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Clin Path II > Week 8 LBP Part 3 (coccyx, hip, SI) > Flashcards

Week 8 LBP Part 3 (coccyx, hip, SI) Flashcards

1
Q

What are two unusual but important cause of posterior pelvic pain?

A

Coccyx

Pelvic floor muscles

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2
Q

How do you adjust the coccyx?

A
  • contact the base of the coccyx through the rectum or vaginal canal
  • external adjustment A-P, slow traction distal
  • you can also find trigger points in the pelvic floor and use ischemic compression
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3
Q

Where do patients feel pain if they have hip issues?

A
  • low back pain
  • groin pain (84%) (M/C location)
  • buttock (79%)
  • anterior thigh (59%)
  • posterior thigh (43%)
  • anterior knee (69%) (must ddx from knee lesions)
  • shin (47%)
  • calf (29%)
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4
Q

With hip issues, which muscles are often the first to go into spasm?

A

Adductors

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5
Q

What are some physical exam procedures for the hip? (9)

A
  • Log roll screen (pain primary indicator)
  • anvil test
  • circumspection
  • Patrick-Faber
  • hip scouring
  • limited and painful in internal rotation
  • assess all active and passive ROM as well as key muscles (piriformis, iliopsoas, adductors, hip extensors and abductors)
  • patient may stand leaning away from painful hip
  • assess ROM and key muscles (piriformis, iliospoas, adductors, hip extensors, abductors)
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6
Q

What are some clues from the history for hip pain?

A
  • pain may be aggravated by weight bearing
  • may be associated with painful and limited internal rotation
  • may have a limp
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7
Q

According to a 2004 study, what three findings are more often predictive of a hip disorder than a spine disorder

A

Presence of limp
Groin pain
Limited internal rotation

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8
Q

What is the ddx for lateral hip pain (4)? What are 2 non-hip causes?

A
  • gluteus medius tendinopathy (NOT A STRAIN)
  • ITB tendinopathy (causing pain by the hip instead of the knee)
  • trochanter is bursitis (swollen and painful near greater trochanter)
  • external snapping hip (ITB/glut max)

Non-hip causes?

  • QL MFTP referral
  • thoracolumbar syndrome
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9
Q

What causes external snapping hip?

A

ITB

Glut max

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10
Q

What are 3 signs for gluteus medius tendinopathy and what are the LR’s?

A
  • Lateral hip pain with single leg stand <30 seconds (+LR 12.2)
  • resisted Fader test (+LR 6.6)
  • no tenderness with palpation of g med or g min insertions (-LR 0.43)
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11
Q

What is the ddx for anterior hip pain inside the hip (5)? What are 2 causes outside the capsule? What are 2 non-hip causes?

A
  • hip OA
  • FAI (femoroacetabular impingement)
  • Labral tear
  • AVN
  • stress fracture

Outside the capsule

  • adductor tear
  • internal snapping hip (iliopsoas)

Not in the hip

  • psoas MFTP referral
  • femoral neuropathy
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12
Q

What is the ddx for posterior hip pain?

A
  • femoralacetabular pathology (e.g. OA, labral tear, AVN)
  • SI lesion
  • hamstring tendinopathy
  • piriformis lesion
  • lumbar spine referral
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13
Q

SI is estimated to account for __% of chronic LBP

A

20% (13-33%)

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14
Q

What is the diagnostic pathway for the SI?

A
  • Is the SI joint involved?(specific ortho tests)
  • If so it is it a disease (sacroiliitis) or an injury?
  • Where and how should I apply
    manipulation? (static palpation & SI provocation tests)
  • are other joints involved? (Hip? Lumbosacral? Pubic symphysis?)
  • are muscles involved? (Piriformis? Lower cross syndrome?)
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15
Q

What are causes of sacroiliItis?

A

An inflammatory arthropathy
- RA (rheumatoid factor, anti-ccp)

  • seronegative spondylitis (negative for RF)
    — ankylosing spondylitis
    — Reiter’s syndrome
    — psoriatic arthritis
    — enteric arthritis (ulcerative colitis, Crohn’s disease)
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16
Q

What are the five screening questions for AS?

A
  • morning stiffness?
  • improves with exercise?
  • Onset pain before 40 y.o.?
  • slow onset?
  • pain persisting >3 months?
17
Q

What are the best tests for SI? (3 and big 5)

A
  • ASLR (patient points to SI causing pain)
  • palpation of the long dorsal SI ligament
  • Patrick faber test

If three of five are positive

  • thigh thrust
  • sacral thrust
  • gaenslens
  • SI compression
  • SI distraction
18
Q

If three or more of the big 5 SI tests are positive, what is the +LR? What causes +LR to increase and what does it increase to?

A

+LR 4.1

- no centralization with repetitive movements = +LR 6.9

19
Q

How is ASLR performed? What’s a positive (4)

A

Patient raises leg 4-8 inches

positive if

  • recreates pain and they point to the SI
  • can’t raise affected side to your hand (or can but with compensation)
  • one side was harder than the other
  • patient cannot resist overpressure or it’s harder to resist on one side

If any are positive, retest with stabilization

20
Q

What can ASLR tell you?

A
  • SIJ is causing pain (during pregnancy sometimes referred to as part of posterior pelvic pain syndrome)
  • SIJ is functionally unstable
21
Q

If ASLR is positive, what should you do next?

A
  • Re-test with patient actively bracing abdomen
    OR
  • Re-test with patient awhile performing SI compression.
    OR
  • Re-test with trochanteric belt (especially with pregnant women)
22
Q

What are conditions in which the piriformis is involved?

A
  • piriformis spasm (common)
  • piriformis syndrome (associated with leg pain due to sciatic nerve irritation)
  • piriformis myofascial pain syndrome (associated with deep referred leg pain, does not usually cross the knee)
23
Q

What are other contributor to SI problems?

A
  • sacroiliac pattern
  • lower cross syndrome
  • tight hamstrings
  • LLI
24
Q

What is janda’s SI muscle imbalance pattern? Which one is not like the lower cross syndrome?

A
  • ipsi glut max inhibition
  • ipsi iliopsoas short and tight
  • ipsi piriformis short and tight (unlike lower cross syndrome)
  • contra glut med inhibited
25
Q

What are pelvic causes of LBP?

A
  • sacroiliac (20%, 13-33%)
  • hip
  • pubic symphysis

All three cause posterior pelvic pain (below belt line), but less commonly cause lumbar pain

Clin Path II (18 decks)

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