positive if leg length changes
21
Q
Manual treatment
A
- muscle energy techniques (anterior vs posterior rotation of innominate)
- prone anterior rotation manipulation
- sidelying posterior rotation manipulation
- supine SI manipulation
22
Q
Indications for SI manipulation
A
- 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
23
Q
Describe SI manipulation technique
A
- 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
24
Q
Exercise treatment for SI joint pain
A
- pelvic floor coordination
- hip and lumbar spine assessment
