The Pelvis and Sacroiliac Joints Flashcards
What innervates the SIJ?
dorsal rami of spinal nerves S1-S4
Pain from the SI joint is generally localized in what region?
gluteal (94%)
In the vertical plane, the ASIS should be aligned with what bony landmark?
pubic tubercles
There is normally less than _ degrees of rotation and _ mm of translation at the SI joint.
4
2
What type of joint is the SI joint?
true diarthrodial joint
In the SI joint _____ cartilage on the sacral side moves against ________on the iliac side.
hyaline
fibrocartilage
Which are the most commonly disrupted and/or torn ligaments of the pelvis?
the iliolumbar ligament and the posterior sacroiliac ligament
Which ligaments resist the load of the sacrum relative to the ilium?
The deep anterior, posterior, and interosseous ligaments
What is the most common symptom of SI joint dysfunction?
Pain in the lower back or the back of the hips
What is the most common cause of SI joint dysfunction? What is another cause?
osteoarthritis
pregnancy
How does lumbar extension/lordosis affect the sacrum?
It increases sacral nutation/flexion
How does lumbar flexion affect the sacrum?
It increases sacral counter-nutation/extension
With an anterior pelvic tilt, what muscles are strong but tight?
Hip flexors (iliosoas and rectus femoris) and back extensors (erector spinae)
With an anterior pelvic tilt, what muscles are stretched but weak?
Abdominals (rectus abdominis) and hamstrings and hip extensors (hamstrings and glute max)
sacral flexion = sacral _____
sacral extension = sacral _______
nutation
counter-nutation
When the trunk flexes what does the pelvis do? What does it do when the trunk extends?
Posterior tilt
Anterior tilt
When the trunk laterally flexes to the left what does the pelvis do?
Lateral tilt to the left
When the trunk rotates to the left what does the pelvis do?
rotates to the left
When the hip flexes bilaterally what does the pelvis do? What does it do when the hip extends bilaterally?
posterior tilt
anterior tilt
When the left leg flexes and the right leg extends at the hip what does the pelvis do?
The left side posteriorly tilts and outwardly rotates, while the right side anteriorly tilts and inwardly rotates
In order for there to be lateral pelvic tilt to the right what muscles have to contract?
left quadratus lumborum
right hip abductors
In order for there to be pelvic rotation to the right what muscles have to contract?
left lumbar rotators
left hip external rotators
right hip internal rotators
What does the trabecular system of he bony pelvis follow?
the weight-bearing Lines
With an lateral pelvic tilt to the left, what muscles are strong but tight?
right pelvis elevators and left hip abductors
With an lateral pelvic tilt to the left, what muscles are stretched but weak?
left pelvis elevators and right hip abductors
In standing when the right knee is flexed the pelvis drops to the ___ side
same
What is the purpose of the standing flexion test?
to assess sacroiliac joint dysfunction
What is a positive result for the standing flexion test?
If one PSIS moves further cranial than the other
When you receive a positive standing or seated flexion test for SIJ what side is affected?
The side with the higher PSIS is the affected side with less SI Joint motion causing movement of the ilium instead of movement at the SI joint.
What is the purpose of the Weber–Barstow Maneuver?
“resets” the pelvis and limbs prior to leg length testing
How is the Weber–Barstow Maneuver performed?
1) Examiner holds the feet of the patient and places the thumbs over the medial malleoli while providing slight traction on the legs
2) The patient is then asked flex both knees and hips to approximately 45°
3) The patient is then instructed to reset the pelvis by lifting the gluteals off of the table and then gently lowering himself or herself back down
What are the positive test implications of the Weber–Barstow Maneuver?
Femoral length difference (lateral view–increased anterior position)
Tibial length difference (front view–increased height difference)
How is Alli’s test performed?
1) The ASIS’s are aligned in the same frontal plane and transverse plane
2) The medial maleolli are placed together
How do you determine if there is a positive result from the Alli’s test?
When viewing from above you can determine if there is a femoral length difference
When viewing from the front you can determine if there is a tibial length difference
What is the importance of the Supine to Long Sitting Test?
To assess the contribution of the sacroiliac joint to an apparent leg length discrepancy
How is the Supine to Long Sitting Test performed?
1) The examiner grasps the patient’s legs above the ankles and fully flexes them, then extends them.
2) The examiner then compares the two medial malleoli to see if a difference in position is present. 3) Have the patient sit up, while keeping the legs extended.
4) Compare the position of the medial malleoli again to see if there is a change.
When moving from supine to long sit the limb appears to lengthen in long sitting indicates what?
posterior innominate rotation
Why does the posterior innominate appears to lengthen following the sit-up?
because activation of the hip flexors anteriorly rotates the innominate to return it to its normal position
When moving from supine to long sit the limb appears to shorten in long sitting indicates what?
indicates anterior innominate rotation
How is true leg length measured?
By measuring the distance from the ASIS to the medial malleoli with a flexible tape measure
A difference of approximately _ cm is considered “normal length”
1
Patrick’s Sign is aka what?
FABER (flexion abduction external rotation) test
In what position is the patient for the FABER test
supine with their leg placed in a “figure-4” position
How is the Gaenslen’s test performed?
The patient is lying on their back, lifting the knee to push towards the patient’s chest while the other leg is allowed to fall over the side of an examination table, and is pushed toward the floor, stressing both sacroiliac joints
7 compensations of leg length asymmetry
- the COG to be shifted to the short leg side
- pelvic tilt to the short side
- lumbar scoliosis convex to the short side
- knee flexion (increased on the long side)
- genu recurvatum (on the short side)
- subtalar joint pronation (on the long side)
- ankle plantar flexion and foot supination (on the short side)
What are positive results of Hibb’s test?
Pain occurs early it is probably in the hip joint indicates a hip lesion
Pain occurs late it is probably rising from the sacroiliac joint, but not the hip, points to a sacroiliac lesion
When performing Goldthwaite’s test if pain occurs between 1º to 30º what should be suspected?
Sacroiliac lesion
When performing Goldthwaite’s test if pain occurs between 30º to 60º what should be suspected?
Lumbosacral lesion
When performing Goldthwaite’s test if pain occurs between 60º to 90º what should be suspected?
L1–L4 disc lesion
What can be seen in lower cross syndrome?
- Lumbar Hyper-lordosis
- Anterior Pelvic Tilt
- External Rotation of the Leg
“Dead butt syndrome” is associated with a weak _____ muscle.
gluteus medius
What often causes “Dead butt syndrome”?
lack of cross-training while competing in marathons
The Iliocostalis erector spinae muscle attaches from what to what?
rib to rib
The Longissimus erector spinae muscle attaches from what to what?
transverse process to transverse process
The Spinalis erector spinae muscle attaches from what to what?
spinous process to spinous process
Where is the iliacus tenderpoint located?
2 to 3 cm caudal to the point halfway between the ASIS and the midline, deep on the side of the dysfunction
In normal standing posture where does the line of gravity fall through the pelvis? What does this mean in reference to where body weight is transferred?
The line of gravity falls posterior to the center of the acetabula, and thus most of the weight of the trunk is transmitted through the posterior pelvis.
What is the most common form of SIJ dysfunction?
Downward wedging of the sacrum during an anterior pelvic tilt
**Think of someone using incorrect body mechanics to lift something or someone landing hard on their butt or leg
When the innominate rotates anteriorly and downward on the sacrum, does the leg appear longer or shorter?
longer
So in order to correct leg length discrepancies how should you rotate the innominate?
Rotate the innominate on the involved side, upward and posteriorly on the sacrum
If anterior SIJ dysfunction is unilateral when the patient is standing, will the SIJ and the PSIS be higher on the affected or unaffected side?
affected
If anterior SIJ dysfunction is unilateral in sitting, will the PSIS will be higher on the affected or unaffected side?
affected
When the innominate rotates posteriorly what muscle and what nerve are stretched?
the biceps femoris and the sciatic nerve
Are tight hip flexors or extensors associated with anterior innominate rotations?
tight hip flexors ipsilaterally
Describe the positions of the ASIS, PSIS, and rami with anterior innominate rotations
ASIS is inferior
PSIS is superior
Rami are symmetric
Are tight hip flexors or extensors associated with posterior innominate rotations?
tight hip extensors ipsilaterally
Describe the positions of the ASIS, PSIS, and rami with posterior innominate rotations
ASIS is superior
PSIS is inferior
Rami are symmetric
When testing for innominate rotations will you get positive or negative test result using the Standing Flexion Test? What about the Seated Flexion Test
(+) StFT, (-) SeFT on ipsilateral side
Are tight hip flexors or extensors associated with inferior pubic shears?
tight hip flexors
During inferior pubic shears is the hemi-pelvis rotated anteriorly or posteriorly?
anteriorly (this causes resistance to posterior motions)
Describe the positions of the ASIS, PSIS, and rami with inferior pubic shears
ASIS is inferior
PSIS is superior
Pubic ramus is inferior
Are tight hip flexors or extensors associated with superior pubic shears?
tight hip extensors ipsilaterally
During superior pubic shears is the hemi-pelvis rotated anteriorly or posteriorly?
posteriorly (this causes resistance to anterior motions)
Describe the positions of the ASIS, PSIS, and rami with superior pubic shears
ASIS is superior
PSIS is inferior
Pubic ramus is superior
An out-flared innominate is due to what muscle groups being tight?
Tight hip extensors and abductors ipsilaterally
How is the hemi-pelvis rotated in an out-flared innominate?
It is rotated laterally which causes resistance to medial motion
Describe the positions of the ASIS, PSIS, and rami with out-flared innominates
ASIS is lateral on ipsilateral side, but rami and PSIS are symmetric
An inflared innominate is due to what muscle groups being tight?
tight hip flexors and adductors ipsilaterally
How is the hemi-pelvis rotated in an inflared innominate?
It is rotated medially which causes resistance to lateral motion
Describe the positions of the ASIS, PSIS, and rami with an out-flared innominate
ASIS is medial on ipsilateral side, but rami and PSIS are symmetric
What is another way you can determine if an innominate is inflared or out-flared?
In an out-flared innominate the distance between the umbilicus and the ASIS is longer on the ipsilateral side.
In an in-flared innominate the distance between the umbilicus and the ASIS is shorter on the ipsilateral side.
Describe the positions of the ASIS, PSIS, and rami with an up-slipped innominate
ASIS, PSIS, and pubic rami are superior on ipsilateral side
Describe the positions of the ASIS, PSIS, and rami with a down-slipped innominate
ASIS, PSIS, and pubic rami are inferior on ipsilateral side
