Term
| Clinical examinations must take into account what (5) structures? |
|
Definition
| lumbar spine, sacroiliac joint, sacrococcygeal joint, pubic symphysis, hip |
|
|
Term
| where do the ilium, ischium, and pubic bone fuse to form each innominate |
|
Definition
|
|
Term
| where do each of the innominates articulate with each other? |
|
Definition
|
|
Term
| why is the pubic symphysis classified as a symphysis? |
|
Definition
| no synoival tissue or fluid, contains a fibrocartiagnious disc |
|
|
Term
| The bone surfaces of the pubic symphysis are covered with what type of cartilage? |
|
Definition
|
|
Term
| what is the role of the sacrum |
|
Definition
| provide stability to the area and transmits the weight of the body from the mobile vertebral column to the pelvic region |
|
|
Term
| the SIJ is considered what type of articulation? |
|
Definition
|
|
Term
| how many fused vertebra make up the sacrum |
|
Definition
|
|
Term
| how many vertebra make up the coccyx? |
|
Definition
|
|
Term
| How many FUSED vertebra are in the coccyx? |
|
Definition
|
|
Term
| Convex/Concave relationships: the sacrum takes what shape? |
|
Definition
|
|
Term
| the sacrum has what type of cartilage on it? |
|
Definition
|
|
Term
| the sacrum has what type of cartilage on it? |
|
Definition
|
|
Term
| convex/concave: what shape does the ilium take? |
|
Definition
|
|
Term
| type of cartilage on the ilium |
|
Definition
|
|
Term
| what type of articulation is the ilium? |
|
Definition
| synovial articulation or diarthroidal |
|
|
Term
| SIJ is thought to recieve innervations ranging from what? |
|
Definition
| L3-S2 ventral or dorsal rami |
|
|
Term
| What produces a very diffuse patttern of pain referral from the SIJ? |
|
Definition
| joint's highly variable and complex innervation |
|
|
Term
|
Definition
| Anterior SIJ, Iliolumbar, Sacrospinous, ANterior Longitudinal, interosseous, sacrotuberous, long/short posterior SIJ |
|
|
Term
| LIgament which is an anterior-inferior thickening of the fibrous capsule |
|
Definition
|
|
Term
| Relatively weak and thin SIJ ligament compared to the rest of the sacroiliac ligaments |
|
Definition
|
|
Term
| where is the anterior SIJ ligament located |
|
Definition
| extends between teh anterior and inferior borders of the iliac auricular surface and the anterior border of the sacral auricular surface |
|
|
Term
| Short ligament deepd to tohe dorsal sacroiliac ligament |
|
Definition
|
|
Term
| ligament which forms the major connection between the sacrum and the innominate, filling the irregular space posterior-superior to the jt between the lateral sacral crest and the iliac tuberosity |
|
Definition
|
|
Term
| ligament comprised of 3 large fibrous bands broadly attached by its base to the posterior inferior iliac spine, lateral sacrum, and partly blended with the dorsal sacroiliac ligament |
|
Definition
|
|
Term
| 2 roles of the sacrotuberous ligament |
|
Definition
| stabilizes against nutation (forward rotation) of the sacrum, counteracts against the dorsal and cranial migration of the sacral apex during weight bearing |
|
|
Term
| Role of the sacrospinous ligament |
|
Definition
| counteracts against nutation of the sacrum |
|
|
Term
| where does the sacrospinous extends from/to (3) |
|
Definition
| from ischial spine, to lateral marigns of the sacrum and coccyx and laterally to the spine of the ischium |
|
|
Term
| the dorsal sacroiliac ligament (long ligament) connects what structures together (3) |
|
Definition
| PSIS and small part of the iliac crest with the lateral crest of the third and 4th segement of the sacrum |
|
|
Term
| What motion will slacken the dorsal sacroiliac ligament? |
|
Definition
| sacral nutation (anterior motion) |
|
|
Term
| What motion of will tauten the dorsal sacroiliac ligament |
|
Definition
| counternutation (posterior motion) |
|
|
Term
| How many mm attach directly to the sacrum or innominate? |
|
Definition
|
|
Term
| primary function of the muscles that attach directly to the sacrum and/or innominate? |
|
Definition
| stabilize that sacroiliac jt rather than to move it |
|
|
Term
| 6 mm of teh SIJ from anterior aspect |
|
Definition
| iliacus, psoas major, pifiriformis, thoracolumbar fascia, coccygeus, hip musculature |
|
|
Term
| 6 mm of the sij from a posterior aspect |
|
Definition
| multifidus, quadratus lumborum, erector spinae, latissimus, gluteus maximus, gluteus minimus |
|
|
Term
| Primary function of teh piriformis |
|
Definition
| produce external rotation and abduction of the femur |
|
|
Term
| Function of the piriformis if the hip joint is flexed beyond 90 |
|
Definition
| internal rotator and abductor of the hip |
|
|
Term
| dysfunction caused by piriformis muscle |
|
Definition
| restricting sacroiliac jt motion |
|
|
Term
| pelvic floor muscles refers to what muscle group name (1) |
|
Definition
|
|
Term
| the levator ani is composed of what mm |
|
Definition
| pubococcygeus, puborectalis, iliococcygeus |
|
|
Term
| the levator ani muscles join what mm to complete the pelvic floor |
|
Definition
|
|
Term
| role of the pelvic floor muscles (5) |
|
Definition
| increase intra-abdominal pressure, provide rectal support during defecation, inhibit bladder activity, help to support the pelvic organs, assist in lumbopelvic stability |
|
|
Term
| which ligament has fibers that blend with the hamstring tendons |
|
Definition
|
|
Term
| how many axis of motion have been described for the SIJ |
|
Definition
|
|
Term
| 14% of the population has no rotation of the SIJ, only this motion |
|
Definition
|
|
Term
| 5 axis of motions of the SIJ describe in lecture |
|
Definition
| superior transverse, middle transverse, inferior transverse, right and left olbique axes |
|
|
Term
| sij axis: superior transverse axis runs through what? |
|
Definition
|
|
Term
| sij axis: superior transverse axis aka |
|
Definition
|
|
Term
| sij axis: superior transverse axis is the respiratory axis for what motions? |
|
Definition
|
|
Term
| sij axis: superior transverse: what happens during inhalation to the sacrum |
|
Definition
|
|
Term
| sij axis: superior transverse axis: what happens to the sacrum during exhalation |
|
Definition
|
|
Term
| sij axis: where does the middle transverse axis run through |
|
Definition
|
|
Term
| sij axis: what is the principal axis of normal sacroiliac function (nutation) or extension (counternutation) |
|
Definition
|
|
Term
|
Definition
| sacrum tilts anterior and ilium tilts posterior |
|
|
Term
| what motion of the sacrum increases the outlet for childbirth |
|
Definition
|
|
Term
| described counternutation |
|
Definition
| sacrum tilts posterior and ilium anterior decreasing the outlet |
|
|
Term
| sij axis: where does the inferior transverse axis run |
|
Definition
| through the inferior pole of the sacral articulations |
|
|
Term
| sij axis: principal axis of normal iliosacral motion |
|
Definition
|
|
Term
| sij axis: which axis of the sij is involved in anterior and posterior rotation of teh innominates |
|
Definition
|
|
Term
| describe anterior rotation of the ilia |
|
Definition
| ASIS rotates anterior/inferior, hip extends, lordosis increases |
|
|
Term
| describe posterior rotation of the ilia |
|
Definition
| PSIS moves posterior/inferior, hip flexes, lordosis decreases |
|
|
Term
| sij axis: where do the right and left oblique axes run from |
|
Definition
| superior articular surface of the sacrum obliquely to the contralateral inferior lateral angle |
|
|
Term
| the pelvic area must function to absorb what while still permitting motion to occur |
|
Definition
|
|
Term
| biomechanics of the SIJ: osteopathic model: how does the sacrum rotate? |
|
Definition
|
|
Term
| biomechanics of the SIJ: osteopathic model: how are the innominates/ilia capable of rotating |
|
Definition
| anteriorly and posteriorly |
|
|
Term
| biomechanics of the SIJ: osteopathic model: distinction between impairments |
|
Definition
|
|
Term
| biomechanics of the SIJ: form and force closure model: authors behind the model (2) |
|
Definition
|
|
Term
| biomechanics of the SIJ: form and force closure model: kinetics within the lumbar/pelvic/hip regions by these concepts |
|
Definition
| extrinsic and intrinsic stability of the pelvic girdle and the self locking mechanism |
|
|
Term
| biomechanics of the SIJ: form and force closure model: form refers to what |
|
Definition
|
|
Term
| biomechanics of the SIJ: form and force closure model: force refers to what |
|
Definition
| muscles around the joint to create stability |
|
|
Term
| examination of the SIJ involves what |
|
Definition
pain provocation/stress (symptom based) tests
biomechanical/dynamic palpation (motion-based) tests that include static palpation (positional tests) |
|
|
Term
| hx that indicates SIJ dysfunction (3) |
|
Definition
hx of sharp pain awakening the pt from sleep upon turning in bed
pain with walking, ascending or descending stairs, standing from a sittin gposition, or with hopping or standing on the involved leg
positive straight leg raise at, or near, the end of range (occasionally early in the range when hyperacute) pain and sometimes limitation on extension and ipsilateral sidebending of the trunk |
|
|
Term
| pain referall patterns for SIJ: descriptors |
|
Definition
| unilateral and dull in character |
|
|
Term
| pain referral patterns for SIJ: specific locations (5) |
|
Definition
PSIS
low back
buttock
lateral thigh
groin |
|
|
Term
| pain referral patterns for SIJ: can be occassionaly distal to what |
|
Definition
| distal knee to posterior or lateral calf into foot and toes |
|
|
Term
|
Definition
1 falling on one buttock
2 lifting with torsion stresses
3 MVA
4 repeated torsional activities (golf, bowling, skating, kicking)
5 pregnancy
6 sex |
|
|
Term
| Exam of the SIJ should always rule out this source for symptoms |
|
Definition
|
|
Term
| specific visceral systems to rule out when examing the SIJ (4) |
|
Definition
| gastrointestinal, reproductive/genitourinary, vascular, neurlogical |
|
|
Term
| important note about palpation of bony landmarks of the SIJ |
|
Definition
| altered positional relatioship within the pelvic girdle should only be considered positive if a mobility restriction of the SIJ and/or pubic symphysis is also found |
|
|
Term
| weight bearing and non weight bearing kinetic tests of the sij are designed to assess what |
|
Definition
| osteokinematics occuring at the SIJ during pt generated movements |
|
|
Term
| weight bearing and on weight bearing kinetic tests asses what |
|
Definition
| mobility of the innominate and the ability of the sacrum nutate |
|
|
Term
| example of a weight bearing and non weight bearing kinetic test |
|
Definition
|
|
Term
| SIJ stress/provocation tests: are believed to be senstive for what |
|
Definition
| severe arthritis or ventral ligament tears |
|
|
Term
| SIJ stress/provocation tests: are designed to do what |
|
Definition
| assess the integrity of the jt and the surrounding ligaments |
|
|
Term
| SIJ stress/provocation tests: examples (5) |
|
Definition
| compression, distraction, sacral thrust, anterior/posterior rotation (gaenslen's test), posterior shear/thigh thrust test |
|
|
Term
| SIJ stress/provocation tests: of the 5 tests how many need to be positive to have a high sensitivity and specificity |
|
Definition
|
|
Term
| Proposed SIJ Exam Schema: 1 of 4 |
|
Definition
| comprehensive Hx: note pain patterns and MOI suggestive of SIJ dysfunction |
|
|
Term
| Proposed SIJ Exam Schema: 2 of 4 |
|
Definition
| note asymmetries during structural exam |
|
|
Term
| Proposed SIJ Exam Schema: 3 of 4 |
|
Definition
| rule out lumbar involvement through AROM, repeated movements, PROM/SSMT/PAIVM and neuro exam |
|
|
Term
| Proposed SIJ Exam Schema: 4 of 4 |
|
Definition
| confirm SIJ involvement through static/dyanmic testing and stress/provocation testing |
|
|
Term
| Possible SIJ dx: involving the ilia/innominiates (2) |
|
Definition
| anterior/posterior rotation, ilial upslips/downslips |
|
|
Term
| Possible SIJ dx: involving the sacrum |
|
Definition
| sacral torsions (forwards and backwards R on L, L on R, R on R, L on L) |
|
|
Term
| Possible SIJ dx: general conditions (2) |
|
Definition
| hypermobility, trauma/inflammation |
|
|
Term
| Possible SIJ dx: dysfunctions (2) |
|
Definition
| symphysis pubis dysfunction, coccydynia |
|
|
Term
|
Definition
| peripeartum pelvic pain syndrome |
|
|
Term
| Right posterior rotation of ilium: what happens to the right acetabulum |
|
Definition
|
|
Term
| Right posterior rotation of ilium: what happens to the right leg |
|
Definition
|
|
Term
| Right posterior rotation of ilium: what happens to the right sacral base |
|
Definition
|
|
Term
| Right posterior rotation of ilium: what happens to the lumbar spine |
|
Definition
| sidebends right and rotates left |
|
|
Term
| Right posterior rotation of ilium: what happens to the structures of teh spine as a result of the lumbar spine sidebending right and rotating left |
|
Definition
| closing of the IV foramen, compression of the disc, stretching of the iliolumbar ligaments |
|
|
Term
| Right posterior rotation of ilium: what happens to the sacral ligaments |
|
Definition
| sacrospinous and sacrotuberous ligaments stretch |
|
|
Term
| Right posterior rotation of ilium: what happens to the mechanics of the hip as a result of lateral deviation of the acetabulum |
|
Definition
| changes in antetorsion angle resulting in external rotaiton of hip affecting gait, overwork of internal rotators |
|
|
Term
| Right posterior rotation of ilium: what happens to the coccyx |
|
Definition
|
|
Term
| Right posterior rotation of ilium: what happens to the pubic symphysis |
|
Definition
|
|
Term
| Exam findings: Anterior torsion (L on L): sacral sulcus |
|
Definition
deep on R
prone on elbows symmetric |
|
|
Term
| Exam findings: Anterior torsion (L on L): ILA |
|
Definition
|
|
Term
| Exam findings: Anterior torsion (L on L): lumbar ext |
|
Definition
|
|
Term
| Exam findings: Anterior torsion (L on L): lordosis |
|
Definition
|
|
Term
| Exam findings: Anterior torsion (L on L): PA pressure to sacrum/L5 |
|
Definition
|
|
Term
| Exam findings: Anterior torsion (L on L): L5 |
|
Definition
|
|
Term
| Exam findings: posterior torsion (R on L): sacral sulcus |
|
Definition
prominent on R
Prone on elbows = asymmetric |
|
|
Term
| Exam findings: posterior torsion (R on L): ILA |
|
Definition
|
|
Term
| Exam findings: posterior torsion (R on L): lumbar ext |
|
Definition
|
|
Term
| Exam findings: posterior torsion (R on L): lordosis |
|
Definition
|
|
Term
| Exam findings: posterior torsion (R on L): PA pressure to sacrum/L5 |
|
Definition
|
|
Term
| Exam findings: posterior torsion (R on L): L5 |
|
Definition
|
|
Term
| rupture of pubic symphysis aka |
|
Definition
|
|
Term
| pubic symphysis dysfunction MOI |
|
Definition
| pregnency and or strucutral malalignment of pelvis |
|
|
Term
| examination findins for pubic symphysis dysfunction (7) |
|
Definition
painful palpation of anteiror pubic symphysis
clicking
positive provocaiton testing (compression, distraction, FABER)
Decreased hip rom
Limited tolerance to single limb stance |
|
|
Term
| how many women experience low back pain during pregnancy |
|
Definition
|
|
Term
| what percnetage of women would describe their low bakc pain as severe during pregnancy |
|
Definition
|
|
Term
| PPPP is associate dwith what (3) |
|
Definition
pelvic and sacral positional faults
decreased joint stability
decreased motor control |
|
|
Term
|
Definition
manual therapy
ther ex targeting lumbopelvic and hip stabilizers
bracing if possible |
|
|
Term
|
Definition
| childbirth, trauma (fall) |
|
|
Term
| coccydynia is a reuslt of what |
|
Definition
| coccyx becoming fixated in an anterior/posterior position and/or developing pain and inflammation of supporting ligaments and structures |
|
|
Term
|
Definition
| increased pain with sitting, weight bearing on area |
|
|
Term
|
Definition
| rest, anti-inflammatic measures, thrust and non thrust manipulation |
|
|
Term
| 4 pieces of advice for pt with SIJ pathology |
|
Definition
attempt symmetry with hypermobility
sit with hips abducted to 45 and bakc straight
avoid asymmetry during sex
bracing |
|
|
