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OCS Cards > SIJ, Pelvis > Flashcards

SIJ, Pelvis Flashcards

1
Q

What tethers the L5 vertebral body to the ilia?

A

Iliolumbar ligaments

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2
Q

In general, is the sacrum wider anteriorly or posteriorly?

A

Wider anteriorly / front

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3
Q

What joins the sacrum to the coccyx?

A

Fibrocartilaginous disk // symphysis

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4
Q

The pelvis being the midpoint of the skeleton results in it being greatest at what principle job?

A

Force attenuation - dissipates forces generated from walking, running, jumping

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5
Q

Activation of what two posterior chain muscles results in inc stiffness in the SIJ?

A

Glute max, biceps femoris

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6
Q

What becomes primary stabilizer when muscular system isn’t properly activated?

A

Ligamentous system -> inflammatory response

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7
Q

What is the ‘typical’ gold standard/reference standard for SIJ diagnosis?

A

Intraarticular block - BUT found extraarticular blocks also alleviated pain due to high prevalence of ligamentous involvement - inaccurate

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8
Q

True/false: the shape and alignment as well as sacral/pelvic ROM are similar from person to person, race to race, etc

A

False - highly variable, shape changes with age, between races, and can be different from one side of pelvis to other

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9
Q

What are the shapes of the sacrum and ilia? What motion primarily occurs at the joints?

A

Sacrum = concave
Ilia = convex
Boomerang shaped surface/ planar with biaxial motions to allow gliding (no rotation)

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10
Q

Four ligamentous structures for the sacrum: name the superior, anterior, inferior and posterior complex/ligaments

A

Superior: lumbosacral band of iliolumbar ligament
Anterior: anterior SI ligament
Inferior: sacrospinous ligament
Posterior: posterior interosseous, short posterior SI ligament (complex)

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11
Q

True/false: the sacrum and ilia maintain space during load

A

True - only approximate when ligaments are cut

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12
Q

What are normative values for SIJ ROM?

A

1 to 2.5 deg of rotation

0.4 to 0.9 mm of translation

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13
Q

What are normative values for pubic symphysis vertical translation for males, females?

A

Males 0.8 mm

Females 1.6 mm

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14
Q

Which ligament is considered a primary source of pain due to multidirectional fiber orientation?

A

posterior SI ligament

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15
Q

The biceps femoris shares an insertion with which ligament which aids with SIJ stabilization?

A

Sacrotuberous - inc biceps femoris force = inc tension on ligament

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16
Q

Sacrotuberous ligament resists what sacral motion?

A

Flexion/ nutation

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17
Q

Long dorsal sacroiliac ligament resists what sacral motion?

A

Extension/ counter nutation

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18
Q

Do the iliolumbar ligaments provide lumbosacral or sacroiliac stability?

A

Both - stabilizes L5 and restricts SIJ mobility

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19
Q

Generally, where does the upper section of the SIJ refer to:

A

Upper buttock, middle buttock, lateral thigh

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20
Q

Generally, where does the lower section of the SIJ refer to:

A

Middle buttock, lower buttock, thigh and lower leg

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21
Q

Hypertonicity in the piriformis

because of low back pain can result in sacral pain due to compression on what nerve?

A

S2 - nerve passes through belly of piriformis

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22
Q

Which type of closure does PT have an impact on in regards to the SIJ?

A

Force closure = muscle activation

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23
Q

Tensioning/strengthening of what UE muscle produces posterior fascial system tension and thus compression of the SIJ?

A

Latissimus dorsi

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24
Q

In the lumbar spine, which group of the erector spinae does not have an attachment?

A

Spinalis

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25
Q

What two muscle groups provide guy wire support and dynamic restraint to anterior/posterior shear forces to the SIJ?

A

Erector spinae and iliopsoas/psoas major

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26
Q

What muscle adds to guy wire support, providing inferior support for the SIJ?

A

Quadratus lumborum

27
Q

True/false: multifidus size remains the same through each region of the spine.

A

False - much larger in the lumbar region

28
Q

Multifidus in the lumbar region tension what fascial layer?

A

Erector spinae aponeurosis - produces extensor torque

29
Q

True/false: multifidus demonstrate fibrosus and/or atrophy after surgery/injury?

A

True - fibrosis with surgery and atrophy with low back pain which does not resolve when pain does

30
Q

What muscle attaches to the iliac crest between the bands of iliolumbar ligament and then to the 12th rib as well as transverse processes of L1-4?

A

Quadratus lumborum

31
Q

What muscle is one of the most important muscles in stability of the lumbopelvic mechanism?

A

Glute max - tenses thoracolumbar fascia, tenses TFL for lateral stability with insertion on femur

32
Q

In single leg stance, how many times body weight is on the stance leg?

A

3-4x times - tensing glute and TFL

33
Q

Psoas major attaches on all lumbar bodies and disks except?

A

L5

34
Q

What major hip flexor/trunk flexor atrophies in the presence of low back pain?

A

Psoas major - results in altered recruitment patterns

35
Q

What other muscle group can have decreased function during low back pain resulting in ASLR?

A

Pelvic floor

36
Q

Persistent lumbopelvic pain at 3 months postpartum is referred to as what diagnosis?

A

Pregnancy related pelvic girdle pain (PGP) - 50% of all pregnant women

37
Q

What are effective treatments coupled with pelvic floor training to treat urinary incontinence?

A

Diaphragmatic breathing
Abdominal strengthening
Functional expiratory patterns

38
Q

What ilial rotation is coupled with hip extension?

A

Anterior

39
Q

What ilial rotation is coupled wtih hip flexion?

A

Posterior

40
Q

What inflare occurs with hip IR (on axis)?

A

ASIS medial rotation / PSIS lateral rotation

41
Q

What outflare occurs with hip ER (on axis)?

A

ASIS lateral rotation/ PSIS medial rotation

42
Q

When the trunk extends, what action does the sacrum tend to perform? (lumbar lordosis)

A

Sacrum tends to flex/ nutate

43
Q

When the trunk flexes, what action does the sacrum tend to perform? (lumbar kyphosis)

A

Sacrum tends to extend/ counter nutate

44
Q

What five tests did Laslett use for SIJ provocation testing?

A

1) thigh thrust
2) sacral thrust
3) compression
4) gapping
5) Gaenslen

45
Q

What five tests did Van der Wurff use for SIJ provocation testing?

A

1) thigh thrust
2) ASIS compression
3) FABER
4) Gaenslen
5) ASIS gapping

46
Q

What is the HABER test and what are its implications in SIJ testing/pathology?

A

Placing pt in prone and performing incremental motion of 10 deg of hip abduction and ER - can discriminate in those with SIJ pain versus LBP

47
Q

What is a named area generally painful area for the SIJ and where is it located?

A

Fortin’s area - 3 cm lateral, 10 cm caudal to PSIS

48
Q

What has more value with palpation in the SIJ, ligamentous or bony palpation?

A

Ligamentous - may have more sensitivity

49
Q

What is the Stork/standing hip flexion test looking at/for? (knee flexion, hip flexion, posterior rotation of ilium, lumbar flexion, sacral extension)

A

For mobility of the SIJ - pelvis may hike in frontal plane, rotate in transverse plane - SIJ may not allow innominate to rotate posteriorly –watching side to side differences in movement pattern

50
Q

What is the contributed value of lumbar flexion and hip flexion for lumbopelvic rhythm?

A

60 deg lumbar flexion, 60 deg hip flexion

51
Q

What are functional tests for pelvic pain, which are more specific for confirming pelvic pain?

A

1) deep squat
2) 8” lateral step up
3) lunging

52
Q

Differentiating between LBP and PGP, in which pathology will you see more lumbar motion than pelvis/hip motion?

A

PGP - pelvic girdle pain

Will see more hip/pelvic motion with LBP

53
Q

How long, typically, does it take for pelvic girdle pain to resolve spontaneously after childbirth?

A

6-12 months

54
Q

What two diagnoses may be discerned by assessing the levelness of the sacral base via radiographs?

A

1) idiopathic scoliosis

2) leg length discrepancy

55
Q

What are five factors for screening for cauda equina?

A

1) saddle anesthesia
2) bladder dysfunction
3) sexual dysfunction
4) bowel dysfunction
5) neurological deficits in the LE

56
Q

What are the 3 clinical features of cancer:

A

1) age > 50
2) hx of cancer
3) no improvement in one month intervention

57
Q

What active combination of movement for the LE is 95% specific for pelvic fractures?

A

Active hip flexion with knee extension

58
Q

What diagnosis is common in IV drug use, inflammatory bowel disease, develops in post operative infections and correlates with septic infection?

A

Chronic destructive pyrogenic sacroilitis

59
Q

What are sxs of Reiter’s syndrome (reactive arthritis)?

A
  • Conjunctivitis
  • pain/stiffness in knees/ankles/feet
  • inc frequency, discomfort with urination
  • enthesitis (pain at soft tissue insertion on bone) -> SIJ
  • low back pain
60
Q

What are the two most useful Rivels criteria to rule in/rule out facet joint as source of pain?

A

1) absence of pain during cough/sneeze

2) no pain when rising from flexed seated posture

61
Q

What test is most specific in ruling in facet joint for source of low back pain?

A

Extension rotation test / Kemps test - positive will reproduce pain at low back for facet inclusion

62
Q

What stance test for > 30 seconds rules out PGP?

A

Single leg stance - absence of pain, can rule out pelvis/SIJ

63
Q

Are pelvic belts like other spinal supports and cause weakness?

A

No, decrease pain and improve stability but don’t cause weakness

OCS Cards (23 decks)

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