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Lifespan > Test 2: Pelvic Health Intro > Flashcards

Test 2: Pelvic Health Intro Flashcards

1
Q

what area is defined as the pelvis and what makes up the greater and lesser portions

A

pelvis = area between trunk and lower limbs

greater pelvis = occupied by inferior abdominal organs as means of protection

lesser pelvis = skeletal framework for pelvic cavity and perineum

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2
Q

what overlaps the pelvis anteriorly, posterolaterally, and inferiorly

A

anterior = inferior anterolateral abdominal wall

posterolaterally = gluteals

inferiorly = perineum

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3
Q

pelvic ring is composed of what 3 bones

A

L and R coxae/coxal bones

sacrum

coccyx

pelvic ring has an inlet and an outlet

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4
Q

describe the interlocking of the SI joint

A

auricular surfaces of the sacrum aid in form closure of SIJ

females have a smaller surface area than males

form closure = passive

force closure = musculature

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5
Q

pelvic girdle anatomy shape males vs females

A

females = circular inlet

males = heart shaped

** lots of variation in pelvic height and girdle shape

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6
Q

ways to describe the biological female/ “gynecoid” pelvic girdle

A

shorter/wider/lighter

ITs further apart

oval/tounded pelvic inlet

large pelvic outlet

wide/obtuse pubic arch and subpubic angle

obturator foramen = oval

acetabulum = small

SIJ = small joint surface

coccyx = smaller

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7
Q

ways to describe biological male/”android” pelvic girdle

A

taller/narrower

thicker/heavier

heart shaped pelvic inlet

small pelvic outlet

narrow/V-shaped/acute pubic arch and subpubic angle

round obturator foramen

large acetabulum

large joint surface of SIJ

larger coccyx

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8
Q

orientation of the pelvic girdle

A

L and R ASIS’s and anterior aspect of the pubic symphysis lie in the same vertical plane (anteriorly oriented)

tip of coccyx appears close to the venter of the pelvic inlet

laterally = sacral promontory is directly superior to the center of the pelvic outlet)

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9
Q

describe the joint architectire of the SIJ

A

strong and weight bearing compound joint

anterior = synovial (between sacrum and ilium + articular cartilage); interlocking; limited mobility

posterior = syndesmotic between tuberosities of sacrum and ilium

joint remains stable as long as apposition (close relationship/congruency) is maintained

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10
Q

how is weight transferred in SIJ

A

from axial skeleton to ilia via SI ligaments

then to femurs when standing

to ITs when sitting

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11
Q

describe sacrotuberous ligaments

A

fibers from posterior margin of ilium/lateral sacrum/base of coccyx pass to IT

divides large sciatic notch (forming large sciatic foramen)

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12
Q

describe sacrospinous ligament

A

fibers from lateral sacrum and coccyx pass to ischial spine

divides large sciatic foramen (created by sacrotuberous ligament) to then create lesser and greater sciatic foramen

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13
Q

describe the pubic symphysis joint

A

it is a secondary cartilaginous joint

fibrocartilage disc and surrounding ligaments unite bodies of the pubis

fibers of the tendinous attachments of the rectus abdominis and external obliques strengthen the pubic symphysis anteriorly

wider in females

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14
Q

describe the sacrococcygeal joint

A

secondary cartilaginous joint with intervertebral disc

fibrocartilage and ligaments join the apex of sacrum to the base of the coccyx with long strands of anterior and posterior sacrococcygeal ligaments to reinforce joints

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15
Q

describe the lumbosacral joints

A

L5-S1 articulate at the inververtebral joint between IV disc between their bodies and the 2 posterior zygapophysial joints between articular processes of vertebrae

facets of S1 vertebrae face posteromedially with anterolaterally facing inferior articular facets of the L5 vertebrae

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16
Q

SIJ ROM

A

greatest flexion/extension at 3 deg

1.5 deg axial RT

0.8 deg lateral flexion

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17
Q

max ROM of SIJ

A

males = 1.2 deg

females = 2.8 deg

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18
Q

average translation of SIJ

A

0.7-2mm

higher in unilateral vs bilateral stance

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19
Q

ortho considerations for pelvic ring fxs

A

can occur with:
- crush accident
- fall from height
- MVA

often encountered post sx in acute care/IPR

unlikely to have just a single fx

pelvic fxs often result in soft tissue damage (i.e. nerves, organs, blood vessels, etc)

may result in rupture, transection, or torn urethra

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20
Q

what happens to pelvic joints/ligaments with pregnancy

A

increased mobility and relaxation of ligaments

increase in intrapubic disc space

increase in flexibility of ligaments/pubic symphysis due to relaxin in latter 1/2 pregnancy

relaxation of ligaments can cause SIJ instability

side to side and transverse demensions may change but the true obstetric diameter remains unchanges

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21
Q

risk factors for pelvic girdle pain

A

prior hx pregnancy

orthopedic dysfunctions

increased BMI

smoking

work dissatisfaction

lack of believe of improvement in the prognosis of pelvic girdle pain

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22
Q

red flags with PGP that may indicate something more serious

A

not associated with the described clinical course of PGP

impairments failing to normalize

symptoms are worsening with increased disability

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23
Q

possible comorbidities associated with PGP population

A

transient osteoporosis

MSK involvement of pelvic floor, hip, L/S

diastasis rectus abdominis (DRA)

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24
Q

recommended measures for PGP

A

oswestry disability index (ODI)
disability rating index
pelvic girdle questionnaire (PGQ)
fear avoidance beliefs questionnaire (FABQ)
pain catastrophizing scale (PCS)

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25
Q

antepartum pelvic girdle pain interventions (based on CPG)

A

pelvic girdle/SIJ belts
- conflicting evidence
- varied duration and applications

exercise

manual therapy
- evidence emerging/weal
- little/no evidence of adverse effects

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26
Q

who is defined as postpartum

A

anyone 12 months post delivery or anyone still breastfeeding given the altered hormone status

*pt can be altered hormone status up to 6 months post weaning

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27
Q

risk factors for PGP postpartum

A

previous hx lumbar or PGP during pregnancy

pain in posterior pelvis

pain rolling in bed

pain WBing

multiparity

depressive S&S

higher pregnancy BMI

work factors

breastfeeding position

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28
Q

systems screen for postpartum individuals with PGP

A

depression

urinary and fecal incontinence and refer to pelvic PT of S&S are present

abdominal wall, back, and hip screen

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29
Q

when to refer to imaging to rule out a stress fx when pt has PGP

A

within 2 weeks of delivery with:
- severe pain
- decreased ability to weight bear
- antalgic gait/limp
- sudden onset SIJ pain, butt, or LBP

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30
Q

exam components to consider with PGP

A

strong evidence for clinical presentation during fucntional mobility

P4 test

FABER

ASLR for supine limb loading/pelvic stabilization

force production, endurance, resting mm tone/length

should NOT perform gaenslens withing firdt 4 weeks postpartum or beyond 4 weeks postpartum in the presence of pubic symphysis pain

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31
Q

interventions for PGP postpartum

A

strong evidence for SIJ/pelvic belt

MT no better than stabilization for long term involvement (>6 months)

strong evidence that MT used with cointerventions can provide short term relief of pain and disability

strong evidence for strengthening of pelvic floor, core, and hip strengthening

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32
Q

prognosis for PGP postpartum

A

depends on initial pain and disability scores
- higher scores recover quicker and return to function
- low scores demonstrate minimal gains; may still have S&S 1-2 years later

present to PT >3 months after delivery = minimal to low gains- ADVOCATE FOR EARLY POSTPARTUM CARE

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33
Q

anterior/inferior pelvic wall is formed by what and bears the weight of what

A

formed by bodies and rami of the pubic bones and pubic symphysis

bears weight of bladder

34
Q

lateral pelvic walls are formed by what

A

R and L innominates

each has an obturator foramen, closed by obturator membrane

35
Q

what covers the internal aspect of the obturator membrane/foramen and pads the lateral pelvic walls

A

obturator internus

OI fibers converge posteriorly with other deep external rotators, pass through the lesser sciatic foramen to attach to the greater trochanter

36
Q

obturator fascia has an opening to allow what to pass through

A

aka pudendal canal or alocks canal

pudendal nerve, internal pudendal artery, and internal pudendal vein

37
Q

what forms the posterior wall/posteriorlateral wall and roof of the pelvic cavity

A

bony wall via sacrum and coccyx

musculoligamentous posterolateral walls = ligaments associated with B SIJs and piriformis (sacroiliac, sacrospinous, and sacrotuberous)

38
Q

where does the piriformis run

A

from superior sacrum

passes laterally leaving pelvis via greater sciatic foramen

attaches to greater trochanter

occupies much of the greater sciatic foramen forming the posterolateral walls

39
Q

where does the coccygeus mm run

A

ischial spine to body of pubis to inferior end of sacrum and coccyx

40
Q

what muscles make up the levator ani and where do they run

A

puborectalis: pubis, around rectum, and back to pubis (most medial mm)

pubococcygeus: pubis to coccyx; wide and thin middle portion

iliococcygeus: pubis to ilia; posterolateral, more aponeurotic, blends with anococcygeal ligament

41
Q

what is a urogenital hiatus

A

anterior gap between medial borders of levator ani on each side

passage for urethra and vagina

42
Q

pelvic diaphragm is composed of what

A

coccygeus

levator ani mm

urogenital hiatus

43
Q

what is the perineal membrane

A

dense fibromuscular tissue deep to the superficial pelvic floor musculature

home to striated urogenital complex

44
Q

describe the striated urogenital complex

A

straited, known as external urethral sphincter

slow twitch that fuse with bladder and encircle the upper 2/3 of the urethra in females

lower 1/3 divides urethrovaginal sphincter and the compressor urethra

provides majority of striated mm compression at the urethra, 1/3 of the resting closure pressure

45
Q

significance of male urethral location

A

EUS is inferior to prostate

can lose voluntary control temporarily or long term

46
Q

describe the contraction of the levator ani of the pelvic floor

A

levator ani forms dynamic floor for supporting abdominopelvic viscera
- tonically contracted most of the time
- full relaxation should occur for defecation, urination, and parturition
-ACTIVELY contracted during forced expiration/management of intra abdominal pressure

47
Q

pelvic floor roles/functions

A

sphincter/continence control

role in stability and posture

sexual function

load transmission (GRF up from LEs to spine)

48
Q

PFM support the fetal head while the cervix is dilating; what is the clinical relevance of this info

A

may lead to injuries of perineum, levator ani, or ligaments of the pelvic fascia

may decrease support of vagina, uterus, bladder, ad or rectum, especially during increases in intra-abdominal pressure - stress urinary incontinence

49
Q

PFM stretch over 3x normal resting length with labor; what is the relevance of this

A

even if a tear doesnt occur, a muscle overstretch injury may occur

perineal body may serve as protective component to overstretching/ stretching more than the mm itself

pudendal nn may also be at risk for stretch or compression injuries

50
Q

describe the parietal peritoneum and its location/function with the pelvic region

A

parietal peritoneum is continuous with abdominal cavity but does not reach the pelvic floor

DOES reach ovaries and uterine tubes

region superior to bladder = not firmly bound to underlying structures = creates supravesical fossa depending on bladder fullness

peritoneum passes over fundus and entire posterior aspect of the uterus onto posterior vaginal wall before reflecting up to the anterior wall of rectum

51
Q

how is the peritoneum different in males

A

peritoneal fold passes over ureter and ductus/vas deferens - separates paravesical and pararectal spaces (male equivalent of broad ligament)

52
Q

describe the parietal and visceral fascia

A

connective tissue that occupies the space between the membranous peritoneum and muscular pelvic walls and floor not occupied by pelvic viscera

continuous, thin endoabdominal fascia that lies between mm abdominal walls and peritoneum

loose and condensed endoplevic fascia

53
Q

6 main arteries that enter the lesser pelvis of females

A

paired internal iliac

paired ovarian arteries

unpaired medial sacral and superior rectal arteries

54
Q

4 main arteries that enter the lesser pelvis of males

A

paired internal iliac

unpaired median sacral and superior rectal

55
Q

internal iliac arteries supply what

A

most of the blood to pelvic viscera

some MSK portions of the pelvis

gluteal, medial thigh, and perineal regions

56
Q

veins of the pelvic vasculature

A

pelvic venous plexus

internal ilia cvein

no veins accompany umbilical arteries between pelvis and umbilicis adn the iliolumbar veins from the iliac fossa drain the common iliac veins instead

57
Q

function of the superior gluteal veins

A

largest tributaries of internal iliac veins except during pregnancy when uterine veins become larger

58
Q

path of testicular veins

A

traverse greater pelvis

pass from deep inguinal ring toward posterior abdominal terminations

do not usually drain pelvic structures

59
Q

function of lateral sacral veins

A

often disproportionally large

anastomose with internal vertebral venous plexus; provide alternate pathways to reach either the inferior or superior vena cava

may also provide a path for metastasis for prostate or ovarian cancer

60
Q

rectal blood supply

A

superior rectal = top of rectum

R and L middle rectal aa (from internal iliac) = middle and inferior

61
Q

blood from rectum drains into what veins

A

superior, middle, and inferior rectal veins

rectal venous plexus

62
Q

innervation of rectum

A

sympathetic = lumbar splanchnic nn and hypogastric/pelvic plexus

parasympathetic = S2-S4 SC passing via pelvic splanchnic nn and L and R inferior hypogastric plexus

63
Q

describe the external iliac lymph nodes

A

above pelvic brim, along external iliac vessels

recieve lymph from inguinal nodes, pelvic viscera, superior pelvic region specifically

do not recieve drainage from parallel nodes

64
Q

describe the internal iliac lymph nodes

A

clustered around anterior and posterior divisions of internal iliac artery and origins of gluteal arteries

receive drainage from inferior pelvic viscera, deep perineum, and gluteal region and drain into common iliac nodes

65
Q

describe the sacral lymph nodes

A

in concavity of sacrum, adjacent to medial sacral vessels

recieve from posteroinferior pelvic viscera and drain into internal or common iliac nodes

66
Q

describe common iliac lymph nodes

A

superior to pelvis along common iliac blood vessels

recieve from external iliac, internal iliac, and sacral lymph nodes

67
Q

urinary organs that make up the pelvic viscera

A

pelvic portions of ureters

bladder (rests on pubic bones and symphysis and on the prostate in males)

68
Q

length of ureters in men vs women

A

men = 18-22 cm

women = 4cm

69
Q

describe the bladder/its position

A

apex points to pubic symphysis

fundus/back of bladder is separated from rectum in males by a fascial septum but it is directly related to the superior anterior wall of the vagina in females

bladder primarily composed of detrusor mm

internal urethral sphincter is at the bladder neck

70
Q

what is the rectum connected to/where is it located relatively

A

continuous with sigmoid colon; junction is approximately at S3

rectum ends at tip of coccyx/anal sphincter

71
Q

female internal genital organs

A

ovaries
uterine tubes
uterus
vagina

72
Q

male internal genital organs

A

epidymides/epidymis

ductus deferens/vas deferens

seminal glands

ejaculatory ducts

prostate

bulbourethral glands

73
Q

what is benign prostatic hypertrophy

A

prostate continues to grow and BPH will affect virtually all males over 80

common after mid life

obstructions may occur; increases risk for UTI; can be relieved endoscopically

TURP (transurethral resection of the prostate) may be used in episodes of prostate cancer or in severe obstruction cases of BPH (risk of urinary incontinence and loss of sexual function)

74
Q

reasons for urinary referrals in pelvic health

A

stress
urge
mixed incontinence
retention

75
Q

reasons for bowel referrals in pelvic health

A

constipation

fecal incontinence

76
Q

reasons for pelvic pain referrals in pelvic health

A

pain at rest
dyspareunia
pain with activity (vulvodynia, vaginismus)
pelvic organ prolapse
coccydynia

77
Q

what hx questions to ask in a pelvic floor eval

A

OBGYN hx
bladder/bowel hx/S&S
pain symptoms
sexual activity
tobacco
falls/trauma
abuse
meds
sx
imaging

78
Q

objective measures for pelvic floor

A

pelvic floor distress intentory PFDI modules (pain, urinary, bowel, prolapse)

Oswestry disability index

LEFS/lower extremity functional scale is an option with concomitant LE impairment

depression inventories

79
Q

different portions of the pelvic floor exam

A

sensory
- light touch
-sharp/dull (if necessary)

reflexes
-anal wink
- cremaster reflex (males)

external
- perineal body mobility testing (ROM of pelvic floor)

internal
- strength test via laycock’s perfect scale
- prolapse testing

coordination

80
Q

PF mm interventions

A

uptrain with respiratory coordination

downtrain with respiratory coordination

coordination training

strategy training/return to activity

exercise with PFM coordination/timing

modalities
- biofeedback
-Estim
-rehabilitative US imaging

tools
- dilators
- therapeutic wands

encourage general mobility/activity

81
Q

how to structure goals with PF therapy and examples

A

should be pt specific and reflectve of objective measures gathered

i.e.
- decrease incontinence pad use
- pain reduction
- fiber/water intake
- SUI goals
- change in PFDI, oswestry, etc

82
Q
A

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