Pelvic Flashcards by Katie Young

Blue flag meaning

Component of yellow flags and often related to workplace demands, time pressure, and other features that could cause an increase in symptoms

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Black flag meaning

Component of yellow flags and often related to policy and work conditions that are out of the patient’s control

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What ligament is most commonly tender in peripartum females?

Long dorsal SIJ ligaments

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Appropriate first line of PT tx for nonspecific SIJ pain may include:

Manual therapy and therapeutic exercise

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Fortin finger sign

Patient points with one finger to PSIS (within 1cm)

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Manual therapy: which is better - general thrust techniques vs specific techniques?

General is JUST AS effective as specific

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T/F: there is evidence for use of TENS and manual therapy for facilitating descending inhibitory mechanisms?

True

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Is palpation reliable for identification of a problem spot and for tx?

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What intra-articular factors make the SIJ stable?

The grooves and ridges that increase the coefficient of friction

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Form closure

Theory that the SIJ is stable due to the sacrum being WEDGED between the ilia and ligaments

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Force closure

Theory that muscles and ligaments provide a compressive force across the SIJ

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Can form and force closures be associated with functional activity limitations/improvements

No, lack of contemporary research to associate those theories

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SIJ is relatively thin where (anterior/posterior)

Anterior, therefore is susceptible to leakage during intra-articular injection

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Sacrotuberous ligament blends with what ligament?

Long dorsal SIJ ligament

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The sacrotuberous ligament has been identified as connected directly to what muscle?

Biceps femoris (sometimes completely fused)

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What is the only muscle that directly attaches to the SIJ?

Piriformis

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Anterior SIJ innervation

L4-S2 branches

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Posterior SIJ innervation

L5-S4

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Is the SIJ capable of nociception

Yes

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Vascular claudication of the pelvis can present like what?

Mechanical pain with movement, trophic changes, temperature changes, LE pulse abnormalities

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Can SIJ motion be detected with palpation

No, SIJ motion appears to be sub-clinically detectable and not reliably palpated by PT’s

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Nutation

PPT, anterior/inferior movement of sacrum, ASIS higher vs PSIS

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Counternutation

APT, posterior/superior movement of sacrum, PSIS higher vs ASIS

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T/F: SIJ movement increases as jt load increases

False, it decreases (becomes more stable)

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What axis has been shown to have the most mobility in the SIJ?

Transverse axis (S2)

Has there been any association between decreased pressure pain thresholds (PPT) and SIJ issues?

Yes, lower PPTs in group with SIJ pain

Pain in Fortin's area (with/without) pain in the ischial tuberosity is likely to be of SIJ origin

Without

Risk factors for NEGATIVE prognosis of antepartum population with PGP

Prior hx of pregnancy, orthopedic dysfunctions, high BMI, smoking, work dissatisfaction, lack of belief in improvement

What other structures should be screened prior to diagnosis of PGP or SIJ pain?

Lumbar spine and hips

T/F: clinicians can cautiously use pain provocation tests to invetigate the SIJ as potential pain source

True, it's been found that the tests alone or in a cluster do not demonstrate diagnostic value

T/F: Pain referral to lumbopelvic region from visceral disorders are rare

False, it's not uncommon = should abdominal screen

Pelvic floor is innervated by what nerve

Pudendal nerve

Questionnaire to determine neuropathic pain

Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) OR Pain Detect questionnaire

+ Babinski

DF of big toe = UMN lesion

DTR - Patella (levels)

L3-L4

DTR - Achilles (levels)

L5-S1

Upper motor neuron lesions (DTR, babinski, bladder actvitiy)

DTR: hyper-reflexive Babinski: + Bladder: overactivity

Lower motor neuron lesions (DTR, babinski, bladder actvitiy)

DTR: hypo-reflexive Babinski: - Bladder: hypoactive

Anal reflex

S2-S5, presence of voluntary sphincter contraction - intact pelvic floor innervation

Bulbocavernosus reflex

S2-S4, squeezing the penis gland or clitoris = reflex contraction of external anal sphincter Absence = sacral nerve damage

2 types of sacral stress fractures

1) Insufficiency fx's 2) Fatigue fx's

Demographics/risk factors for insufficiency fractures

Think "OLD" and SUDDEN - Mean age 70.5 y/o Risk factors: post-menopausal, older, female w/hx of osteoporosis, hx of pelvic radiation, RA, and long-term corticosteroid use Sudden onset and pain w/ walking

Demographics/risk factors for fatigue fractures

Think "YOUNG" and GRADUAL - Mean age 21.5 y/o Risk factors: Increased training, deficient diet Sudden onset and pain w/ walking

What is the best imaging tool for diagnosis of sacral fractures?

MRI

Most concordant sign with sacral stress fractures?

Pain with palpation over sacrum or SIJ

Role of PT in management of sacral fractures?

Appropriate load management

Is non-radiographic (nr-axSpA) or radiographic (axSpA) commonly known as ankylosing spondylitis (AS)?

radiographic (axSpA)

T/F: damage from nr-axSpA can be visible when using magnetic resonance imaging (MRI)

True (most of the time)

Individuals with both types of axSpA typically present in what manner? And demographics?

<40 y/o, males (2/3) Long duration of symptoms that include: morning stiffness (especially in buttock), stiffness of spine, fatigue Other complaints may include tendon insertion pain, eye irritation, inflammatory bowel disease

T/F: vertebral fx is common with axSpA

True - d/t association with low bone mineral density

Best test that is most informative vs functional tests when identifying someone with nr-axSpA

FABER (moderate)

What antigen is commonly found in those with AS?

HLA-B27 Present in 85-90% of those with AS

Osteitis condensans ilii

Self-limiting condition marked by sclerosis of the iliac bone

Demographics of osteitis condensans ilii

Women who have had children, 40's Typically asymptomatic

Best tx of osteitis condensans ilii

Unknown, use impairment-based approach

Blood tests for AS

Increased levels of inflammatory markers: C-reactive protein, erythrocyte sedimentation rate Presence of HLA-B27

Best approach to management of AS: meds vs PT

A combo of both is best

(Flexion/extension) exercises have been shown to be beneficial for axSpA

Extension

Cardiovascular & strengthening exercises VS traditional tx (posture, stretching, breathing) for tx of AS?

Cardio and strength = better

(Low/high) intensity exercise best improves the overall quality of life and reducing disease progression of axSpA.

High intensity

5 types/classifications of PRPGP (pregnancy-related pelvic girdle pain)

1) Pelvic girdle syndrome 2) Symphysiolysis 3) One-sided sacroiliac syndrome 4) Double-sided sacroiliac syndrome 5) Misc

Pelvic girdle syndrome: Pain location + tests

Pain in BOTH SIJ and pubic symphysis FABER, thigh thrust

Symphysiolysis syndrome: Pain location + tests

Pain in symphysis pubis TTP over SP, pain w/ trendelenburg test

One-sided sacroiliac syndrome: Pain location + tests

Pain in one SIJ + thigh thrust

Double-sided sacroiliac syndrome: Pain location + tests

Pain in bilat SIJ + thigh thrust

Miscellaneous (PRPGP) category: Pain location + tests

Daily pain in 1 or more pelvic jt's Inconsistent findings

IS PRPGP self-limiting

Overall yes

Being physically active during pregnancy (does/does not) reduce the odds of developing pain during pregnancy or post-pregnancy

Does not HOWEVER, physical activity can be preventative for LBP

Education or a stabilization belt alone (are/are not) good as a stand alone tx's for PRPGP

are not needs to be a combo

When selecting exercises for PRPGP, what is the best approach

Exercises should address the patient's weakness and functional limitations ALSO emphasize return to regular activity as able

Study for PRPGP: exercise with highest amount of gluteus medius activation

Side-plank (aka side-bridging)

Study for PRPGP: exercise with highest amount of gluteus maximus muscle activity

Bird-dog Also good for TA activation

Study for PRPGP: exercise with highest amount of lumbar multifidus activation

Free-weight exercises

What level of evidence for manual therapy in PRPGP patients? (A-E)

Level C Including HVLA

T/F: manual techniques are all equal when treating PRPGP population

True, one is not better vs the others Still Level C evidence but no evidence to show harm

Is it reasonable to apply tx concepts for non-specific LBP to those with non-specific PGP?

Yes

Are core stabilization exercises better vs other forms during tx of PGP?

T/F: Is TENS is okay to use on someone with nociplastic pain

Yes, however the evidence is conflicting regarding the efficacy. TENS activates descending inhibitory systems in the CNS

Is manual therapy indicated in tx of central nociplastic pelvic girdle pain?

Some evidence, can increase both pressure and thermal pain thresholds Many techniques have an isometric muscle contraction component

Is exercise indicated in tx of central nociplastic pelvic girdle pain?

Yes, but limited evidence in how much improvement it can really make

T/F: there is a significant relationship between poor sleep and pelvic pain?

Yes, in chronic pelvic pain Should education re sleep hygiene

Does diet play a role in pelvic pain?

Yes, it appears that it does

Only outcome questionnaire developed specifically for PGP

Pelvic girdle questionnaire (PGQ)

What test was the strongest predictor of ODI score at 1yr post-partum

ASLR test

Oswestry disability index vs Roland Morris disability questionnaire for high/low disability

ODI = higher disability RMDQ = lower disability Tests are not better vs the other

Step count associated with lower all cause mortality

8,000 steps per day