SIJ Flashcards
What does marching test test for
SI or pubic joint strain, fracture
Hypermobility, joint dysfunction
Ipsilateral SIJ dysfunction
Rotation of nominate bone on sacrum
Marching test technique
Pt standing, hand on wall
Examiner palpates PSIS and S2 SP
Pt instructed to flex ipsilateral hip to 90- ipsilateral hip flexion, thumbs move together
Examiner observes/palpates motion of PSIS relative to S2
Examiner then instructs the Pt to flex contralateral hip to 90- contralateral hip flexion, thumbs move apart
Examiner observes/palpates motion of S2 relative to PSIS
Normal motion should move S2 away from PSIS
Repeat test on contralteral SIJ
+ve Marching test
Localised P- SIJ or pubic Jt sprain, pelvic #
Excess motion- hypermobility, Jt dys
Decreased ROM- ipsilateral SIJ dys
Lack of thumb movement indicates Jt fixation
Marching test clinical notes
Can modify this test by palpating the PIIS and sacral apex or S2 SP + ischial tuberosity to evaluate the lower SIJ separatley
What does flamingo test for
Ipsilateral SIJ dysfunction
Flamingo technique
Pt standing on one leg
Can ask P to hop to increase symptoms
Observe signs of discomfort or P
By standing on one leg pressure is increased on ipsilateral hip, SIJ and pubis symphysis
+ve Flamingo
Localised P
P in pubis symphysis + SIJ= lesion in whichever structure is painful
What does Gaenslen’s test for
SIJ sprain, instability
Iliopsoas contracture
Lsp or hip pain origin
Gaenslen technique
Screening
Pt to edge of couch
Hold leg towards chest
Drop other off couch
Apply pressure to knee and flexed leg, to produce shearing of SIJ
+ve Gaenslen
SI or ant thigh P- SIJ Jt patho (lig sprain, instability)
Elevation of extended hip, no SIJ pain- iliopsoas contracture
P may be due to ipsilateral SIJ lesion, hip pathology or L4 N root lesion
What does thigh thrust test for
SIJ or hip pathology
Thigh thrust technique
Hold leg to chest
Hand under sacrum/SIJ
Apply force down through knee + hip
+ve Thigh thrust
P in SIJ- SIJ patho
Hip P- hip Jt patho
Thigh thrust sens
80-93
Thigh thrust spec
69-100
What does compression test for sij
SIJ posterior ligs, fracture, SIJ dysfunction
SIJ instability
Compression technique
Pt on side
Find ASIS + PSIS, apply contact medially
Apply force down through
+ve Compression
P- SI sprain/strain, fracture, SIJ dys
Reduced P- SI instability (instability is also indicated if Pt stands with feet wide apart + P is reduced, abducted hips inc SIJ compression and pelvic stability)
What does distraction test for
Ant SIJ or pubic Jt sprain, fracture
Test L+R SIJ simultaneously
Distraction technique
Contact on both ASIS
Push outwards + down
Low couch, lean weight on to Pt
+ve Distraction
Localised P
What does sacral thrust test for
SIJ dysfunction
Sacral thrust technique
Pt on front
No pillow under pelvis
Find apex of sacrum
Hands point towards head, flat on sacrum, reinforce with other hand
Apply force anteriorly
+ve Sacral thrust
P in SIJ
Rotational shift of SIJ produces shearing of sacrum on ilium
Active SLR procedure
Pt supine
Examiner instructs Pt to lift affected leg 15cm off table
If movement= P examiner stabilises pelvis by compressing over ASIS + asks Pt to repeat movement
Active SLR interpretation
Inability to raise leg or P with pelvic stabilisation= pelvic #
No P with SIJ stabilisation= sacrioilliac lesion
Active SLR clinical notes
Test may be more sensitive in Pts with SIJ P during pregnancy
Seated flexion test procedure
Pt seated
Examiner locates the PSIS bilaterally
If one PSIS is higher than other Pt instructed to lean forward
Seated flexion test interpretation
Lower PSIS becomes higher with forward flexion= SIJ dys, abnormality in torsion movement
P with forward flexion- SIJ dys
Seated flexion test, false +ve
Potential for anatomical variation in ilium size + shape that may result in false +ve
Seated flexion sens
69
Seated flexion spec
98
PSIS asymmetry procedure
Pt standing or seated
Examiner compares PSIS height and symmetry
Iliac crest height should be assessed at same time
PSIS asymmetry interpretation
Standing or seated asymmetry= SI lesion, anatomical variation in osseous structure size and shape
PSIS asymmetry clinical notes
Test may indicate pelvic rotation with an anterior ilium having a less prominent PSIS
Trendelenburg test procedure
Pt standing is instructed to lift one leg off the ground
Examiner observes for hip motion from behind
Trendelenburg interpretation
Pelvic lateral tilt- weak hip abductor muscles (esp glute med), neuro or muscle conditioning deficit
Sens- 73
Spec- 77
P in SI on support leg- SI patho
Sens- 7-19
Spec- 98-100
False +ve trendelenburg
10% of Pts with hip P will demonstrate a false +ve- muscle weakness due to P
