SI Joint Exam Flashcards
Rule out by asking special questions by asking about
Bladder Problems Groin Area Numbness Bilateral LE numbness or tingling --all possible indicators of central cord compression or cauda equina syndrome Constitutional Symptoms Imaging Medications Previous TX and results
Walking
requires optimal lumbo-pelvic-hip function
leg-length discrepancy and accompaying increase or decreased lordisis
Getting up from sitting
Does it cause pain
Removing clothes and shoes
for posture check
General Static Posture
-Standing, sitting without back support, and long-sitting
Head and shoulder alignment
Spinal Curves
Level of Pelvis
Weight bearing equality or lateral pelvic tilt may clue into leg length
Clear Related Joints
Lumbar Spine active movements
all active movements should be performed to the end of ROM or to the point of pain
–Overpressure can be provided if no pain present at the end ROM
–Qudrant test–combines ext, SB and Rot.
—-Have the a ptient reach toward the back of the opposite knee
HIP-performed in standing with patient using UE on table to balance or supine
Special Test
Anesthetic Injection is the current gold standard for diagnosing SIJ dysfunction
Pain reduction of 50% is needed to confirm that the pain is originating from the SIJ
Not feasible for practitioners who lack training and not cost-effective as an examination tool
Grouping of tests a more feasible means of diagnosis.
Area of Pain
Usually unilateral, dull ache over the back of the SIJ and buttock
SIJ pain may refer to
groin, greater trochanter, down posterior thigh to knee as far down as the toes
Baer’s Point
Localized tenderness over the iliacus muscle
1-2 inches from ASIS down the inguinal ligament
SIJ pain may also present
Over the pubic symphysis or adductor tendon origin
The Behavior of SIJ pain is
- Usually a dull ache
- Local tenderness with increased pain upon position changes such as ascending or descending stairs (especially when leading with involved side) and lying-sitting-standing
- May worsen with prolonged sitting or standing
- May be transient and progress to more constant
- Early morning stiffness that is relieved with a period of weight bearing
Often an SIJ injury is from a traumatic onset
Fall on the buttocks, unexpressed heel-strike, golf swing, or abnormal stresses occurring during something like punting a football
Conditions that can involve SIJ
ankylosing spondylitis, RA, Paget;s disease and osteitis deformans
SIJ can also be caused from
a recent child birth or use of contraceptives
Gillet’s Marching Test
1.Indications: Hypomobility of SIJ
2.Evaluates whether or not symmetrical movement of SIJ is occurring
3. Examines the ability of the innominate to posteriorly rotate
SN 43
SP 68
reliability .22
Gilets Marching Test
Pt.: standing with one hand on a table for support
PT: palpate the inferior aspect of the PSIS with one thumb while using the other thumb to palpate the spinous process of S2
Instructions: Flex the hip of the side bending palpated to greater than 90’
Directions: assess motion during hip flexion and return to neutral
Gillet’s MarchingTest
• Therapist:Thenassesscontralateral SIJmobility
whiletheptliftsthesamehipagainto>90
degreesofflexion
• Forthecorrectsequencewiththismotion,S2
shouldmovepriortothemovementofPSIS
• ExamplewhenassessingformotionwithRhip
flexion,thefirststepshouldindicatethattheR
PSISismovingpriortoS2,DuringtheSecond
step,S2shouldmovepriortotheLPSIS
SI provocation tests
Thigh Thrust Distraction Compression Sacral Thrust Patrick Gaenslen's
Distraction (GAPPING) test 50-98
Instructions:
Pt is supine, PT applies posterior/laterally directed force over both ASIS
Causes the distraction of the anterior SIJ
Positive: pt’s symptoms reproduced
+PAIN in SIJ
Possible indications : inflammation, ligamentous injury, arthritis, rotated innominate
SN: 23-60
SP:74-90
Thigh Thrust (Passive Mobility Test)
+Abnormal Movement, provocation
Possible Indications: hypomobility of SIJ
SN 36-88
SP 50-98
Interrater reliability 91%
Pt. supine with hip and knee flexed to 90’ with slight adduction
PT: From opposite side of the table, foot hand is placed under the sacrum to block motion; head hand wraps around the flexed knee in a cradling position
Directions:: push down along the longitudinal axis of the femur in a posterior direction on the patient’s knees
Gaenslen’s Test
Pt: supine near the edge of plinth with one leg hanging off and one knee flexed towards chest
PT: applies firm pressure to the flexed knee while also pressing down on the hanging knee
–this causes a posterior rotation of the hip on the flexed side, and an anterior rotation of the hanging side
+Pain
Possible Indications: SI lesion, pubic instability, hip pathology
SN: 36-53
SP:71-80
Inter-rater reliability 81-92
Compression Test
Patient is supine (or sidelying)
PT places hands (arms crossed) on iliac crests and applies inward pressure causing the SIJ’s to approximate anteriorly
+PAIN
Possible indications: Inflammation, ligamentous injury, arthritis, rotated innominate
SN 22-69
SP 63-100
IR Reliability 91’
FABER, Patricks Test
Can detect pathology in the SI or hip joint
Pt: SUPINE
PT: places the pt’s test leg atop the contralateral knee putting the hip in flexion, ABD, and ER
Directions: placing one hand on the flexed knee and other hand on the contralateral ASIS and pressing down as if opening the binding of a book pathology in the hip or surrounding muscles
Inguinal pain generally indicates pathology in the hip or surrounding muscles
Concordant pain is the SI region is considered a positive test
TrueLegLengthDiscrepancy
• Ptposition:Supine
•PTplacesthept’slegsinpreciselycomparablepositionsby applyinglongitudinaltractionattheankles.
• MeasurethedistancefromtheASIStothemedial malleolus bilaterally
• UnequaldistancesverifythatoneLEisshorterthanthe other
• NOTE:SomebelieveASIStolateralmalleolus isamore accuratemeasurement
• Determinewherethediscrepancyliesbyhavingptlie supinewithkneesflexedto90andfeetflatonmat
– Ifkneeishigherononeside,thattibiaislonger
– Ifkneeisfarthercaudal,thatfemurislonger
LegLengthChangeTest
• Ptsupinewithfeetoveredgeofplinth
•PtbridgesandthenextendsLE’s.PTgentlypullsonboth LEsattheankles
• PTthenpalpatesinferioraspectofthemedialmalleoli
whilepullingbothmalleoli closetoeachother
• Barringpelvicobliquityortrueleglengthdiscrepancy, malleoli shouldbeeven
• Instructthepttositup.
•Monitorthemedialmalleolitodetermineanychangein theirrelativepositions.
• Ifanychange,itisassumedthatthelongerleghasa posteriorly rotatedilium
Palpation
Do not rely strictly on palpation Use the hands to assess bony structures and then confirm visually • Posterior – Iliaccrests – ASIS – PSIS – PSISdepth – Sacrotuberous ligament – Piriformis • Anterior – ASIS – Iliaccrest – Pubis
Combination of Tests
• Laslett’s ClusterI – ThighThrust – Distraction – Compression – SacralThrust • 2ofthe4testspositive – Sn=88% – Sp =78% • Usethighthrustand distractiontestsfirst
Combination of Tests
• Laslett’s ClusterII – Thighthrust – Distraction – Comprssion – Gaenslen’s test – SacralThrust • 3outof5positivetests – Sn=91% – Sp =87%
Combinations of Test
• VanderWurff’s Cluster – ThighThrust – Distraction – Compression – Patrick(FABER) – Gaenslen’s Test • 3of5positivetest – Sn=85% – Sn=79%
Palpation of Iliac Crests
- Ptposition:Standing;feetshoulderwidthapart, weightevenlydistributed
- PTposition:Kneelinginfrontofpt
- PTinstruction:movethehandsalongthept’sskin upthewaistandmovethefingersoftheanterior portionoftheiliaccresttotheapexlaterally. Posteriorly,palpatetheL4spinous processand movelaterallytothecrest
- Assessbilateralheightbyplacingthehandacross thetopoftheeachcrestwithpalmar surface down
Palpation of ASIS
• Ptposition:Standingwithfeetshoulderwidth
apartandweightevenlydistributed
• PTposition:Kneelinginfrontofpt
• PTinstruction:Placehandsonsideofwaist
andthumbonanteriorsurfaceofthepelvis
fingersonanterioriliaccrest;bringthehands
upwardtoabonyledge
• ExaminethealignmentofbothASISsin
relationtoeachother
Palpation of PSIS
• PtPosition:Standing;feetshoulderwidthapart, weightevenlydistributed
• PTposition:Kneelingbehindpt
• PTinstructions:Findthespinous processofS2 andmovelaterallytofindabonyledge
• Toassessalignment,thethumbsshouldbe positionedsothatitrestsunderneathandnot atoptheprominence
• NOTE:ThelocationofthePSIScanalsobe indicatedbytheirproximitytodimplesbilaterally atthelevelofS2
•Bringthehandsdownfromthelocationofthe
PSIStoapositioninferiorandslightlymedially
• Refertoaskeletalmodelforhelp
Palpation: PSIS depth
• Ptposition:prone
• PalpatethepositionofbothPSISandPIIS
bilaterallyandrelatetothepositionofthe
sacrum
• Usingtheindexfingerbetweenthetwobones
todetermineifadifferenceispresenton
eitherside
• Differencesindepthcanbecausebyrotated
ilia oranutated sacrum
Palpation: PUBIS
• PtPosition:Supine
• PTPosition:AttheleveloftheT‐spinetooneside
facingawayfromthept’shead.
• PTinstruction:Thehandsareplacedoverthe
lowerabdomenwiththethumbstogetherand
FINGERSUP;proceedslowlyandkeepptprivacy
inmind;willpresentasabonyridgejustproximal
tothegenitalia
• Checkwhetherthetwosidesofthejointareeven
fromthesuperiorandanterioraspect
Palpation: Ischial Tuberosity
• PtPosition:ProneorSLwithupperhipflexed
• Placefingersonthegreatertrochanterand
movethethumbfromthePSIStotheareaof
theischialtuberosity
• Thetuberosityliesinthesamehorizontal
planeaslessertrochanterwhenhipisflexed
Palpation: Sacrotuberous Ligament
• Runsfromthesacrumtotheischialtuberosity;
hasawideproximalattachmenttothedorsal
surfaceofthesacrum,coccyx,andthePSIS
• PtPosition:Prone
• PTInstructions:Afterpalpatingtheischial
tuberosityandlateralborderofthesacrum
distinguishthesacrotuberous ligamentbetween
thetwoasatight,band‐likestructure
• CompareLandRligamentsforrelative
depth/tension
Palpation: Piriformis
• Originatesonthepelvicsurfaceofthesecondtofourth
sacralsegments,superiormarginofthegreatersciatic
notch,andsacrotuberous ligament
• Insertsongreatertrochanter
• Ptposition:Prone
• DistinguishfromthefiberofGluteusmaximus by
knowingtheapproximatelocationandrunningyour
fingersperpendiculartothelengthofthepiriformis;
shouldbeableto“roll”overthemusclebelly
• Checkfortightnessandtendernessespeciallywith
sciaticinvolvement
Clear Related Joints
Lumbar Spine active movements
–all active movements should be performed to end of ROM ir to the point of pain
–Overpressuere can be provided if no pain present at end ROM
–Quadrant test –combined ext, SB, and Rotation
—have patient reach toward the back of the opposite knee
Hip performed in standing with pt using the UE on table to balance or supine
Special Tests
- Anesthetic Injection is the current gold standard for diagnosing SIJ dysfunction
- Pain reduction if 50% is needed to confirm that the pain is originating from the SIJ
- Not feasible for practitioners whi lack training and not cost-effective as an examination tool
- Grouping of tests a more feasible means of diagnosis
