SIJ Flashcards
Functional pelvic girdle parts
- L4-L5 vertebrae - L5 is tethered securely to the ilia by the iliolumbar ligament.
- 2 ilia
- sacrum (5 fused sacral vertebrae)
- pubic bones
- sacrococcygeal joint (sacrum and coccyx)
- hip joints
Muscles associated with lower extremity that cross the hip joint (17)
- TFL
- Sartorius
- rectus femoris
- gluteus medius
- glute min
- iliacus
- psoas
- 2 gemelli
- obturator externus
- obturator internus
- piriformis
- glut max
- hamstrings
- adductors
- gracilis
- pectineus
- quad femoris
Role of the pelvic girdle
- weight transfer system
- load is transferred from one leg to the other and from upper body to lower body
- also a force generator (rotational force during gait - midstance to terminal stance)
Lumbar fusion affects on pelvic girdle
- disrupts force attenuation system
- causes predictable pathology in pelvic joints
SIJ joint type
combination of diarthrosis and synarthrosis (syndesmosis)
-planar joints - biaxial diarthroses allowing for gliding
Pubic symphysis movement
- 0.8mm of vertical translation in males
- 1.6mm vertical translation in females
- rotation averages 2*
Intrinsic ligaments
- short posterior SI ligament
- long posterior SI ligament
- posterior interosseous ligament
Short posterior sacroiliac ligament
- connects sacrum to ilium
- runs obliquely from medial to lateral
- transverse and vertical fibers
- can often be a source of pain due to it’s multidirectional fiber orientation
- ligament forms part of the posterior joint capsule
Long posterior (dorsal) ligament
- attaches the ilium to the sacrum from inferior PSIS to sacrum
- blends with sacrotbuterous ligament
- restricts anterior rotation of innominate or extension of the sacrum
Posterior interosseous ligament
- tough syndesmosis bonding ilium to sacrum
- forms part of posterior joint capsule
Extrinsic ligaments
- sacrotuberous
- sacrospinous
- iliolumbar
Sacrotuberous and sacrospinous ligaments
- play a significant role in stabilization of SIJ
- sacrotuberous runs from PSIS and sacrum to ischial tuberosity
- sacrotuberous restricts motion of sacrum flexon (nutation) and restricts posterior rotation of innominate
- sacrospinous ligament runs from lateral sacrum and coccygeal vertebrae to inferior SIJ capsule
Iliolumbar ligament
- anterior and posterior bands connecting L5 TP to iliac crest and anterior SIJ capsule
- stabilizes L5 in the sagittal and frontal planes
Hypermobility vs. instability
- ## hypermobility is impaired stability and can usually be treated by non-invasive exercises l
SI CPR 1
- thigh thrust
- compression
- distraction
- sacral thrust
- gaenslan
3 of 5 tests +
Sn 0.91, Sp 0.87
SI CPR 2
- distraction
- compression
- faber
- thigh thrust
- gaenslen
3 of 5 tests +
Sen. 0.85, Sp 0.79
Diagnosing SIJ pain
- cluster of findings including provocation testing, pain location, palpation, strength, mobility, quadrant length screening
- no clear reference or gold standard
Laslett SI cluster
- thigh thrust
- sacral thrust
- gapping
- compression
- gaenslen
Sn 0.91, Sp 0.87 3/5 tests +
Fortin finger test
-patient points to region of pain with one finger consistently and is within 1 cm of psis
Distraction (gapping)
- lying supine
- examiner applies cross armed pressure to ASIS in dorsal and lateral direction
- +=pain
Compression (approximation)
- SL with affected side up
- hips flexed to 45-90*
- place hands over anterior edge and place downward force through ilium
- +=pain
Thigh thrust
- supine
- hip flexed to 90* and C/L leg extended
- examiner places hand under sacrum and adds slight adduction - apply downward pressure through long axis of femur
- +=pain
Gaenslen test
- subject supine
- guide symptomatic knee to chest with a force pushing hip into flexion
- counter pressure applied to straight knee of hanging leg towards floor
- +=pain
Patellar-pubic percussion test
- patient supine
- place bell of stethoscope over pubic bone - percuss patellae
- if normal, sounds from both sides should be equal
- affected side should be decreased pitch/intensity
-assessing for fracture
Hip flexion tests
- assessing for pelvic fracture
- supine
- patient raises hip (active SLR)
- = inability to raise leg
Posterior pelvic palpation
- sitting or prone
- palpate sacrum and (B) SIJ
- = local tenderness with moderatly deep palpation
Fulcrum test
- for femoral stress fx
- seated with lower legs dangling
- examiner’s arm is fulcrum under thigh and is moved distal to proximal thigh as gentle pressure is applied to the knee with the opposite hand in an inferior direction
- at point of fulcrum under stress fracture, gentle pressure on knee produces increased discomfort described as sharp pain
HABER
- hip abduction, ER
- capable of reproducing pain in SIJ
Lumbopelvic rhythm
- comparative range of motion in forward bending of lumbar spine and pelvis
- total range of motion in forward bending is 120*
- normal rhythm is 60* lumbar and 60* hip
Sacral motion testing
- described, but not researched
- ability of sacrum to flex in sagittal plane
Upslip
- superior shear dysfunction
- assessed and treated in the clinic, but no research to support
Chronic pelvic pain syndrome
- urinary symptoms
- psychological dysfunction
- visceral organ-specific
- infection
- neurologic/system conditions
- myalgia
- sexual dysfunction
Primary clinical history for spine/hip/pelvic fractures
- major trauma
- point tenderness
- increased use of corticosteroids
Ruling out fracture
-negative active flexion of the hip with extension of teh knee - 0.90 sn
Most common area for stress fractures
upper third of femur
