SIJ/Pelvic Clinical Presentations

Question 1

Where are sacral fractures often observed?

Answer 1

observed vertically at ala (parallel to SIJ)

Question 2

symptoms of sacral stress fracture

Answer 2

• LBP/pain into buttock
• may be similar to cauda equina syndrome

Question 3

physical exam findings of sacral stress fracture

Answer 3

• similar presentations associated with HNP, spinal stenosis, tumors
• antalgic gait
• TTP area of stress fracture
• lumbar spine ROM more likely normal

Question 4

symptoms of mechaincal SIJ disorder

Answer 4

• pain in butt/groin/thigh
• aggravated by transitions, sitting, activities that require longer strides

Question 5

physical exam findings of mechanical SIJ disorders

Answer 5

• asymmetry with postural landmark exam
• TTP affected SIJ stabilizers
• provocation with procedures that stress affected SIJ ligament/capsule structures
• Laslett’s cluster

Question 6

Laslett’s cluster

Answer 6

• thigh thrust test
• distraction test
• sacral thrust
• compression test
• gaenslien’s test

Question 7

Van der Wurff’s cluster

Answer 7

• thigh thrust test
• distraction test
• Patrick’s sign - FABER sign
• compression test
• gaenslen’s test

Question 8

who is at increased risk for athletic pubalgia

Answer 8

• males
• 3rd and 4th decades of life

Question 9

history of athletic pubalgia

Answer 9

• insidious onset
• sports injury
• cutting sports

Question 10

symptoms of athletic pubalgia

Answer 10

• unilateral pain, progression to bilateral pain
• lower abdominal/groin pain
• bilateral presentation over time

Question 11

physical exam findings of athletic pubalgia

Answer 11

• L-spine and hip should be eliminated
• TTP pubic tubercles, rectus abdominis insertion, adductors, inferior pubic rami
• painful/weak resisted hip abduction
• painful with resisted sit-up or crunch
• squeeze test + - squeeze fist inbetwee knees in supine with hips and knees flexed reproduces concordant pain
• • active straight leg raise

Question 12

normal coccygeal flexion and extension

Answer 12

flexion - > 25 deg
extension - > 20 deg

Question 13

symptoms of coccydynia

Answer 13

• pain in coccyx
• aggravated by transitions, sitting without weight-shift, defecation, intercourse

Question 14

physical exam findings of coccydynia

Answer 14

• TTP coccyx
• sitting posture - weight-shifted
• painful provocation testing

Question 15

physical exam findings of PPPP

Answer 15

• pain in lumbar region and over SIJs
• findings consistent with mechanical SIJD
• • active SLR test

Question 16

stress incontinence

Answer 16

• urethral or pelvic floor weakness
• incontinence with increased abdominal pressure

Question 17

urge incontinence

Answer 17

• overactive bladder
• often idiopathic but can be caused by meds, alcohol, bladder infections, bladder tumor, neurogenic bladder, bladder outlet obstruction
• trigger: cold, running water, “key in the door”

Question 18

mixed incontinence

Answer 18

combination of urge and stress

Question 19

overflow incontinence

Answer 19

• overdistention of the bladder and the bladder cannot empty completely
• urine leaks or dribbles out
• client does not have any sensation of fullness or emptying
• caused by acontractile or deficient detrusor muscle

Question 20

functional incontinence

Answer 20

• occurs when bladder is normal but mind and body are not working together
• occurs secondary to mobility or access deficits like confined to wheelchair, altered mentation

Question 21

What is diastasis recti abdominis (DR/DRA)? How do you treat this?

Answer 21

split between the 2 rectus abdominis muscles to the extent that the linea alba may split under the strain
- normal 1-2 finger width
- treat with TA activation