The Pelvis / Sacrum Flashcards
Classify the sacro-iliac joint
Diarthrosis = part synovial part fibrous
Forms base of the trunk and supports the abdominal contents
2 innominate bones thy contain the ilium, pubis and ischium, they fuse to make the pubis symphysis anteriorly
the SIJ posteriorly is formed by the fusion of the two bones and sacrum
Classify the public symphysis
A secondary cartilaginous joint
2 pubic rami covered in hyaline cartilage with fibrous disc inbetween
What are the major muscles across the pelvis and sacrum
What is their major roles and what does injury result in
Glut max and med
Last Dorsi
Mulifidus
Biceps femoris
Psoas
Piriformis
Transversus and obliquus abdominus
Role in locomotion and postural stability
Muscle injury usually affects weight bearing and loco-motion functions
What are the movement at the pelvis
Pelvic tilt
Forward / anterior = combo of hip flexion and lumbosacral hyper extension
Back/posterior = combo of hip extension and lumbosacral flexion
Right lateral tilt = combo of left lateral flexion of LS flex, abd of right hip and adduction of left hip
Left lateral tilt = combo of opposite to above
What are the movements of the sacro-iliac joint
Nutation and counternutation
How is the pelvic stabilised
Through the muscle system that crosses over and is used to aid stability around the pelvic region
Contralateral muscles but work in unison
How can we understand the affect that muscular dysfunction has in the pelvic girdle
We need to understand how the muscles work togther to aid stability to the pelvic girdle through 2 systems
The anterior oblique system of the outer unit
The posterior oblique system of the outer unit
What is the anterior oblique system of the outer unit
This system creates movement and stability around the pelvis when functioning properly
It includes the internal and external obliques, the contralateral adductors of the thigh and the intervening anterior abdominal fascia.
These muscles are contralateral but work in unison
What is the posterior oblique system of the outer unit
This includes the latissimus dorsi, glute max and the intervening thoracodorsal fascia
What is the inner unit of the body
What effect does it have on training
The abdominals
Activation of these muscles is caused when contracting the pelvic floor
If you incorporate the abdominal wall into training there is better ability to isolate the muscles of the pelvic floor
What are potential causes of pain in the pelvis / groin
Muscle strain
Ligament sprain
PG pain
Lymph node infection
Kidney stones
Legg-calve-perthes disease
Referred pain from lumbar region
SIJ dysfunction
Stress fracture
Bursitis
Synovitis of hip joint capsule
What are the symptoms of pelvic girdle pain (PGP)
Pain is experienced between the posterior iliac crest and gluteal fold
The pain may radiate into the posterior thigh
There is non-dermatomal pattern of pain described
What populations are vulnerable of pelvis pain
Women - pregnant and child birth
Sports that cause fatigue, asymmetry, impact, sustained posture or torsion to area
Trauma / RTA victims
Inflammatory / reactive arthritis / AS
Metabolic disease / infection
Post surgerical L gynaecological
What are subjective clues for sacro-iliac joint - pain discription
Unilateral pain
Dull ache
Not usually below the knee
Pain is localised over sacral sulcus and typically referred to groin, buttock and thigh
What are the aggs and eases in subjective examination for pelvic pain
Aggs = standing on one leg / turning over in bed / getting in or out of bed / stepping up on affected side / walking up or downhill
Eases = pelvic support belt
Are there any AM symptoms with pelvic pain
In anklylosing spondylitis the cardinal sign is erosion of the sacro iliac joints
Often this is pain and stiffness in the first few hours of the morning
What should be observed in objective examination of pelvic pain
Gait deviation
Stance abnormalities
Unequal weight distribution side to side
Difficult moving around from sitting to standing
Observe any hesitancy or gaurding
Check levels of ASIS and PSIS
What are spinal movement tests in standing for pelvic patient
Assess lumbar flexion, extension, side flexion, Rotation in sitting
What neurological tests can be done for patients with pelvic girdle pain
S1 myotome - ankle plantarflexion
Slump tests
Dermatomes of lower limb
Myotomes of lower limb
Reflexes of lower limb - patella and Achilles
Straight leg raise
Femoral nerve test
What special tests can be done for pelvic girdle pain objective assessment
Modified Trendelenburg test
Leg length
SI joint compressions
Gaenslens test
Hip quadrant tests
Mobilising techniques
What are SI joint tests when patient is supine
Compression - posterior force to both ASIS
Posterior gapping test - force applied to left and right ASIS to try and posh them togther
Posterior shear test - hip flexed to 90 degrees on painful side, pressure applied to flexed knee along femur
What is the gaeslens test for special tests in patients supine objective assessments
Patient clasps flexed knee towards abdomen, overpressure by therapist to fix lumbar spine
Opposite thigh is slowly hyper extended by the examiner by pressure over the knee
Positive = pain felt across SI joint
What SI joints tests are used when the patient is side lying
Longitudinal caudad - hip flexed to 90 degrees, longitudinal caudad force is allied to the ilium through iliac crest
Anterior rotation of the ilium = anterior pressure on the ASIS with cephalad pressure on ischial tuberosity
Posterior rotation of illium = posterior pressure on ASIS with anterior pressure on ischial tub
Compression test = painful side upmost
Apply compression force using both hands to anterior part of uppermost illium
What are SI joint tests when patient is prone lying
Sacral thrust - PA pressure over sacral base, body and apex
