Lab 4: SIJ Examination and Interventions

Question 1

ALWAYS test ____ before SIJ

Answer 1

LUMBAR

EXAM OPTIONS:
Lumbar spine exam
Lumbar spine + SI joint exam
Hip exam
Hip exam + SI joint exam
Lumbar spine + SI joint exam + hip exam

Question 1

few joint dysfunction signs:

Answer 1

fortin’s sign
Frequent hx trauma (falls)
pain change w/ rotation, SLS, Transitional

Question 2

subjective hisotry, medical screening questions and observations (do this every time) slide 5-8

Question 3

Patient with SI joint will have pain with

Answer 3

transitional movement
stairs
SLS

Question 4

pt is positive for lumbar disc clearing for pathology

Answer 4

+ pain with cough and sneeze
pain decrease with walking

Question 5

lumbar spine joint clearing test clearing for pathology

Answer 5

(-) pain w/ coughing and sneezing
(+) pain w/ extension or flexion
(+) pain w/ PA joint glides

Question 6

hip joint clearing for pathology

Answer 6

(+) Trendelenberg sign
(+) pain or ↓ ability to squat
(+) sign of buttock test

Question 7

scan or not to scan?

Answer 7

1. proximal cause distal sx
2. no MOI
3. non MSK

just 1 of the 3 = SCAN

Question 8

DURING LQ SCANNING exam… if any of the following are positive, proceed to full SI joint exam

Answer 8

Fortin’s sign
1º SI joint stress tests: gapping or compression
TTP at post SI ligaments
Pain/weakness w/ SLS

PERFORM LUMBAR EXAM FIRST
ADD SI JOINT EXAM IF INDICATED

Question 9

Special Tests: 1º SI Joint Stress Tests

Answer 9

Gapping (distraction) - anterior SI
Compression - posterior SI

Question 10

Special Tests: 2º SI Joint Stress Tests

Answer 10

1. Sacral thrust test (SI joint PA glide)
2. Gaenslen’s test
3. FABER/patrick’s
4. thigh thrust
5. pubic stress

Question 11

Sacral thrust test (SI joint PA glide)
provocates what?
what makes it a positive test?

Answer 11

provocating posterior SI ligament at S3

positive = reproduction of concordant sx over SIJ or posterior SI ligament

• pt is prone and PT applies significant PA pressure at S3… up to 6 thrusts 2-3x

Question 12

Positive SI joint dysfunctioin CPR 1
If > 3 out of 5 tests (+) = SI joint dysfunction

Answer 12

Compression
Distraction
Sacral thrust
Gaeslen test
Thigh thrust

Question 13

negative SI joint dysfunciton CPR

Answer 13

Compression
Distraction
Gaeslen test
FABER
Thigh thrust
If < 3 out of 5 tests (+) ≠
SI joint dysfunction

Question 14

Gaenslen’s test

Answer 14

Pt positioned in supine w/ 1 leg near the edge of the side of a table or mat
PT assesses pt’s resting symptoms in this position
PT flexes hip furthest from edge of mat to 90° and maintains that position
PT then passively positions testing leg off the side of the table, resulting in hip hyperextension
PT then applies forces to both legs, resulting in ↑ hip extension of testing leg and ↑ hip flexion of non-testing leg

(+) test = reproduction of concordant pain at SI joint or pubic symphysis

Question 15

FABER test

Answer 15

AKA: ‘Flexion ABduction External Rotation’ test
Screening test for lumbar, SI joint and hip pathology
Pt positioned in supine
PT places pt’s heel of 1 leg over opposite knee
PT passively ER and abducts testing leg while stabilizing opposite ASIS
If no symptoms, can add overpressure to further assess

(+) test for SI joint dysfunction = reproduction of concordant pain over posterior pelvis/buttock

NOT SI if pain is anterior

Question 16

Thigh thrust test

Answer 16

Pt positioned in supine w/ PT standing on painful side
PT flexes hip (on painful side) to 90° w/ neutral adduction
PT then slightly rolls pt to 1 side to place hand under pt’s sacrum to form a stable base
Once sacrum stabilized, PT slightly adducts pt’s hip and then applies downward force through the femur causing a posterior translation of the innominate on the sacrum

(+) test = reproduction of concordant pain at SI joint

Question 17

sign of buttock test

Answer 17

Indicates serious pathology:
Neoplasm
Fracture
Infection
Osteomyelitis
Abscess in muscle
Septic arthritis

Question 18

sign of buttock test procedure

Answer 18

Passive SLR = (+) pain
Return LE to neutral
Passively flex hip w/ knee flex = (+) test when ↑ pain w/ no Δ ROM

Question 19

bending the knee in sign of buttock test

Answer 19

puts the sciatic nerve on slack.

Question 20

sx before 90 degrees
sx around 70 degree
sx after 90 degrees

Answer 20

WAY before 70 - 90: infeciton, tumor
arond > 70 degrees: hip pathology
> 90: SI pathology

Question 21

Palpation
SLIDE 26-28

Question 22

if the patient made it this far.. meaning + CPR, Palpation concerns, and Hypomobility : do these Special Tests: Mobility / functional tests

Answer 22

1. seated flexion test
2. long sitting (supine to sit)
3. standing flexion test
4. Gillet’s (strok) test
5. Active SLR

Question 23

If the seated flexion test is negative (no asymmetry in PSIS movement) but the standing flexion test is positive (asymmetric PSIS movement),

Answer 23

this suggests that lower extremity factors, such as leg length discrepancy or hamstring tightness, might be influencing the standing test results rather than true SIJ dysfunction.

Question 24

seated flexion test what makes it positive?

Answer 24

Pt positioned in sitting w/ legs over edge of table and feet supported PT uses both thumbs to palpate just inferior to both PSIS PT instructs pt to flex trunk forward keeping 🡪 PSIS should move equal distance in superior direction Can use to rule out LE dysfunction such as LLD or hamstring tightness when compared to standing test (+) test = PSIS do not move equal distances w/ affected side moving more than unaffected side

Question 25

long stitting (supine to sit) test

Answer 25

Used to determine direction of innominate rotation Pt positioned in supine PT then instructs pt to perform double limb bridge to standardize position prior to testing PT then palpates superior surfaces of both medial malleoli and assesses positions of malleoli relative to each other PT instructs pt to sit up (into long sitting position) while maintaining thumbs on malleoli PT then re-assesses positions of malleoli in long sitting position Both medial malleoli should move equal distance in inferior direction (+) test = malleoli do not move equal distances

Question 26

which inniminates will make the limb shorter v longer?

Answer 26

Longer limb = posterior innominate on respective side Shorter limb – anterior innominate on respective side

Question 27

standing flexion test

Answer 27

Pt positioned in standing PT places thumbs just inferior to each PSIS PT instructs pt to flex trunk forward keeping knees extended 🡪 PSIS should move equal distance in superior direction (+) test = PSIS do not move equal distances w/ affected side moving more than unaffected side

Question 28

gillet's (strok) test

Answer 28

Pt positioned in standing PT uses thumb to palpate just inferior to 1 PSIS and other thumb to palpate base of sacrum on opposite side (just medial to PSIS) PT instructs pt to stand on 1 leg and then flex the opposite hip to >90° PSIS should move inferiorly to sacrum during test Test should be repeated on opposite leg (+) test = PSIS does not move inferiorly when compared to sacrum OR causes concordant SI joint pain

Answer 29

Part 1: Pt positioned in supine w/ both legs extended PT instructs pt to lift 1 leg off table w/o flexing knee PT observes pt’s movement strategy during test (+) test = reproduces concordant pelvic/SI joint pain OR compensatory pattern(s) observed Insufficient FORM closure Part 2: If (+) test present in part 1, test is repeated w/ PT applying compression force through pelvis (+) test = if pt able to perform ASLR test w/ less pain OR fewer compensatory patterns when compressive force was applied Insufficent FORCE closure Part 3: If (+) test present in part 1, test is repeated w/ PT instructing pt to contract core mm. prior to lifting leg Can add resistance at opposite shoulder for ↑ mm contraction (+) test = if pt able to perform ASLR test w/ less pain OR fewer compensatory patterns when core mm. activated **Part 1 has to be (+) before continuing to Part 2 or Part 3 of this test **

Question 30

SIJ interventions

Answer 30

chicago roll (banana) Sidelying SI gapping long axis traction (prone) 2-person technique prone sacral PA prone joint mobilizaiton to restore anterior innominate rotation MET