Flashcards in 03 SI 2 Deck (43):
SI motion tests
- supine to sit
- standing forward flexion test
- Gillet's test
What is the only info the SI motion tests can provide?
- information about asymmetry in the motion
- not accurate enough to pick a side
What is the supine to sit test supposed to tell you?
whether there's a leg length discrepancy or a pelvic rotation
supine to sit test
- symptomatic side longer in supine and shorter in sitting
anteriorly rotated innominate on that side
supine to sit test
- symptomatic side shorter in supine and longer in sitting
posteriorly rotate innominate on that side
For the supine to sit test, where are you basing your observations on?
underside of the medial malleoli
What does the supine to sit test tell you if it's longer in supine and doesn't change upon sitting?
- nothing is rotated
- potentially a true leg length difference
What is lacking for the supine to sit test?
doesn't have great intra-rater reliability
What is the purpose of the standing forward flexion test?
looking for asymmetry
standing forward flexion test procedure
- palpate both PSIS
- pt bends forward
- look at level of thumbs as they bend
If the patient is symptomatic on the right side and the right thumb moves more than the left in the standing forward flexion test, what does this tell you?
- sacrum and ilium are stuck together and as you bend, the sacrum takes the ilium with it
If the patient is symptomatic on the right side and the left thumb moves more than the right in the standing forward flexion test, what does this tell you?
- sacrum doesn't bring ilium as much with it
- said to be unstable
What positions can you do the forward flexion test in?
For Gillet's test, where are you palpating?
- S2 spinous process
Gillet's test procedure
- pt standing
- one finger on S2, the other on PSIS
- pt flexes hip
- PSIS should move inferiorly
What constitutes a positive Gillet's test?
- asymmetry between sides
- one side drops more than the other
*This is ONLY stating that there's a difference*
Can you test positive for all 3 motion tests?
What types of tests are on the SI algorithm?
provocation - provoke SI pain
What are you looking for on the provocation tests?
reproduction of pain
When are the provocation tests the most useful?
in the absence of centralization and directional preference
Which two tests can you do where a positive result on both means you don't have to go further down the algorithm? Why can you stop here?
- thigh thrust
*good likelihood that there's SI pathology
If both the thigh thrust and distraction tests are negative, what can you assume?
not likely that there's SI pathology
If only one of the first two tests (thigh thrust, distraction) are positive, what must you do?
- need a second test to corroborate findings
- move on to the compression test
How long do you hold each of the provocation tests?
What are the provocation tests (in the correct order for the algorithm)
1. thigh thrust
4. sacral thrust
Where does the PT stand for the thigh thrust test?
thigh thrust test procedure
- hand under sacrum
- bend knee and press AP
What does the thigh thrust actually do?
shear force of the ilium on the sacrum
What is another method you can use for the thigh thrust test if a patient is uncomfortable with your hand on their sacrum?
rolled up towel
For the thigh thrust test, what are some drawbacks to using a towel?
- could roll off it, meaning no control of motion
- can't feel it in your hand
For the distraction test, what structures are you stretching?
anterior ligament of the SI joint
What do you tell patients when you do the distraction test?
- tell them they'll feel pressure when you push
- let them know if it reproduces their symptoms
PT hand position for the distraction test
arms crossed gives better leverage
compression test position/procedure
- pt sidelying
- go 1-2 body inches posterior to ASIS
- 45˚ hip flexion
- press down and back to compress the joint
For the compression test, which side is up?
What is the compression test doing?
pressing the ilium into the sacrum
sacral thrust position/procedure
- pt prone
- PA pressure on sacrum = CPA over S2
What is the sacral thrust test doing?
shearing the sacrum on the ilium
What is the sacral thrust test opposite to?
- thigh thrust test
- sacrum on ilium vs. ilium on sacrum
What are you looking for in the sacral thrust test?
reproduction of symptoms
Which of the SI tests is the least valid?
Gaenslen's test procedure
- one leg in full hip flexion, the other in extension
- have them resist with both legs
- do this on both legs