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Musculoskeletal PT 2 > SI joint Assessment > Flashcards

SI joint Assessment Flashcards

1
Q

SI joint articulation

A
  • 2 ilia with sacrum
  • iliac crest comes to around L4-L5 interspace
  • Apex is inferior to base
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2
Q

SI joint: articular anatomy

A
  • irregular
  • interlocking surfaces = little motion
  • aging and degeneration increases interlocking = less motion
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3
Q

SIJ articular anatomy

Articular cartilage

A
  • sacral - hyaline cartilage thicker 2.5 mm
  • ilial fibrocartilage thinner
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4
Q

SIJ articular anatomy

Pubic symphysis

A
  • hyaline cartilage
  • fibro-cartilagenous disc
  • ligaments (anterior, inferior, posterior, superior)
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5
Q

SIJ gender differences

A

Males:

  • < mobility more stability
  • surface area larger
  • morer irregular surface

Females:

  • smaller/smoother surface area
  • hormonal changes (relaxin)
  • pregnancy stresses
  • SIJ sits more posterior/more posterior torsion forces on the ilia
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6
Q

What gives the SIJ stabiliity

A

Form fit

Force closure:

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7
Q

What gives the SIJ stabiliity: form fit

A

Form fit

  • osteologic locking
  • scarum is wedged between ilia
  • BW from above and ground reaction forces up through LE futherr wedges it
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8
Q

What gives the SIJ stabiliity: force closure

A

Force closure:

  • from musculature
  • lats, thoracolumbar fascia
  • glute maximus
  • Obliques
  • abdominal fascia
  • hip adductors/abductors
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9
Q

What are the mechanical relationships at the SIJ

A
  1. LEs to innominates -ground Reaction forces of LE into acetabulum affect innominates more
  2. spine to sacrum -spine forces affect sacrum more
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10
Q

Ilial movements on the scarum

A
  • minimal movement: translation = 2mm and rotation = 4º
  • posterior ilial rotation = linked with hip flexion
  • anterior ilial rotation = linked with hip extension
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11
Q

Accessary ilial movements (translations or glides)

A
  1. anterior translation: occurs with anterior ilium rotation
  2. posterior translation: occurs with posterior ilium rotation
  3. Superior translation: is an upslip of ilium on sacrum
  4. inferior translation: is a downslip of ilium on sacrum
  5. ER: outflare; anterior translation of ilium occurs
  6. IR: inflare; posterior translation of ilium occurs
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12
Q

Sacral movements

A
  • also small; rotation = 2ºand translation 1-2 mm
  • sacral flexion (nutation) = sacral base goes anterior => sacral sulcus deepens
  • Sacral extension (counter-nutation) = sacral base goes posterior => sacral sulcus shallows
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13
Q

Posterior intrinsic interosseous ligaments at the SIJ

A
  • both limit posterior separation of ilium from scarum and sacral flexion; long also limits ilia upslip
  • interosseous and short posterior SIJ ligament
  • longer posterior SIJ ligament scarum to PSIS
  • also anterior SIJ ligament that limits anterior separation of iliam frorm sacrum
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14
Q

Posterior extrinsic ligaments

A
  • extrinsic ligament limit ilial posterior rotation and sacral flexion
  • iliolumbar ligament also limits anterior translation of L5
  • sacrospinous limits posterior rotation of ilium/sacral flexion
  • sacrotuberous anterior and posterior rotation of ilium, sacral flexion
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15
Q

Musculature acting on ilium for

anterior rotation of ilium

A
  • iliopsoas
  • rectus femoris
  • TFL
  • sartorious
  • hip adductors
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16
Q

Musculature acting on ilium for

Posterior rotation of ilium

A
  • gluteus max
  • hamstrings
  • abdominals
17
Q

Musculature acting on ilium for

Superior translation of ilium

A
  • quadratus lumborum
18
Q

Musculature acting on ilium for

pelvic stabilization in frontal plane

A
  • abductors
  • adductors
19
Q

Musculature acting on scarum for

sacral extension

A
  • lumbar errector spinae
  • multifidi
20
Q

Musculature acting on scarum for

sacral flexion

A
  • piriformis: anterior sacrum to greater trochanter
21
Q

SJI pain presentation = source most likely

A
  • 40% disc
  • 15% facet
  • SIJ 13%
  • other 11%
  • Disc modic 10%
  • NR 10%
  • stenosis 1%
22
Q

What happens with each of these scenerios

  1. if no centralization (-disc) and (+) SIJ provocation tests
  2. If no centralization (- disc) and (-) SIJ provocation test
A
  1. then probability of SIJ increases
  2. then probability of facet joint increases

however facet joint reference standard is diagnostic anesthetic injections

23
Q

What happens when you rule in SIJ as a pain souce

A
  • can be SIJ dysfunction: aberant position or increased movement at SIJ = instability
  • Pain from SIJ articulation structures (intrinsic)
24
Q

What are some intrinsic causes of SIJ articulation pain

A
  • intra-arrticular inflammatory conditions: sacroiliitis, DJD
  • inject anesthetic into SIJ and if decreased pain and inflammation it confirms pain intrinsic to SIJ inself
25
Q

SIJ S&S

A
  • nocioceptic pain; nocioplastic - psychological/chronic
  • acute = sharp, lcoal assoicated with trauma
  • chronic = SIJ instability, DJD- more diffuse pain
  • pain is usually unilateral
  • pain palpation of dorsal ligaments
  • ispilateral muscle guarding in ES, multifidi
  • pain increased with provocation - springing, gapping, torsion
  • worse standing (esp. on one leg) walking, stairs, stepping down off curb, hop on involved LE
26
Q

Intra-articular injection

A
  • local anesthetic
  • diagnostic of SIJ pain but not pain from extra-articular extrinsic ligaments
  • injection often done twice to rule out false positive
  • determine a significant clinical response
27
Q

SIJ injury

Posterior rotation ilium on scarum: sprain/pain MOI

A
  • persistent one leg standing
  • fall on ischial tuberosity
  • vertical thrust on extended leg (falling off a ladder, land on heel, miss step)
  • intercourse position
  • birthing process
28
Q

SIJ injury

Anterior rotation of ilium on scarum: sprain/pain

MOI

A
  • horizontal thrust on knee w/ hip flexed - MVA
  • Axial load through femur
  • golf swing
29
Q

Exam

what clinical tests can be used for SIJ

A
  • static tests: palpation/look for asymmetry
  • passive mobility tests: manually moving ilium or scarum to assess amount of motion and joint play
  • dynamic tests: patient performs active motion s as PT performs landmark palpation to assess SIJ movement
  • provocation test: SIJ spring torsion test to elict pain (most reliable)
30
Q

Examples of provocation test

A
  • distraction: hands on ASIS foring them apart
  • Compression: iliac compression sidelying
  • thigh thrust:
  • Gaensalens test; pelvic torsion
  • FABER
31
Q

what is the clinical prediciton rule for SIJ

A
  • 3 or more + SIJ provocation test
  • centralization does not occur with repeated ROM or sustaing positions
32
Q

SIJ provcation test: drop test

A
  • get a force going through SIJ but going up on two legs (calf raise) and then leaning to one side
33
Q

Pain descriptors that lend to support SIJ dx

A
  • the absence of pain in the lumbar region
  • pain below L5
  • pain in the region of the PSIS
  • pain in the groin area (if pubic symphysis is involved)
34
Q

Pelvic girdle PT managment

overall what should be addressed first

A
  • first correct lumbar and hip problems => SIJ problems may resolve
  • then correct pelvic/SIJ dysfunction: decrease pain, restore alignment via manual techniques
  • if pubic pain first correct pubic alignment
  • muscle re-education/stabilization exercises
  • lengthening, strengthening of muscle imabalnces
  • suppot - SIJ belt worn jest below ASIS
35
Q

Non PT interventions

for SIJ dysfunction

A
  • injections: anesthetics into joint or glucocorticoids (between diffusion into extrinsic liagments)
  • minimally invasive SIJ stabilization surgery
36
Q

Supine to sit test - results mean what?

A
  • If one side goes from relatively short in supine to relatively long in long sitting it is said that the pelvic innominate on that side is in posterior rotation.
  • If one side goes from relatively long in supine to relatively short in long sitting it is said that the pelvic innominate on that side is in anterior rotation.

Musculoskeletal PT 2 (25 decks)

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