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MSK > SIJ Eval & Treat > Flashcards

SIJ Eval & Treat Flashcards

1
Q

Lumbo-Pelvic-Hip Complex

A

-isolated SIJ dysfunction is rare
-check with hip and/or lumbar exams

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2
Q

Sacroiliac Joint

A

-load tranfers from lumbar to pelvis to hips
-contributes to 15-30% of non-specific LBP

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3
Q

Sacrum

A

-5 fused vertebra
-concave on anterior side, convex on posterior
-attachment for Piriformis, glutt max, ER, multifidi, TL fascia
-L shaped facet with innominate, noncongruent

Base: articulates with :L5
Apex: articulates w/ coccyx
Ala: articulates w/ ilium

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4
Q

Innominates

A

-ischium, ilium, and pubic bone fused together at the acatabulum
-articulates with the sacrum= SIJ

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5
Q

Anterior SIJ Ligaments

A

-binds sacrum to ilia
-limits all motions
-pain generators

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6
Q

Interosseous Ligs

A

-most important
-thick
-binds sacrum to ilia posteriorly
-limits ant and inf movements of sacrum

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7
Q

Posterior SIJ Ligs

A

-easily papable
-limit ant iliac rotatation (or sacral counternutation)
-attachment for: ES, glute max, TL fascia
-pain generators

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8
Q

Sacrotuberous Lig

A

-isch tub to PSIS
-limits post iiac rotation (sacral nutation)

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9
Q

Sacrospinous Lig

A

-ischual spine to sacrum
-limits post iliac rotation (sacral nutation)

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10
Q

Pubic Symphysis

A

-transfer loads
-connected by fibrocartilage
-common source of groin pain

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11
Q

Pelvic Floor Muscles

A

-assist im lumbosacral stability
-increase intra-abdominal pressure

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12
Q

Muscles that can produce SIJ motion…

A

-piriformis
-Pubococcygeaous

2/35 SIJ muscles

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13
Q

Posterior Oblique System

A

-lats, contra glue max, L fascia
-helps with SLS

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14
Q

Anterior Oblique System

A

-EO/IO, contra hip add and abdominal fascia
-helps wih SLS

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15
Q

Lateral Muscle System

A

-Glute med/min and contra hip add

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16
Q

Inner Muscle System

A

-multifidi, pelvic floor, and diaphragm
-stabilize SIJ
-pressure management

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17
Q

Nerve Supply of SIJ

A

Anterior portion : Post rami L2-S2
Posterior portion: post rami L3-S3

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18
Q

Sacral Nutation

A

-flexion in relation to innominates
-base moves ant and inf
-Apex moves pos and sup
-Posterior innominate, PPT, decreased lordosis, hip flx

19
Q

Sacral Counternutation

A

-extension in relation to innominates
-base moves post and sup
-Apex moves ant and inf
-Anterior innominate, APT, increased lordosis, hip ext

20
Q

3 Categories of SIJ Pain

A

-Pregnancy
-Pathology: infection, fx, tumor
-Non-specific: MSK

21
Q

Causes of Pelvic/SIJ Pain: Visceral

A

-Appendicittis
-GYN
-UTI/kidney stones
-GI tract
-Vascular: AAA, femoral

22
Q

Causes of Pelvic/SIJ Pain: Serious Origin

A

-infection
-fx
-tumors: prostate, colon, gyn
-Inflammatory disorders: Ankylosing spondylitis starts in SIJ

23
Q

Causes of Pelvic/SIJ Pain: MSK Origin

A

-SIJ dysfunction : instability and trauma
-L-Spine disorders
-Hip Dysfunction
-Hernia

24
Q

Subjective Hx of SIJ Dysfunction

A

-Fortin Sign: pain over PSIS**
-Pain with transitional movements**
-Pain with SLS activities**
-Pain at end range of Active SLR
-Prolonged sitting/standing
-(-) Neuro
-No s/s below knee

25
Q

Systems Review of SIJ Dysfunction

A

-vitals
-cancer
-infection
-Trauma
-Neuro
-postpaterm psycological

26
Q

SIJ Joint Diagnoses: Referred Pain

A

-Lumbar Spine
-Hip joint

27
Q

SIJ Joint Diagnoses: Hypomobility

A

Innominate Rotation
-anterior rot on one side and posterior on the other
-ASIS OR PISIS different heights and superficialness

Upslip
-ASIS, PSIS, ISCH tub ALL up on one side
-leg forced up

Downslip
–ASIS, PSIS, ISCH tub ALL down on one side
-rare
-leg pulled down

Pubic Lesion
-superior or inferior

Tx:
-manual
-core exercises

MOI:
-unilateral forces
-falls
-back lifting
-swinging

28
Q

SIJ Joint Diagnoses: Joint Arthritis (Sacroilitis)

A

S/s:
-pain in post sacrum or groin
-radiating into thigh
-increase SLS pain
-Turning in bed pain
-lumbar extension painful
-(+) SI stress tests
-(+) Compression test with SI Belt

Tx:
-NSAIDs, ice, core exercises and LE exercises

29
Q

SIJ Joint Diagnoses: Pelvic Girdle Instability

A

Form Closure:
-assessed 1st with ASLR
-passtive stability malfunction (joint shape, ligaments, bony stability)
-Tx: SI Joint compression belt

Force Closure:
-assessed 2nd with ASLR
-active stability malfunction (muscles and fascia)
-Tx: core stabilization exercisess

30
Q

SIJ Joint Diagnoses: Piriformis Syndrome

A

S/s:
-persistent low back pain into butt and thigh
-(+) pain provocation of piriformis
-(+) pain w/ sitting or squatting
-persistent hip ER
-Difficuly lying
-(+) LE paresthesias

Tx: manual, stretching, core exercises

31
Q

Diagnostic Imaging of SIJ Dysfuntion

A

-MRI best to see changes
-no imaging indicated if no serious pathology syspected

32
Q

Evaluation Order of SIJ Dysfunction

A
  1. Do Hip and/or Lumbar Exam
  2. Confirm Presence of SIJ dysfunction with Provocation
  3. Determine side of Hypomobiltiy (mobility/functional tests)
  4. Determine Pathology
  5. Determine if Form or Force are a component
  6. Select Intervention (treat lumbar or hip dysfunction first, then SIJ hypomobility first)
33
Q

Conservative Management of SIJ Dysfunction

A

-Manips
-SI Belt
-Exercise
-Education

34
Q

Pharmacologic Management of SIJ Dysfunction

A

-NSAIDS
-Muscle relaxants
-Opioids
-Implanted devices
-Anti-depressants
-Injections

35
Q

Prolotherapy

A

-injection of dextrose into joint space
-increases friction
-painful

36
Q

Platelet-Rich Plasma

A

-increases friction
-increases healing

37
Q

Sugrical Techniques for SIJ Dysfunction

A

Stabilization
-Fractures
-SI joint fusion (last resort for chronic s/s)

38
Q

Lumbar Disc Joint Clearing Tests

A

(+) pain with coughing and sneezing
Decreased pain with walking

39
Q

Lumbar Spine Joint Clearing Tests

A

(-) pain with coughing and sneezing
(+) pain with extention or flx
(+) pain with PA joint glides

40
Q

Hip Joint Clearing Tests

A

(+) Trendelenburg signs
(+) Pain or decreased ability to squat
(+) Sign of buttock test

41
Q

SI Joint Clearing Tests

A

(+) Fortin’s Sign
(+) Joint gapping or compression tests
(+) TTP at SI ligs
(+) Pain/weakness with SLS

42
Q

Mobility Exercises

A

-foam roll
-AROM
-Stretches

43
Q

Stability Exercises

A

-AROM
-Spinal Stability
-Pelvic Floor Strength**
-Glute Strength**

44
Q

SI Belt Application

A
  1. Pt flexes hip and crease is where bottom of belt will go
  2. Middle seam goes in mid back
  3. Pull belt traps snugly
  4. Pt exercises or performs ADLa for s/s reduction

belt goes on skin

MSK (30 decks)

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