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PHTH 565 - MSK > PELVIS > Flashcards

PELVIS Flashcards

1
Q

What does the functional uint of the pelvic girdle consist of

A
  • 2 Innominates
  • The sacrum
  • Bilateral hip joints
  • L4/L5
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2
Q

What is the definition for form closure

A

A stable situation with closely fitting joint surfaces, where no extra forces are needed to maintain the state of the system

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3
Q

What structures does the passive system of form closure of the SI joint include

A

Joint congruency: Interlocking grooves and ridges + wedge shape of sacrum
Ligamentous support: Interosseous ligament, ventral and dorsal SI ligaments, sacrotuberous ligament, sacrospinous ligament, long dorsal ligament

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4
Q

What disrupts the form closure of the SI joint

A

Disruption in bony integrity

Pregnancy

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5
Q

When is force closure of the pelvis needed

A

during loading

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6
Q

Are muscles that are perpendicular or parallel to the joint surface more important for force closure

A

perpendicular

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7
Q

Which muscles are particularly important for force closure of the pelvis

A

Glute max

TA

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8
Q

What is the self-locking mechanism of the pelvis

A

The combination of form and force closure used for optimal pelvic function

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9
Q

What is the axis of motion of the SI joint

A

unknown

- Proposed that there may be many axes

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10
Q

What are the arthrokinematics of the SI joint

A

unknown

Small amounts of cranial/caudal, ventral/dorsal gliding occurs

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11
Q

What is the total ROM of the pelvis

A

up to 4 degrees

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12
Q

Why is movement of the pelvis essential

A

For shock absorption and to absorb torque force in locomotion

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13
Q

What are the available movements of the innominate

A

Anterior and posterior rotation

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14
Q

What are the motions of the sacrum

A

Nutation and counternutation

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15
Q

What is nutation of the sacrum? What occurs to the sacral sulcus in nutation? Is nutation stable or unstable?

A

flexion of sacrum in pelvic bowl
Sacral sulcus deepens
Stable for SI joint

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16
Q

What occurs to the Sacrotuberous and sacrospinous ligaments in nutation

A

they tension

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17
Q

What is counternutation of the sacrum? What occurs to the sacral sulcus in nutation? Is nutation stable or unstable?

A

Extension of the sacrum
Sulcus shallow
Unstable for the SI joints

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18
Q

What is the cause of pelvic girdle pain

A

loss of form or force closure

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19
Q

What are some differential diagnosis for Pelvic girdle pain syndrome

A
  • Inflammatory conditions (AKS)
  • Systemic diseases (Reiters syndrome)
  • Pelvic inflammatory disease
  • Visceral dysfunction (UTI)
  • Lumbar spine and hip dysfunction
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20
Q

What is the onset for Pelvic girdle pain syndrome

A
  • Traumatic: fall, sports, MVA
  • Insidious: Repetitive strain, pregnancy, peri-partum, muscle imbalance, post abdominal, surgery, biomechanical adaptation, cyclical
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21
Q

What is the location for Pelvic girdle pain syndrome

A
  • Local/unilateral
  • Referral to buttock, groin, posterior thigh, anteromedial thigh
  • Tenderness - particularly over the posterior SI joint line
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22
Q

What are the aggravated and easing factors seen with Pelvic girdle pain syndrome

A

Aggravating: rolling over in bed, single leg stance, stepping out of car
Easing: Rest, side lying pillow between knees

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23
Q

What are special questions for Pelvic girdle pain syndrome

A
  • Bladder/bowel dysfunction
  • Perianal numbness
  • bilateral paraesthesia
  • Anaesthesia
  • Clicking and location (pubic symphysis)
  • Feeling of giving way
24
Q

What should you do before completing an objective assessment of the pelvic girdle

A

Do lumbar scan

25
Q

What is included in the objective assessment of the pelvic girdle

A
  • Observation
  • Trunk movements (watching for asymmetries)
  • Active mobility tests
  • Kinetic tests - ipsi and contralateral
  • Hip extension test - standing/prone
  • FBT - standing/sitting
  • Positional tests
  • Passive mobility tests
  • Stability and pain provocation test
  • Muscle length and strength tests
26
Q

What are you looking for in positional tests

A

asymmetry

27
Q

What are the positional tests

A
  • ASIS
  • AIIS
  • iliac crest
  • PSIS
  • Ischial tub
  • Sacral sulcus (deep or shallow)
  • ILA (inferior lateral angle - deep or shallow)
28
Q

What are you looking for in passive mobility tests

A

Asymmetry

End feel

29
Q

Where do you apply force for sacral nutation

A

Sacral base (between PSIS?)

30
Q

Where do you apply force for sacral counternutation

A

Sacral apex (between ILA)

31
Q

Do you get nutation or counternutation with respiration

A

counternutation

32
Q

What indicates a positive test for SI/pubic symphysis pathology when conducting stability and pain provocation tests

A

Local pain at the SI joint or pubic symphysis

Groin pain is often felt with these tests but does not indicate a positive test

33
Q

What are the 7 stability and pain provocation tests

A
  1. P4’ test (Posterior Pelvic Pain Provocation)
  2. Gaenslen’s test
  3. Fabers test
  4. Palpation; at pubic symptoms and/or over the posterior SI ligament
  5. Cyriax test (compression and distraction)
  6. Modified trendelenburg (flamingo stand)
  7. Active SLR
34
Q

When is Fabers indication of SI pathology

A

When pain is experienced in SI region

35
Q

What are you producing in the gaenslen’s test? how are you producing this?

A

Intrapelvic torsion

One hip maximally flexed whil other is over side of the bed

36
Q

How do you conduct a modified trendelenburg

A

Patient stands on one leg and palpates for asymmetry at the pub symphysis and notes any local pain

37
Q

How do you utilize an ASLR test? What are you looking for? How can the test direct your treatment?

A
  • actively bring one leg up at a time about 30 degrees
  • Looking for lumbopelvic stability
  • Can repeat test with therapist compression - if this takes away pain: good candidate for Pelvis belt
  • Can repeat while instructing to engage core - if this removes pain they are good candidate for core work
38
Q

What is a painful palpation of pubic symphysis indicative of

A

Osteitis Pubis

39
Q

How are lesions named

A

for the position they are held in

i.e. an anterior innominate means that the innominate is held anteriorly and cannot go posteriorly

40
Q

It is only a lesion if there is ______

A

a restriction on passive testing

41
Q

If there is no restriction on passive testing, it is not a lesion but rather a ____

A

positional fault

42
Q

How do you differentiate a spinal referral from an SI joint

A
  • PIVM
  • PAVM
  • Stability test
    would be positive
43
Q

How do you best restore force closure

A

Restore those closest to pelvis: pelvic floor and TA

44
Q

How do you restore proprioception to the pelvis

A

Balance board
seated ball
bosu ball

45
Q

When do you refer a Pelvis issue

A
  • Failure to respond to clinical treatment
  • Pelvic floor issues
  • inflammatory condition
  • major instability
46
Q

Who may be a good candidate for prolotherapy

A

people with major instabilities

47
Q

What is prolotherapy

A

A solution that is injected into ligaments to try and create an inflammatory response. The idea is by injecting sclerosing or inflammatory producing agent the person will create their own connective tissue proliferation providing stability. Normally three sets of injections. The proliferation can last for months. Can use pain management meds as long as they are not NSAIDs - because you want the inflammatory stat

48
Q

what are outcome measures for pelvic girdle pain

A
  • Pelvic girdle pain questionnaire

- Disability rating index

49
Q

Is there a specific test that diagnosis pelvic girdlepain

A

no it is a cluster

50
Q

What are risk factors for pelvic girdle pain

A
  • History of pregnancy
  • History of orthopaedic dysfunction
  • Increased BMI
  • Smoking
  • Job dissatisfaction
  • Belief they wont get petter
51
Q

What is the incidence of pelvic girdle pain in pregnant women

A

20%

52
Q

People with asymmetric laxity of the SIF during pregnancy have a threefold higher risk for what?

A

Moderate to severe pelvic pain to persist into the postpartum period

53
Q

What cluster of tests is recommended for SI joint pain

A
  • Posterior Pelvic Pain Provocation test
  • Fabers test (with pain in SI joint region)
  • Gaenslen’s test
  • Tenderness on palpation over the long dorsal ligament
54
Q

What cluster of tests is recommended for symphysis pubis dysfunction

A
  • Tenderness on palpation (especially if it lasts >5seconds after palpation
  • modified trendelenburg test
55
Q

Manual diagnosis is more effective than _____ for diagnosis

A

SI joint injection

56
Q

Are MRIs of value for the diagnosis of pelvic girdle pain?

A

No - unless tumour or AKS is suspected

57
Q

Water based exercises for the treatment of pelvic girdle pain are beneficial for which population

A

pregnant women

PHTH 565 - MSK (8 decks)

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