Innominates

Question 1

What are innominates?

Answer 1

Hip bones

Question 2

What are the important bony landmarks?

Answer 2

Iliac crests
ASIS
Pubic tubercles
Medial Malleoli 
PSIS

Question 3

What are the pelvic ligaments that stabilize the pelvis?

Answer 3

Iliolumbar
Sacroiliac - anterior and posterior
Sacrospinous
Sacrotuberous

Question 4

What does muscle tension do for the pelvis and what can it lead to?

Answer 4

Stabilizes pelvis but can also lead to pain and somatic dysfunction

Question 5

Form closure

Answer 5

SI joint stabilized by gravity and shape of joint (sacrum and innominate bones)

Question 6

Force closure

Answer 6

SI joint stabilized by joint compression by muscles, ligaments, thoracolumbar fascia (all non-bone things)

Question 7

Form closure and Force closure are important for?

Answer 7

Stable foundation for trunk and to transmit force with gait

Question 8

SI joint pain is _____ % of chronic low back pain

Answer 8

15-25%

Question 9

What are the 3 innominate motions?

Answer 9

Innominate rotation
Innominate and pubic shear
Innominate flare

Question 10

When testing for innominate dysfunction what are you comparing bony landmarks to?

Answer 10

The contralateral side!

Question 11

If an innominate rotates anterior, describe the locations of the ASIS and PSIS

Answer 11

ASIS = inferior
PSIS = superior

Question 12

If an innominate rotates posterior, describe the locations of the ASIS and PSIS

Answer 12

ASIS = superior
PSIS = inferior

Question 13

At what stage in walking is the innominate rotated posteriorly?

Answer 13

Heel strike

Question 14

At what stage in walking is the innominate rotated anteriorly?

Answer 14

Toe off

Question 15

What motions of the innominates are generally pathologic and cause pain?

Answer 15

Shear and flare

Question 16

Innominate shear

Answer 16

ENTIRE innominate is superior or inferior

Question 17

Pubic shear

Answer 17

ONLY PUBIC TUBERCLES are superior or inferior

Question 18

Innominate flare

Answer 18

ASIS is more medial or lateral compared to opposite side - measure relative to umbilicus

Question 19

Innominate inflare

Answer 19

ASIS more medial

Question 20

Innominate outflare

Answer 20

ASIS more lateral

Question 21

What are the 3 sacral motions?

Answer 21

Flexion (nutation)
Extension
Oblique axis rotation

Question 22

The sacrum flexes and extends around what axis?

Answer 22

Transverse axis

Question 23

Sacral nutation

Answer 23

Flexion

Question 24

When the sacrum flexes around the transverse axis, what tips forward?

Answer 24

Sacral base

Question 25

The sacrum rotates around what axis?

Answer 25

Oblique

Question 26

What is an oblique axis?

Answer 26

Vertical axis slightly tilted

Question 27

How is the sacral oblique axis named?

Answer 27

For which sacral base (R/L top corner) it passes through

Question 28

Ex. Left oblique axis with right rotation. What is the sacral movement?

Answer 28

Top right sacral base rotates posteriorly

Question 29

4 steps to assessing innominates for somatic dysfunction

Answer 29

1. Screen innominates for somatic dysfunction (TART) 2. Lateralization tests 3. Palpate bony landmarks 4. Diagnose innominate somatic dysfunction

Question 30

How do you screen innominate for somatic dysfunction (step 1)?

Answer 30

Have them stand, and you sit behind them and assess for posterior spine/innominates TART - find one side that is worse

Question 31

What are the lateralization tests (step 2)?

Answer 31

ASIS compression test | Standing flexion test

Question 32

ASIS compression test

Answer 32

Posteromedial compression of both ASIS | - find which side is more resistant to compression

Question 33

Standing flexion test

Answer 33

Have patient stand and you monitor both PSIS's with your thumbs. Have patient bend over and see which PSIS moves SUPERIORLY

Question 34

For the lateralization tests, the dysfunctional sides move how?

Answer 34

ASIS compression test - harder end feel | Standing flexion test - PSIS moves superior

Question 35

What are the bony landmarks to palpate (step 3)?

Answer 35

``` Iliac crests ASIS Pubic tubercles Medial malleoli PSIS ```

Question 36

Anterior rotated innominate

Answer 36

Iliac crests and pubic tubercles = EVEN ASIS and medial malleolus = INFERIOR PSIS = SUPERIOR

Question 37

Posterior rotated innominate

Answer 37

Iliac crests and pubic tubercles = EVEN ASIS and medial malleolus = SUPERIOR PSIS = INFERIOR

Question 38

Superior innominate shear

Answer 38

ALL boney landmarks are SUPERIOR

Question 39

Inferior innominate shear

Answer 39

ALL boney landmarks are INFERIOR

Question 40

Innominate inflare

Answer 40

ASIS more medial

Question 41

Innominate outflare

Answer 41

ASIS more lateral

Question 42

Superior/Inferior pubic shear

Answer 42

Pubic tubercle ONLY is either superior or inferior compared to other side

Question 43

What should you do before you begin the ASIS compression test?

Answer 43

Reset the hips! | - Have patient push hips toward sky and then back down