Innominates

Question 1

roles of the pelvis

Answer 1

• body support
• locomotion
• maintains stability
• at base of vertebral column but still far from ground

Question 2

Pelvis potential for dysfunction

Answer 2

weight of the upper body directed through the spine and axial skeleton downward and the resistance to forces from below form a balance at the pelvis. injury, postural and muscle imbalances from above or below can cause somatic dysfunction

Question 3

pelvis roles

Answer 3

• bowl for GI system
• supports GU system
• contains lymphatic and vascular structure for all pelvic contents and circulatory structures below

Question 4

significant structures influencing LE circulation and drainage

Answer 4

• pelvic diaphragm

- inguinal area

Question 5

Summary of pelvic functions

Answer 5

• biomechanical function and balance (foundation for support and locomotion)
• reproduction (genital structures)
• elimination (GI and urologic)
• vascular and lymphatic functions for the region

Question 6

Innominates child vs adult

Answer 6

3 separate bones as child, completely fuse as adult

Question 7

Acetabulum composition

Answer 7

bone from 3 different ossification centers

Question 8

true ligaments

Answer 8

bone to bone

Question 9

accessory ligaments

Answer 9

attach at another ligament, a tendon or other fascia

Question 10

ligament functions

Answer 10

• limit abnormal or excessive motion at a joint
• permits normal motion
• quality is slightly elastic
• prevent excessive motion as part of a reflex response

Question 11

sacrospinous ligament

Answer 11

sacrum to spine of the ischium, deep to sacrotuberous ligament, blends with sacrotuberous at sacrum, forms part of origin where coccygeus muscle arises

Question 12

iliolumbar ligament

Answer 12

from ilia to 5th lumbar vertebrae, stabilizes L5, stabilizes anterior motion of lower lumbar spine, restricts anterior and rotary motion of L5, blends with the upper part of the anterior SI ligament

Question 13

anterior sacroiliac ligament

Answer 13

covers much of sacroiliac joint, connects third sacral segment to the lateral side of the pre-auriclar sulcus, thicker than the posterior SI ligaments to prevents the sacrum form popping out anteriorly

Question 14

inguinal ligament

Answer 14

asis to superior pubic rami, forms the floor of the inguinal canal, origin to the internal oblique and transversus abdominus muscle

Question 15

sacrotuberous ligament

Answer 15

sacrum to ischial tuberosity, gluteus maximus attachment, connects with the fascia of the pelvis

Question 16

posterior sacroiliac ligament

Answer 16

covers much of sacroiliac joint, from the third and fourth sacral segments, ascend to PSIS and posterior end of internal lip of liliac crest, blends with sacrotuberous ligament and thoracolumbar fascia

Question 17

interosseous sacroiliac ligament

Answer 17

major bond between the bones, filling the irregular space posterosuperior to the joint. covered posteriorly by the posterior sacroiliac ligament

Question 18

pubic symphysis

Answer 18

each of joints surfaces covered by fibrocartilage, linked across the midline to adjacent surfaces by fibrocartilage, surrounded by interwoven layers of collagen fibers, two ligaments associated: superior pubic ligament, inferior pubic ligament

Question 19

forces on pubic symphysis

Answer 19

• strong posterior ligaments of the sacrum
• articulation of the sacroiliac joint
• forces pushing symphysis together

Question 20

Heel strike (right foot) innominate position

Answer 20

right innominate rotates posteriorly, left rotates anteriorly, iliopsoas and quadriceps femoris contracted to flex the LE at the hip

Question 21

toe off (right foot) innominate position

Answer 21

anterior rotation of the right innominate which is mainly a passive process; iliopsoas relaxation allows anterior rotation of the innominate with gluteus maximus and hamstring contraction

Question 22

hip flexors

Answer 22

major: iliacus, psoas
minor: rectus femoris, sartorius

Question 23

hip extensors

Answer 23

gluteus maximus, hamstrings (biceps femoris, semitendinosis, semimembranosis)

**hamstring tension may cause a posterior rotation of the innominate and affect pelvic mechanics

Question 24

hip adductors

Answer 24

major: adductor magnus, adductor brevis, adductor longus
minor: gracilis, pectineus

Question 25

hip abductors

Answer 25

gluteus medius, gluteus minimus, tensor fascia lata

Question 26

trendelenburg sign

Answer 26

- measures hip abductor strength (glut medius) (supplied by the superior gluteal nerve L5)

Question 27

hip external rotators

Answer 27

- piriformis - obturator internus and externus - superior and inferior gemellus - quadratus femoris

Question 28

piriformis

Answer 28

* only hip rotator that connects directly to the sacrum - abnormal contraction may cause sciatica - piriformis does abduction when the hip is flexed - piriformis does external rotation when the hip is extended

Question 29

innominant secondary muscle attachments

Answer 29

rectus abdominis, transversus abdominis, internal and external oblique muscles, quadratus lumborum

Question 30

nerves of the pelvis

Answer 30

- lumbar plexus - sacral plexus - coccygeal plexus - sacral sympathetic trunk (forms ganglion impar) - pelvic splanchnic perves (s2-4): left colon - inferior hypogastric plexus

Question 31

lumbar plexus levels

Answer 31

L1-L4

Question 32

sacral plexus levels

Answer 32

L5-S4

Question 33

coccygeal plexus

Answer 33

S5-coccygeal nerve

Question 34

dysfunction of quadratus lumborum

Answer 34

may produce symptoms similar to a groin pull or hernia by irritating the ilioinguinal and iliohypogastric nerves (L1) as the pass anterior to quadratus lumborum

Question 35

what separates the greater and lesser sciatic foramen

Answer 35

sacrospinous ligament

Question 36

gravitational line structures

Answer 36

- auditory meatus - acromion process - greater trochanter - body of L3 - anterior 1/3 of sacrum - lateral condyle of the knee - lateral malleolus

Question 37

structures used to diagnose the innominates

Answer 37

iliac crests, ASIS, pubic tubercles, medial malleoli heights (least reliable), PSIS

Question 38

when are pubic tubercles used for diagnosis

Answer 38

pubic somatic dysfunction or subluxation

Question 39

when are ischial tuberosities used for diagnosis

Answer 39

used for "small hemipelvis" AKA when one side of the pelvis is congenitally smaller than the other

Question 40

steps for pelvic somatic dysfunction Dx

Answer 40

1) lateralization test 2) palpation of landmarks 3) diagnosis

Question 41

lateralization tests

Answer 41

standing flexion, ASIS compression

Question 42

anterior innominate rotation landmarks

Answer 42

ASIS is iinferior PSIS is superior Iliac crest is level medial malleolus is inferior (long)

Question 43

posterior innominante rotation landmarks

Answer 43

ASIS is superior PSIS is inferior Iliac crest is level medial malleolus is superior (short)

Question 44

superior shear landmarks

Answer 44

ASIS is superior PSIS is superior Iliac crest is superior Medial malleolus is superior (short)

Question 45

inferior innominate shear landmarks

Answer 45

ASIS is inferior PSIS is inferior Iliac crest is inferior medial malleolus is inferior (long)

Question 46

innominate inflare Dx

Answer 46

measure from the midline (umbilicus) to each ASIS, lateralization test decides the side of dysfunction, somatic dysfunction side displays smaller distance from ASIS to midline

Question 47

innominate outflare Dx

Answer 47

measure from the midline (umbilicus) to each ASIS, lateralization test decides the side of dysfunction, somatic dysfunction side displays LARGER distance from ASIS to midline

Question 48

pubic shear Dx

Answer 48

palpate the superior aspect of the pubic ramus and decide if superior or inferior