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MSK PT > SIJ > Flashcards

SIJ Flashcards

1
Q

what 2 m directly attach to the sacrum and directly produce SI motion

A

piriformis and pubo coccygeal m

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2
Q

what does the long dorsal SI ligament limit

A

anterior iliac rotation or sacral counter-nutation

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3
Q

what motions do the short SI ligament limit?

A

all motions

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4
Q

what is the function of the anterior sacroiliac ligaments

A

bind the sacrum and ilia

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5
Q

what are the most important ligaments of the SIJ and why?

A

interosseus sacroiliac ligaments
strong and thick, bind sacrum and ilia

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6
Q

what ligament is continuous with the tendon of the biceps femoris

A

sacrotuberous ligament

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7
Q

describe the attachments of the sacrotuberous ligaments

A

ischial tuberosity to ilia (PSIS)
lateral side of sacrum and coccyx

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8
Q

the sacrotuberous ligament blends with _______ ligament and together they resist _____

A

sacrospinous lig
nutation and posterior innominate rotation

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9
Q

what are the deep m that stabilize the SIJ

A

multifidi, TrA, pelvic floor and diaphragm

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10
Q

what is the function of the piriformis in NWB

A
  • hip ER and ABD
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11
Q

what is the function of the piriformis during WB

A

restrains excessive hip IR
(deceleration of IR)

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12
Q

how does the function of the piriformis change with hip position

A

when hip flexed > 90, becomes a hip IR

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13
Q

what structures are part of the deep longitudinal system (sling)

A

ES
deep thoracolumbar fascia
sacrotuberous ligament
biceps femoris

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14
Q

what is the main function of the m sling systems

A

increase SIJ stability

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15
Q

what structures are involved in the posterior oblique system

A

Lats
C/L glut max
thoracolumbar fascia

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16
Q

what structures are involved in the anterior oblique system

A

EO
IO
C/L hip ADD
anterior abdominal fascia

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17
Q

what structures are involved in the lateral m systems

A

glut medius
minimus
C/L hip ADD

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18
Q

what are the inner muscles that stabilize the pelvis

A

miltifidi, TrA, pelvic floor

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19
Q

what is the iliac articular surface of the iliac covered with

A

fibrocartilage

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20
Q

what is the articular surface of the sacrum covered with

A

hyaline cartilage

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21
Q

what structure connects the pubic symphysis

A

fibrocartilage

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22
Q

what is a non-infectious inflammatory condition localized to the pubic area

A

osteitis pubis

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23
Q

what are some common causes of osteitis pubis

A

pregnancy, childbirth, high-level athletic activity, urological or gynecological surgery, trauma, psoriatic arthritis

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24
Q

the superior transverse axis travels through ______

A

the second sacral segment

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25
Q

describe the motion that occurs at the superior transverse axis during respiration

A

with inhalation - sacrum extends/counter-nutates
exhalation - sacrum flexes/nutates

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26
Q

the transverse pelvis axis travels through the _____

A

symphysis pubis

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27
Q

the middle transverse axis is located ____

A

at the 2nd sacral body

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28
Q

what is the principle axis of normal SI motion (nutation and counter nutation)

A

middle transverse axis

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29
Q

what is the principle axis of IS motion (anterior and posterior rotation)

A

Inferior Transverse Axis

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30
Q

the inferior transverse axis travel thru ___

A

inferior pole of SI articulation and PSIS

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31
Q

the R and L oblique axis runs thru ___

A

superior end of articular surface of sacrum to opposite inferior lateral angle

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32
Q

what is sacral motion

A

nutation and counternutation

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33
Q

nutation and counternutation occurs at what axis

A

middle transverse

34
Q

what is the capsular pattern of sacral motion

A

pain with stress

35
Q

describe the gliding motion of the sacrum during nutation

A

glides inferiorly down short limb and posteriorly along long limb

36
Q

what is the CPP of the sacrum

A

nutation - occurs during WB

37
Q

during nutation of the sacrum, what happens to the iliac bones and the ischial tuberosities

A

iliac bones move closer
ischial tuberosities move farther apart

38
Q

nutation is resisted by what 3 ligaments

A

sacroiliac, sacrotuberous, and sacrospinous

39
Q

describe the gliding motion of the sacrum during counter-nutation

A

glides anteriorly along the long limb and superior along the short limb

40
Q

what is the OPP of the sacrum

A

counternutation

41
Q

what 2 m produce counter-nutation

A

piriformis and pubococogeal

42
Q

what happens to the iliac bones and the ischial tuberosities during counter nutation

A

iliac bones move farther apart
ischial tuberosities move closer

43
Q

what ligaments resist counternutation

A

sacroiliac ligamnets

44
Q

describe Forward torsion of the sacrum on the iliac bones

A

around the oblique axis
Ex: when the R base of sacrum points forward (rotating to the L) –> L torsion around the L oblique axis = L on L

also can look at L inferior angle –> when it is directed upwards –> L on L

45
Q

describe backward torsion of the sacrum on the iliac bones

A

around the oblique axis
Ex: R base of sacrum moves backwards –> R torsion around the L oblique axis = R on L

46
Q

what happens to the articular surface of the ilium during anterior rotation

A

glides inferior and posterior relative to sacrum

47
Q

what happens to the articular surface of the ilium during posterior rotation

A

glides anterior superior in relation to sacrum

48
Q

flexion at the hip will produce what innominate motion

A

posterior rotation (coupled with ER)

49
Q

extension at the hip will produce what innominate motion?

A

anterior rotation (coupled with IR)

50
Q

flexion of the lumbar spine will produce what sacral motion and what innominate motion

A

sacral - nutation THEN counternutation
innominate - anterior rotation

51
Q

extension of the Lumbar spine will produce what sacral motion and what innominate motion

A

sacral - nutation
innominate - posterior rotation (slight)

52
Q

during heel strike of R LE, what position is the R innominate in and what position is the L innominate in?

A

R (I/L side) - posterior rotation
L (C/L) - anterior rotation

53
Q

during R heel strike - what axis is motion occuring at

A

R oblique axis - R on R or L on R

54
Q

during R heel strike with the L foot still in contact with the ground - what m pulls the sacrum forward on the L side?
what motion is occurring?

A

L psoas pulls sacrum forward
R on R motion

55
Q

During Mid-stance (L LE toe off and beginning to flex hip) what position is at the L iliac and what position is the R side

A

L - posterior rotation
R - Anterior roation

56
Q

during midstance on the R LE (the R LE is the WB leg) - what axis is motion occurring at

A

R oblique

57
Q

during R sided midstance, and the L innominate is posteriorly rotated, what torsion occurs ?

A

L on R torsion

58
Q

at the moment of L heel strike, the axis _____

A

changes from R oblique axis to L oblique axis

59
Q

what is the main cause of pelvic pain

A

sacroiliac arthritis

60
Q

describe the referral pattern of the SIJ

A

TO the: lumbar spine, butt, hip, upper thigh

Hip and Lumbar spine can refer to the SIJ

61
Q

do pts with SIJ pain have positive or negative neuro signs?

A

(-) SLR

62
Q

what sign is used to determine SIJ pain

A

Fortin - can pinpoint pain in buttock region/over SIJ

63
Q

S/S of sacroiliac arthritis

A
  • pain in posterior sacrum
  • radiating to post thigh
    increased with walking (unilateral WB) or hopping
  • increased with turning in bed
  • lumbar ext is most painful
    + stress test
    + compression test with belt
64
Q

the following will cause what injury to the IS:
- repeated unilateral standing
- fall on ischial tub
- vertical thrust onto and extended leg
- back lifting

A

posterior innominate

65
Q

the following will cause what injury to the IS:
- golf or baseball swing
- horizontal thrust to the knee (dashboard)
- forceful diagonal mvmt

A

anterior innominate

66
Q

what do kinetic tests look for

A

hypomobility

67
Q

what structures are responsible for force closure of the SIJ

A

TrA, sacral multifidi, pelvid floor and hip ER

68
Q

what is responsible for form closure of the pelvis

A
  • high friction coefficient compared to other joints
  • wedge shape of sacrum
    -ridges and grooves on articular surface
  • extensive ligement support
69
Q

the active SLR is for?

A

funcitonal test for pelvis girdle stability

70
Q

a positive ASLR is ____

A

decreased ability to actively lift leg in supine position from pain or difficulty

71
Q

a positive ASLR is highly correlated with ______

A

excessive mobility of pelvic girdle

72
Q

how do you augment form closure?

A

compression of SIJ - manual or SI belt

73
Q

how can you augment force closure of the SIJ

A

use of slings

74
Q

Pts with SIJ pain have a delayed activity of what m?

A

IO, MF, glut max

75
Q

what is intra-articular SIJ injection used for?

A

short-term pain relief

76
Q

what is prolotherapy and when is it effective?

A
  • glucose compound injection used to stiffen SIJ
  • effective ONLY when used in conjunction with other PT interventions
77
Q

what has better evidence for longer lasting effects? Prolotherapy or SIJ steroid injection

A

prolotherapy

78
Q

pelvic belt causes a significant decrease in ___

A

sagittal plane rotation of the SIJ

79
Q

does the use of an SI belt have an effect on abdominal m thickness during ASLR?

A

no immediate effects on TrA or IO thickness

80
Q

in comparison of 2 exsc for SIJ laxity (ADIM - TrA or general abdominal bracing exsc) which one is more effective?

A

BOTH decreased joint laxity BUT ADIM decreased laxity more

MSK PT (7 decks)

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