Ortho III Final- Pelvis/ SI

Question 1

What 3 muscles attach to the sacrum?

Answer 1

IMP

-illiacus, multifidus, piriformis

Question 2

The pelvic ring consists of _ joints. Differences b/w men and women occur at _. Females have a _ sacrum that is _ _, and appears _.

Answer 2

Pelvic ring consists of 3 joints

Differences occur at PUBERTY

Females have a SHORTER sacrum that is ANTERIORLY ROTATED, and appears HYPERLORDOTIC

Question 3

The articular surface of the SI joint: -_ segment is shorter; _ segment is longer. Is _ in females, but still _ -.

Answer 3

CRANIAL segment is shorter

CAUDAL segment is longer

Is SMALLER in females but still spans S1-S3

Question 4

The sacrum is _ until puberty and then develops _ _ _. Is built for _.

Answer 4

The sacrum is SMOOTH until puberty and then develops IRREGULAR SURFACE AREA.

Is built for stability

Question 5

The pelvis is stabilized posteriorly by _, due to a lack of _. The main function is to _ _ in all _.

Answer 5

Pelvis stabilized posteriorly by LIGAMENTS, due to lack of a CAPSULE.

The main function is to LIMIT MOTIONS in all PLANES

Question 6

Anteriorly the ligaments are _ to _ and _. Makes them difficult to _ but stress to them can _ _.

Answer 6

Anteriorly the ligaments are DEEP to MUSCLE and VISCERA.

Makes them difficult to PALPATE, but stresses to them can CAUSE PAIN

Question 7

Anatomically the pelvis is _, and movement _ _. IT functions to _ _ _ _ .

Answer 7

The pelvis is COMPLEX, and movement OCCURS TOGETHER.

It functions to DISTRIBUTE WEIGHT BEARING FORCES

Question 8

How many degrees of movement are there in the pelvis?

Answer 8

6 DEGREES OF MOVEMENT

Question 9

The _ and _ forces react with each other, and the _ _ complete the _ _ or _ _ mechanism.

Answer 9

The GROUND and TRUNK FORCES react with each other, and the LIGAMENTOUS STRUCTURES complete the SCREW HOME OR SELF LOCKING mechanism

Question 10

Lumbopelvic rhythm: Normal standing position with lumbar concavity, _ _ is directly _ _ _

Answer 10

Normal standing position with lumbar concavity, BODY WEIGHT is directly OVER THE HIPS

Question 11

Lumbopelvic Rhythm: With flattening of the lumbar spine (flexion) the pelvis _ _, hips and pelvis _ _.

Answer 11

The pelvis ROTATES ANTERIORLY, hips and pelvis MOVE POSTERIORLY

Question 12

Lumbopelvic Rhythm: Reversal of the lumbar curve (extreme flexion) the pelvis _ _ to the fullest with the pelvis and hips _ _.

Answer 12

Reversal of the lumbar curve (extreme flexion) the pelvis ROTATES ANTERIORLY to the fullest with the pelvis and hips DISPLACED POSTERIORLY

Question 13

During gait: the torso swings _ _ out of phase with the pelvis with the axis being at -. The Innominate _ _ with swing switching to an _ direction at midstance.

Answer 13

The torso swings 180 DEGREES out of phase with the pelvis with the axis being at T12-L1

The Innominate ROTATES POSTERIORLY with swing, switching to an ANTERIOR-WARD direction at midstance

Question 14

Gait: the sacrum is at _ _ about the _ _ _ on heel strike. (Ex- at _ heel strike, sacrum is in _ _ around the _ _ _)

Answer 14

The sacrum is at IPSILATERAL ROTATION about the IPSILATERAL OBLIQUE AXIS on heel strike.

Ex: at RIGHT heel strike, sacrum is in RIGHT ROTATION around the RIGHT OBLIQUE AXIS

Question 15

During the subjective examination patients with SI pain will most likely complain of pain in the _ _, _, and _ (in that order)

Answer 15

Most likely to complain of pain in the LOWER BACK, BUTTOCK and THIGH

Question 16

MOI: forceful golf, baseball or hockey slap shot; horizontal thrust to the the knee (dashboard injury); and a forceful diagonal pattern such as chopping wood, tennis serve or swinging a sledge hammer can all cause?

Answer 16

Anterior innominate rotation

Question 17

MOI: repeated unilateral standing, fall on the IT, vertical thrust onto extended leg (miss curb/ step), lifting in a forward bend position with locked leg, and hyper flexion/ hyper abduction injury to the hips during intercourse in females can all cause?

Answer 17

Posterior innominate rotation

Question 18

MOI: fall onto buttocks, forceful vertical thrust on an extended leg (misstep/ leg bracing during MVA); or a fall or injury resulting in EROM of hip ER can cause?

Answer 18

Can cause INNOMINATE OUTFLARE

Question 19

MOI: fall or injury resulting in EROM of hip IR can cause? Not _ _, can be seen in sports such as _.

Answer 19

Can cause INNOMINATE INFLARE

Not AS COMMON, can be seen in sports such as SNOWBOARDING

Question 20

When slipping and falling injuries usually occur?

Answer 20

Usually occur on the landing side

Question 21

MOI: forceful misstep, fall onto buttock, and prolonged single limb stance or assymetrical weight bearing can cause?

Answer 21

Can cause INNOMINATE upslip

Question 22

Which types of innominate injuries can occur due to a forceful misstep with leg extended? (3)

Answer 22

Posterior rotation
OUTFLARE
Upslip

Question 23

Which innominate injuries can occur due to a fall on the buttocks? (2) What innominate injuries can occur to prolonged or repeated unilateral/ single limb standing? (2)

Answer 23

FALL ON BUTTOCKS: Outflare, upslip

PROLONGED SL STANCE: Posterior rotation, upslip

Question 24

Sacral bilateral dsyfunctions can occur due to a _ on _ or other _ _. Don’t usually happen due to __ _ and _

Answer 24

Can occur due to a FALL ON BUTTOCKS or other DIRECT TRAUMA

Don’t usually happen due to EVERYDAY WEAR AND TEAR

Question 25

_ _ _ are similar to bilateral sacral dysfunctions, but may have a ambulatory or injury while running component to it.

Answer 25

SACRAL TORSION INJURIES are similar to . .. .

Question 26

What are aggravating factors that you may see in a patient with SI pain in the clinic? (6)

Answer 26

SOUP With Prawns - stairs - obesity - unilateral standing - prolonged standing - walking - pregnancy

Question 27

What are easing factors that are associated with SI/ Pelvic injury? (3)

Answer 27

SLaB - sitting - lying supine - belt support

Question 28

A healthy person will change positions up to _ _ in an _ _ sleep period

Answer 28

A healthy person will change positions up to 50 TIMES in a 8 HOUR sleep period

Question 29

With _ _ the cardinal and earliest sign is erosion of the SIJ manifested by pain and stiffness of the SIJ and lumbar spine for the _ _ _ of the _. (_ pain)

Answer 29

With ANKYLOSING SPONDYILITIS the cardinal and earliest sign is erosion of the SIJ manifested by pain and stiffness of the SIJ and lumbar spine for the FIRST FEW HOURS of the DAY (MORNING pain)

Question 30

What are 3 special questions you might want to ask in patients presenting with SIJ pain?

Answer 30

Have you recently fallen on your buttocks? Have you had a sudden jolt o your leg, like a misstep off of a curb? Have you recently been chopping wood or shoveling snow?

Question 31

Unless there is _ _ the SI joint is usually not first on the hypothesis list. Usually complete a _ or _ evaluation first or at least _ those _.

Answer 31

Unless there is DIRECT TRAUMA the SI joint is usually not the first on the hypothesis list. Usually complete a HIP OR LUMBAR evaluation first or at least CLEAR THOSE JOINTS.

Question 32

What test is being described: the patient can localize the pain with 1 finger, area pointed to immediately inferior and medial to the PSIS within 1 cm, and the patient consistently points to the same area over 2 trials. What does it indicate?

Answer 32

FORTIN FINGER TEST It indicates that the the SI joint might be the problem

Question 33

What are 3 things to look for when observing a patient in standing?

Answer 33

``` Pelvic obliquity (anterior or posterior rotation) Lumbar lordosis (excessive or decreased) Muscle tone (butt grippers) ```

Question 34

What are the 6 SI joint provocation tests?

Answer 34

SSSS FG - SI distraction - SI compression - sacral compression/ thrust - SLR - Femoral compression - Gaenslens test

Question 35

What are the 6 provocation tests that Laslett looked at? Which one of the 6 we learned in class is NOT part of the Laslett article?

Answer 35

GG DC ST - Gaenslens (right and left) - distraction - compression - sacral thrust - thigh thrust There is NO SLR test

Question 36

How many tests were considered positive to identify an increased probability of SIJ inolvement? (2) What is the significance of 0/6 of the tests being positive?

Answer 36

3 out of 6 OR 2 out of the first 4 (all but Gaenslen's) were considered to indicate SIJ involvement If 0/6 tests were positive you can rule out SIJ pain

Question 37

What was the most reliable and sensitive test? Most Specific?

Answer 37

Femoral Compression/ Thrust was the most reliable and sensitive test SIJ Distraction was the most specific

Question 38

What are the SIJ positional fault (dynamic) tests? (5)

Answer 38

SSS ML - standing flexion - sacral rotation - sacral flexion and extension - March test (Gillet's) - Leg rotation test

Question 39

What test is being described: patient is supine with test hip off of plinth in extension and contralateral hip flexed to end range, therapist provides extension force to the test leg and counter flexion force to the contralateral side? What is a positive result?

Answer 39

Gaenslen's test Positive result is reproduction of symptoms

Question 40

What test is being described: Pt is standing with therapist behind palpating inferior portion of PSIS, ask patient to slowly bend forward, PSIS should move together. What is a positive result? (2)

Answer 40

Standing Flexion test Positive result: if one side moves first or further - that side is the involved side

Question 41

What test is being described: Pt. standing holding onto chair/ table for balance, therapist is behind palpating the inferior portion of the PSIS on test side and the S2 SP, pt lifts and flexes Ipsilateral hip and knee, pt then repeats movement with contralateral leg.

Answer 41

Gillet's or March test

Question 42

What is a positive result for the Ipsilateral leg in March's test? Contralateral leg? What is the normal for each test?

Answer 42

Ipsilateral leg- if both innominate and sacrum move together it is considered positive (posterior rotation limitation) - normal pelvis should rotate first then the sacrum should move Contralateral leg- if both innominate and sacrum move together is is considered positive (anterior rotation limitation) -normally you should feel the sacrum move first then the innominate

Question 43

What test is being described: patient stands with back to therapist, PT is behind patient sitting/ kneading with thumbs just medial to the PSIS on the sacral base, pt laterally flexes to one side and then the other, PT notes the depth and symmetry of the sacrum on the same side as lateral flexion.

Answer 43

Sacral rotation test

Question 44

What is normal movement for left lateral flexion during the sacral rotation test? What would be considered a positive test?

Answer 44

During left lateral flexion the sacrum rotates to the right around a right oblique axis causing the sacral base on the LEFT TO MOVE ANTERIORLY (deeper) If there was no movement or if the left sacral base popped out/ became more superficial then the test would be considered positive

Question 45

What test is being described: patient stands with back to therapist, PT kneels or sits behind patient with index fingers on ASIS and thumbs on PSIS (or on top of illiac crest if you can't reach), pt marches a couple times to 'reset' pelvis, then patients is asked to ER one hip and then the other, test is repeated with IR. PT notes degree of innominate and hip rotation.

Answer 45

Leg rotation test

Question 46

What would be a normal innominate excursion during hip ER and IR? Compared to what equivalent of hip excursion? What would be considered a positive result of the leg rotation test?

Answer 46

Normal innominate excursion is 5 DEGREES during hip IR and ER, with 45 DEGREES hip ROM Test would be considered positive if the movement of the innominate was less than 5 degrees with 45 degrees of hip IR or ER, or markedly less ROM when compared bilaterally *if test is too close to call then it is considered negative*

Question 47

What test is being described: pt is standing, PT is kneeling or sitting behind patient with thumbs just medial to the PSIS on the sacral base, pt bends forward, and then it is repeated with pt. bending backwards. PT notes the symmetry and amount of movement and palpates for nutation and counter nutation of the sacral base.

Answer 47

SACRAL FLEXION AND EXTENSION TEST

Question 48

Sacral flexion assess sacral nutation during _ _. Sacral extension assess sacral counter nutation during _ _.

Answer 48

Sacral flexion assess sacral nutation during LUMBAR EXTENSION Sacral extension assess sacral counter nutation during LUMBAR FLEXION

Question 49

What 3 things should you assess in supine?

Answer 49

Leg length discrepancy Excessive hip rotation (ER/ IR) Pelvic obliquity

Question 50

Supine to long sit: if there is a leg length discrepancy in supine and the patient comes to long sit position and it is still the same then?

Answer 50

Then pt has an actual leg length discrepancy

Question 51

If a patient has an innominate posterior rotation dysfunction then in supine the right leg will appear _ and in long sitting both legs _ _ or right leg is _.

Answer 51

Then in supine the right leg will appear SHORTER and in long sitting both legs ARE SYMMETRICAL or right leg is LONGER

Question 52

If a patient has a Anterior rotation dysfunction on the right: in supine the right leg will appear _, and in long sitting both legs _ _ or right leg appears _.

Answer 52

In supine the right leg will appear LONGER, and in long sitting both legs APPEAR SYMMETRICAL or right leg appears SHORTER *ALS*

Question 53

To check pelvic obliquity in supine you should palpate _ to _ and look to see if one is _ or _ to the other.

Answer 53

You should palpate INFERIOR TO ASIS and look to see if one is SUPERIOR OR INFERIOR to the other

Question 54

When checking for excessive hip ER or IR in supine you should palpate _ to _ and check by _ _ to _ _.

Answer 54

You should palpate MEDIAL TO ASIS and check by MEASURING ASIS TO UMBILICUS DISTANCE

Question 55

When checking for pelvic obliquity in prone you should palpate just _ to the _, and look to see if one is more _ or _ to the other.

Answer 55

When checking for pelvic obliquity in prone you should palpate just MEDIAL TO THE PSIS, and look to see if one is more SUPERIOR OR INFERIOR to the other.

Question 56

When checking for outflare versus inflare in prone what are you assessing?

Answer 56

Outflare: PSIS will be closer to spine on out flared side Inflare: PSIS will be farther away from spine on inflared side

Question 57

The _ _ _ _ runs vertically from inferior margin of PSIS to sacrum and is palpated just _ to _. Purpose is to check _ _.

Answer 57

The LONGER POSTERIOR SI LIGAMENT runs vertical from inferior margin of PSIS to sacrum and is palpated just INFERIOR TO PSIS. Purpose is to check ANTERIOR ROTATION

Question 58

The _ _ _ _ runs medially and inferiorly from the medial margin of the PSIS to the S1 and S2 transverse tubercles. Is palpated just _ to _. Checks _ _ and _ _.

Answer 58

The SHORT POSTERIOR SI LIGAMENT runs medially . . . Is palpated just MEDIAL TO PSIS Checks INNOMINATE MEDIAL and ANTERIOR ROTATION

Question 59

Dysfunction of which ligament is associated with decreased lumbar lordosis, frontal plane pelvic instability during gait and Sagittal plane hip restrictions?

Answer 59

LONG POSTERIOR SI LIGAMENT

Question 60

Which ligament is associated with increased lumbar lordosis and increased frontal plane instability during gait? (2)

Answer 60

Short posterior SI and sacrotuberous ligament

Question 61

The _ _ travels between the _ _ _ of the sacrum to the _ _. Is palpated at the _ between _ _ _ and _ _.

Answer 61

The SACROTUBEROUS LIGAMENT travels between the INFERIOR LATERAL BORDER of the sacrum to the ISCHIAL TUBEROSITY Is palpated at the MIDPOINT between INFERIOR LATERAL ANGLE AND ISCHIAL TUBEROSITIES

Question 62

The axis of rotation of the sacrum is named for?

Answer 62

Named for the top corner

Question 63

Anteriorly rotated innominate/ held in anterior rotation (osteopathic language) is the same as _ _ _ _ (movement science language). What is the difference between the two types of language?

Answer 63

Is the same as LIMITED INNOMINATE POSTERIOR ROTATION The difference is language is that : Osteopathic- looks at what IT IS doing Movement science- looks at what IT CAN'T do

Question 64

Muscle energy techniques involve _ _ _ action. Meaning?

Answer 64

Involve REVERSED ORIGIN-INSERTION action Meaning with AROM insertion moves towards origin, with MET it moves the opposite- origin towards insertion with the distal joint partner fixed(similar to CKC)

Question 65

MET to the illiacus muscle corrects innominate _ _ _, stuck _ by resisting knee and hip flexion.

Answer 65

Corrects innominate POSTERIOR ROTATION DYSFUNCTION, stuck POSTERIORLY

Question 66

MET of the illiacus muscle corrects an _ _ _ with leg figure 4 position

Answer 66

Corrects an INNOMINATE INFLARE DYSFUNCTION

Question 67

MET of the illiacus muscle with the leg in flexion, adduction and IR (FADIR) position corrects an _ _ _.

Answer 67

Corrects an INNOMINATE OUTFLARE DYSFUNCTION

Question 68

MET of the sartorius muscle with the leg in FADIR position corrects an _ _ _

Answer 68

Corrects an INNOMINATE OUTFLARE DSYFUNCTION

Question 69

MET of the gluteus Maximus muscle with the hip and knee flexed and resisting extension corrects an _ _ _ _

Answer 69

Corrects an INNOMINATE ANTERIOR ROTATION DSYFUNCTION

Question 70

MET to the piriformis muscle with the hip flexed at 60 degrees (pure _ _ occurs at this degree) will correct _ _ _ both _ and _. When performing the treatment side is _.

Answer 70

With the hip flexed at 60 degrees (pure ADDUCTION ACTION occurs at this degree) will correct BACKWARD SACRAL TORSIONS BOTH LOR AND ROL. When performing the treatment side is DOWN

Question 71

MET to the multifidus muscle in the position of lower back rotational manipulation- except using an isometric contraction instead, will correct _ _ _ both _ and _. Treatment side is?

Answer 71

Will correct FORWARD SACRAL TORSIONS both LOL AND ROR Treatment side is UP

Question 72

MET to the gluteus medius muscle with knee and hip flexed to 90 degrees on treatment side and resisting adduction force, is used to correct _ _ _.

Answer 72

Used to correct INNOMINATE INFLARE DSYFUNCTION.

Question 73

Balancing the pubes or shotgun technique is used to correct an _ _ _ by pulling the pubis bone _.

Answer 73

Used to correct an INNOMINATE UPSLIP DYSFUNCTION by pulling the pubis bone INFERIORLY