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OCS > SIJ > Flashcards

SIJ Flashcards

1
Q

Functional pelvic girdle parts

A
  1. L4-L5 vertebrae - L5 is tethered securely to the ilia by the iliolumbar ligament.
  2. 2 ilia
  3. sacrum (5 fused sacral vertebrae)
  4. pubic bones
  5. sacrococcygeal joint (sacrum and coccyx)
  6. hip joints
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2
Q

Muscles associated with lower extremity that cross the hip joint (17)

A
  1. TFL
  2. Sartorius
  3. rectus femoris
  4. gluteus medius
  5. glute min
  6. iliacus
  7. psoas
  8. 2 gemelli
  9. obturator externus
  10. obturator internus
  11. piriformis
  12. glut max
  13. hamstrings
  14. adductors
  15. gracilis
  16. pectineus
  17. quad femoris
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3
Q

Role of the pelvic girdle

A
  • 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)
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4
Q

Lumbar fusion affects on pelvic girdle

A
  • disrupts force attenuation system

- causes predictable pathology in pelvic joints

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5
Q

SIJ joint type

A

combination of diarthrosis and synarthrosis (syndesmosis)

-planar joints - biaxial diarthroses allowing for gliding

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6
Q

Pubic symphysis movement

A
  • 0.8mm of vertical translation in males
  • 1.6mm vertical translation in females
  • rotation averages 2*
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7
Q

Intrinsic ligaments

A
  1. short posterior SI ligament
  2. long posterior SI ligament
  3. posterior interosseous ligament
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8
Q

Short posterior sacroiliac ligament

A
  • 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
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9
Q

Long posterior (dorsal) ligament

A
  • 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
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10
Q

Posterior interosseous ligament

A
  • tough syndesmosis bonding ilium to sacrum

- forms part of posterior joint capsule

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11
Q

Extrinsic ligaments

A
  • sacrotuberous
  • sacrospinous
  • iliolumbar
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12
Q

Sacrotuberous and sacrospinous ligaments

A
  • 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
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13
Q

Iliolumbar ligament

A
  • anterior and posterior bands connecting L5 TP to iliac crest and anterior SIJ capsule
  • stabilizes L5 in the sagittal and frontal planes
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14
Q

Hypermobility vs. instability

A
  • ## hypermobility is impaired stability and can usually be treated by non-invasive exercises l
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15
Q

SI CPR 1

A
  • thigh thrust
  • compression
  • distraction
  • sacral thrust
  • gaenslan

3 of 5 tests +
Sn 0.91, Sp 0.87

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16
Q

SI CPR 2

A
  • distraction
  • compression
  • faber
  • thigh thrust
  • gaenslen

3 of 5 tests +
Sen. 0.85, Sp 0.79

17
Q

Diagnosing SIJ pain

A
  • cluster of findings including provocation testing, pain location, palpation, strength, mobility, quadrant length screening
  • no clear reference or gold standard
18
Q

Laslett SI cluster

A
  • thigh thrust
  • sacral thrust
  • gapping
  • compression
  • gaenslen

Sn 0.91, Sp 0.87 3/5 tests +

19
Q

Fortin finger test

A

-patient points to region of pain with one finger consistently and is within 1 cm of psis

20
Q

Distraction (gapping)

A
  • lying supine
  • examiner applies cross armed pressure to ASIS in dorsal and lateral direction
  • +=pain
21
Q

Compression (approximation)

A
  • SL with affected side up
  • hips flexed to 45-90*
  • place hands over anterior edge and place downward force through ilium
  • +=pain
22
Q

Thigh thrust

A
  • 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
23
Q

Gaenslen test

A
  • 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
24
Q

Patellar-pubic percussion test

A
  • 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

25
Q

Hip flexion tests

A
  • assessing for pelvic fracture
  • supine
  • patient raises hip (active SLR)
    • = inability to raise leg
26
Q

Posterior pelvic palpation

A
  • sitting or prone
  • palpate sacrum and (B) SIJ
    • = local tenderness with moderatly deep palpation
27
Q

Fulcrum test

A
  • 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
28
Q

HABER

A
  • hip abduction, ER

- capable of reproducing pain in SIJ

29
Q

Lumbopelvic rhythm

A
  • 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
30
Q

Sacral motion testing

A
  • described, but not researched

- ability of sacrum to flex in sagittal plane

31
Q

Upslip

A
  • superior shear dysfunction

- assessed and treated in the clinic, but no research to support

32
Q

Chronic pelvic pain syndrome

A
  • urinary symptoms
  • psychological dysfunction
  • visceral organ-specific
  • infection
  • neurologic/system conditions
  • myalgia
  • sexual dysfunction
33
Q

Primary clinical history for spine/hip/pelvic fractures

A
  • major trauma
  • point tenderness
  • increased use of corticosteroids
34
Q

Ruling out fracture

A

-negative active flexion of the hip with extension of teh knee - 0.90 sn

35
Q

Most common area for stress fractures

A

upper third of femur

OCS (13 decks)

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