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SPINE > SI Joint Exam > Flashcards

SI Joint Exam Flashcards

1
Q

Rule out by asking special questions by asking about

A 
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
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2
Q

Walking

A

requires optimal lumbo-pelvic-hip function

leg-length discrepancy and accompaying increase or decreased lordisis

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3
Q

Getting up from sitting

A

Does it cause pain

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4
Q

Removing clothes and shoes

A

for posture check

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5
Q

General Static Posture

A

-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

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6
Q

Clear Related Joints

A

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

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7
Q

Special Test

A

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.

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8
Q

Area of Pain

A

Usually unilateral, dull ache over the back of the SIJ and buttock

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9
Q

SIJ pain may refer to

A

groin, greater trochanter, down posterior thigh to knee as far down as the toes

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10
Q

Baer’s Point

A

Localized tenderness over the iliacus muscle

1-2 inches from ASIS down the inguinal ligament

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11
Q

SIJ pain may also present

A

Over the pubic symphysis or adductor tendon origin

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12
Q

The Behavior of SIJ pain is

A
  1. Usually a dull ache
  2. Local tenderness with increased pain upon position changes such as ascending or descending stairs (especially when leading with involved side) and lying-sitting-standing
  3. May worsen with prolonged sitting or standing
  4. May be transient and progress to more constant
  5. Early morning stiffness that is relieved with a period of weight bearing
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13
Q

Often an SIJ injury is from a traumatic onset

A

Fall on the buttocks, unexpressed heel-strike, golf swing, or abnormal stresses occurring during something like punting a football

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14
Q

Conditions that can involve SIJ

A

ankylosing spondylitis, RA, Paget;s disease and osteitis deformans

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15
Q

SIJ can also be caused from

A

a recent child birth or use of contraceptives

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16
Q

Gillet’s Marching Test

A

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

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17
Q

Gilets Marching Test

A

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

18
Q

Gillet’s MarchingTest

A

• Therapist:Thenassesscontralateral SIJmobility
whiletheptliftsthesamehipagainto>90
degreesofflexion
• Forthecorrectsequencewiththismotion,S2
shouldmovepriortothemovementofPSIS
• ExamplewhenassessingformotionwithRhip
flexion,thefirststepshouldindicatethattheR
PSISismovingpriortoS2,DuringtheSecond
step,S2shouldmovepriortotheLPSIS

19
Q

SI provocation tests

A 
Thigh Thrust
Distraction
Compression
Sacral Thrust
Patrick
Gaenslen's
20
Q

Distraction (GAPPING) test 50-98

A

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

21
Q

Thigh Thrust (Passive Mobility Test)

A

+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

22
Q

Gaenslen’s Test

A

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

23
Q

Compression Test

A

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’

24
Q

FABER, Patricks Test

A

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

25
Q

TrueLegLengthDiscrepancy

A

• Ptposition:Supine
•PTplacesthept’slegsinpreciselycomparablepositionsby applyinglongitudinaltractionattheankles.
• MeasurethedistancefromtheASIStothemedial malleolus bilaterally
• UnequaldistancesverifythatoneLEisshorterthanthe other
• NOTE:SomebelieveASIStolateralmalleolus isamore accuratemeasurement
• Determinewherethediscrepancyliesbyhavingptlie supinewithkneesflexedto90andfeetflatonmat
– Ifkneeishigherononeside,thattibiaislonger
– Ifkneeisfarthercaudal,thatfemurislonger

26
Q

LegLengthChangeTest

A

• Ptsupinewithfeetoveredgeofplinth
•PtbridgesandthenextendsLE’s.PTgentlypullsonboth LEsattheankles
• PTthenpalpatesinferioraspectofthemedialmalleoli
whilepullingbothmalleoli closetoeachother
• Barringpelvicobliquityortrueleglengthdiscrepancy, malleoli shouldbeeven
• Instructthepttositup.
•Monitorthemedialmalleolitodetermineanychangein theirrelativepositions.
• Ifanychange,itisassumedthatthelongerleghasa posteriorly rotatedilium

27
Q

Palpation

A 
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
28
Q

Combination of Tests

A 
• Laslett’s ClusterI
– ThighThrust
– Distraction
– Compression
– SacralThrust
• 2ofthe4testspositive
– Sn=88%
– Sp =78%
• Usethighthrustand
distractiontestsfirst
29
Q

Combination of Tests

A 
• Laslett’s ClusterII
– Thighthrust
– Distraction
– Comprssion
– Gaenslen’s test
– SacralThrust
• 3outof5positivetests
– Sn=91%
– Sp =87%
30
Q

Combinations of Test

A 
• VanderWurff’s Cluster
– ThighThrust
– Distraction
– Compression
– Patrick(FABER)
– Gaenslen’s Test
• 3of5positivetest
– Sn=85%
– Sn=79%
31
Q

Palpation of Iliac Crests

A
  • Ptposition:Standing;feetshoulderwidthapart, weightevenlydistributed
  • PTposition:Kneelinginfrontofpt
  • PTinstruction:movethehandsalongthept’sskin upthewaistandmovethefingersoftheanterior portionoftheiliaccresttotheapexlaterally. Posteriorly,palpatetheL4spinous processand movelaterallytothecrest
  • Assessbilateralheightbyplacingthehandacross thetopoftheeachcrestwithpalmar surface down
32
Q

Palpation of ASIS

A

• Ptposition:Standingwithfeetshoulderwidth
apartandweightevenlydistributed
• PTposition:Kneelinginfrontofpt
• PTinstruction:Placehandsonsideofwaist
andthumbonanteriorsurfaceofthepelvis
fingersonanterioriliaccrest;bringthehands
upwardtoabonyledge
• ExaminethealignmentofbothASISsin
relationtoeachother

33
Q

Palpation of PSIS

A

• PtPosition:Standing;feetshoulderwidthapart, weightevenlydistributed
• PTposition:Kneelingbehindpt
• PTinstructions:Findthespinous processofS2 andmovelaterallytofindabonyledge
• Toassessalignment,thethumbsshouldbe positionedsothatitrestsunderneathandnot atoptheprominence
• NOTE:ThelocationofthePSIScanalsobe indicatedbytheirproximitytodimplesbilaterally atthelevelofS2
•Bringthehandsdownfromthelocationofthe
PSIStoapositioninferiorandslightlymedially
• Refertoaskeletalmodelforhelp

34
Q

Palpation: PSIS depth

A

• Ptposition:prone
• PalpatethepositionofbothPSISandPIIS
bilaterallyandrelatetothepositionofthe
sacrum
• Usingtheindexfingerbetweenthetwobones
todetermineifadifferenceispresenton
eitherside
• Differencesindepthcanbecausebyrotated
ilia oranutated sacrum

35
Q

Palpation: PUBIS

A

• PtPosition:Supine
• PTPosition:AttheleveloftheT‐spinetooneside
facingawayfromthept’shead.
• PTinstruction:Thehandsareplacedoverthe
lowerabdomenwiththethumbstogetherand
FINGERSUP;proceedslowlyandkeepptprivacy
inmind;willpresentasabonyridgejustproximal
tothegenitalia
• Checkwhetherthetwosidesofthejointareeven
fromthesuperiorandanterioraspect

36
Q

Palpation: Ischial Tuberosity

A

• PtPosition:ProneorSLwithupperhipflexed
• Placefingersonthegreatertrochanterand
movethethumbfromthePSIStotheareaof
theischialtuberosity
• Thetuberosityliesinthesamehorizontal
planeaslessertrochanterwhenhipisflexed

37
Q

Palpation: Sacrotuberous Ligament

A

• Runsfromthesacrumtotheischialtuberosity;
hasawideproximalattachmenttothedorsal
surfaceofthesacrum,coccyx,andthePSIS
• PtPosition:Prone
• PTInstructions:Afterpalpatingtheischial
tuberosityandlateralborderofthesacrum
distinguishthesacrotuberous ligamentbetween
thetwoasatight,band‐likestructure
• CompareLandRligamentsforrelative
depth/tension

38
Q

Palpation: Piriformis

A

• Originatesonthepelvicsurfaceofthesecondtofourth
sacralsegments,superiormarginofthegreatersciatic
notch,andsacrotuberous ligament
• Insertsongreatertrochanter
• Ptposition:Prone
• DistinguishfromthefiberofGluteusmaximus by
knowingtheapproximatelocationandrunningyour
fingersperpendiculartothelengthofthepiriformis;
shouldbeableto“roll”overthemusclebelly
• Checkfortightnessandtendernessespeciallywith
sciaticinvolvement

39
Q

Clear Related Joints

A

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

40
Q

Special Tests

A
  1. Anesthetic Injection is the current gold standard for diagnosing SIJ dysfunction
  2. Pain reduction if 50% is needed to confirm that the pain is originating from the SIJ
  3. Not feasible for practitioners whi lack training and not cost-effective as an examination tool
  4. Grouping of tests a more feasible means of diagnosis

SPINE (20 decks)

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