Sacrum and Pelvis S/CS

Question 1

inguinal ligament TP

Answer 1

superior surface of pubic tubercle

pt. is supine
Technique: flex both legs 90 degrees and place on doc’s thigh. Move leg on tender side under the opposite leg. Adduct the femur. Internally rotate the femur by moving the ipsilateral leg towards yourself until the TP resolves

Question 2

Iliacus (Psoas) TP

Answer 2

TP is 2 in inferior and 2 in medial from ASIS (press post-laterally)

Pt: supine

Technique: stand on tender side. Flex patient’s legs, externally rotate the legs and place them on your thigh. Flex, sidebend toward the TP until it resolves

Question 3

Low Ilium (SI )

Answer 3

TP is on lateral ramus of the pubic bone anterior surface
Pt: supine
Technique: flex the tender side only (90 degrees); add abduction if needed for resolution of pain

Question 4

lateral trochanter SI

Answer 4

TP is on the lateral surface of the femur 0-15 cm distal from great trochanter in the ITBand

Pt: prone

Technique: doctor is seated supporting the pt’s leg on his thigh. Slightly flex the hip, add abduction (generally more than flexion) and internal rotation (sometimes)

Question 5

posterior lateral trochanter

Answer 5

TP is on the superior lateral surface of the posterior greater trochanter

Pt: prone

Technique: doctor is standing with knee on table under the pt’s thigh; add in a moderate amount of extension, some abduction and a whole lot of external rotation until the TP resolves

Question 6

posterior medial trochanter

Answer 6

TP is 3-5 mm inferior to the greater trochanter between the posterior medial surface of the shaft of the femur and the posterior lateral surface of the ischial tuberosity

Pt: prone

Technique: grasp leg on tender side and place your knee under the thigh; slightly extend the leg, moderately externally rotate it and bring the leg across the midline with adduction until the TP resolves

Question 7

anterior lateral trochanter

Answer 7

TP is 5-7 cm lateral and inferior to the ASIS but anterior and superior to the greater trochanter

Pt: supine
Technique: flex hip 70-90 degrees; add abduction and external rotation until the TP resolves
Hold for 90 sec

Question 8

High Ilium Sacroiliac (HISI)

Answer 8

TP is 4-5 cm lateral to PSIS
Pt: prone or supine (picture is prone)
Technique: doctor is standing on affected side; extend leg and slight abduction until TP resolves

Question 9

mid pole sacroiliac (ilium in-flare superior) = MPSI

Answer 9

TP is 3-4 cm inferior to PSIS in the divot in the muscle just lateral to the sacrum. Approach the TP from the lateral side

Pt: prone
Technique: doctor is standing on affected side; slightly flex the hip and knee; add in abduction (major component of this treatment) and some external rotation of the hip until the TP resolves

Question 10

Piriformis TP

Answer 10

TP is in the belly of the piriformis 8-9 cm medial and slightly superior to greater trochanter (but can be anywhere along the track of the muscle)
Pt: prone

Technique: doctor is seated on side of TP. Suspend pt’s leg off table and rest the leg on your thigh. Flex the hip to about 135 degrees, abduct slightly via the knee and internally or externally rotate the knee until the TP resolves

Question 11

high ilium out flare (HIFO)

Answer 11

Seen in coccydynia
TP is at sacrococcygeal joint or on the coccyx
Pt: prone
Technique: doctor is standing won affected side; raise (extend) the affected side just enough to be able to adduct the leg over the other leg and then adduct the leg

Question 12

sacral tenderpoints

Answer 12

Found along the median crest of the sacrum
They would be located on the spinous and transverse processes of the sacrum if it were not fused

Pt: prone
Technique: doctor is standing and will apply gentle pressure to the opposite part of the sacrum of where the TP is located