Exam 1 - Pelvis and hip 1

Question 1

describe the sacroiliac joint

Answer 1

synovial, non axial

very stable joint with irregular articular surfaces

fibrous capsule reinforced by ligaments in multiple directions

Question 2

describe the pubic symphysis

Answer 2

midline of body
rigth and left pubic ones joined with fibrocartilage disc and ligs
amphiarthrodial joint

Question 3

what is an amphiarthrodial joint

Answer 3

not synovial joint
more stable

Question 4

what are the attachments of the superior pubic ligament

what is its function

Answer 4

attaches the pubic tubercles on each side

strengthens the joint superiorly and anteriorly

Question 5

what are the attachments of the inferior pubic ligaments

what is its function

Answer 5

attaches between the 2 inferior pubic rami

strengthen the joint inferiorly

Question 6

what is the function of the SI joint

Answer 6

designed for stability and has very little mobility

Question 7

what is the incidence of SI joint dysfunction

Answer 7

20% during pregnancy
13% not pregnant with LBP

Question 8

what are the risk factors for SI joint dysfunction

Answer 8

laxity and hormonal changes
during pregnancy - previous LBP/pelvic trauma
none located if not pregnant

Question 9

what is the etilogy of SI joint dysfunction

Answer 9

peri-partum

immature skeletons d/t lack of bony irregularity and congruency

trauma

autoimmune diseases (AS)

Question 10

what are the symptoms of SI joint dysfunction

Answer 10

localized to SIJ
gluteal region and lateral hip
possibly pubic symphysis P!
often like hypermobility/instability

Question 11

why is SI joint dysfunction symptoms often like hypermobility/instability symptoms

Answer 11

too much movement in the SI joint

joint gets loosened and gets off position and gets stuck again

Question 12

what are the signs of SI joint dysfunction

Answer 12

A/PROM: no consistent pattern with just SI dysfunction with

RST: impaired local mm, weak anti-gravity hip mm

ST: >/= 3 (+) of SI provocation tests

Question 13

what is the evidence for palpation for position for SI joint dysfunction

Answer 13

poor studies

considered a special test

Question 14

t/f
movements in the SIJ are so minute that external determination by manual methods is virtually impossible

Answer 14

true

Question 15

what motion test for SIJ is most useful but is still considered unreliable

Answer 15

march or gillet test

Question 16

t/f
research consensus that motion and palpation SIJ tests are unreliable and invalid

Answer 16

true

Question 17

what special test would you predict to be (+) for SIJ dysfunction

Answer 17

ASLR (+) for impaired local mm

Question 18

t/f
imaging is diagnostic for SIJ dysfunction

Answer 18

false
imaging is not diagnostic

Question 19

what is the gold standard for diagnosing SIJ dysfunction

Answer 19

SI block

Question 20

what is the PT rx for SIJ dysfunction

Answer 20

POLICED

STM/muscle energy/acupuncture for P!/ muscle guarding

pelvic belt

JM

MET

education

Question 21

what is the outcome for manipulation of SIJ dysfunction

Answer 21

improved symptoms and clinical test findings

did not alter positions per RSA imaging

likely a positive soft tissue and muscle influence per manipulation

Question 22

what is the focus of MET for SIJ dysfunction

Answer 22

primary focus is stabilization

local mm and lumbar hypermobility/instability MET

Question 23

what is the focus of pt education for SIJ dysfunction

Answer 23

reduce fear

early mobilization without provocation

reassurance of good prognosis

Question 24

what is the MD rx for SIJ dysfunction

Answer 24

intra-articular SIJ injections for AS, not recommended without AS

P!/anti-inflammatory meds - mixed short-term benefit

no evidence for prolotherapy or fusion

Question 25

what is the prognosis of SIJ dysfunction

Answer 25

rapidly declines during first 3 months after pregnancy "serious P!" during pregnancy left 21% with symptoms 2 years later

Question 26

what is femoral acetabular impingement

Answer 26

abnormal hip joint morphology or bony shape and arrangement symptomatic contact between proximal femur and acetabulum

Question 27

what is the prevalence of femoral acetabular impingement

Answer 27

males > females higher with vigorous or end range activities (dance)

Question 28

what are the risk factors for femoral acetabular impingement

Answer 28

genetics and gender: abnormal bony morphology, higher risk for sibling vigorous loading in athletics use of excessive motion pediatric hip conditions abnormal hip/pelvis kinematics

Question 29

describe the abnormal hip/pelvis kinematics that can lead to femoral acetabular impingement

Answer 29

anterior pelvic tilt limited posterior tilt that may also limit the coupled hip ER excessive hip adduction limited hip IR but is more likely d/t bony abutment than capsular tightness

Question 30

what is the etiology of femoral acetabular impingement

Answer 30

largely unknown more often: abnormal hip mechanics, vigorous athletic loading, combo less often: slipped capital femoral epiphysis, femoral neck fx/malunion, legg-calve-perthes disease

Question 31

describe the cam femoral acetabular impingement

Answer 31

less spherical femoral head head contacts anterosuperior acetabulum/12:00 more common in males 37% presence in general population without P! 55% presence in athletes without P!

Question 32

describe the pincer femoral acetabular impingement

Answer 32

deeper acetabulum or anterior osteophyte neck primarily contact anterior but may also contact posterior labrum (countercoup phenomenon) most common in middle-aged athletic females

Question 33

what type of femoral acetabular impingement is most common

Answer 33

both cam and pincer

Question 34

what structures are involved with femoral acetabular impingement

Answer 34

with/out age-related changes/labral tears labrum

Question 35

t/f articular cartilage damage and labral damage are very common with femoral acetabular impingement

Answer 35

true 83% with articular cartilage damage 93% with labral damage

Question 36

the labrum is primarily made up of what type of collagen

Answer 36

type 1 collagen

Question 37

up to __% of labrum changes are insidious or gradual

Answer 37

75%

Question 38

what patients should be considered with mechanical groin pain without alternative radiological diagnosis related to labrum tears

Answer 38

active individuals

Question 39

_% of athletes with groin pain have labrum tears related to femoral acetabular impingement

Answer 39

20%

Question 40

labral tears related to femoral acetabular impingement affect __% of pts with hip and groin pain

Answer 40

55%