Pelvic conditions

Question 1

Sacroiliac joint pain epidemiology

Answer 1

Arthritis
Trauma
Pregnancy and post-partum
Inflammatory conditions

Question 2

Age groups affected by SIJ pain

Answer 2

More common in females
Increased frequency in 40-55 year olds

Question 3

Risk factors of SIJ pain

Answer 3

Older age
Arthritis
Pregnancy
Trauma

Question 4

Clinical presentation of SIJ pain

Answer 4

Low back and/or buttock pain with or without lower extremity pain
Sharp, stabbing and /or shooting pain in buttock which extends down post thigh, usually not past knee
Pain frequently misdiagnosed as radicular pain
Difficulty sitting for too long

Question 5

Prognosis for SIJ pain

Answer 5

Dependent on severity, acute= several days- weeks
Chronic- persists for more than three months

Question 6

Osteitis pubis epidemiology

Answer 6

Overuse of hip and leg muscle
Particularly common in athletes who play sports involving changing direction, kicking or pivoting
Repetitive stress on pelvic bones

Question 7

Age groups affected by osteitis pubis

Answer 7

Common in men aged 30-50
Woman affected more in mid 30s

Question 8

Risk factors of osteitis pubis

Answer 8

Overusing hip and leg muscles particularly in sport

Question 9

Clinical presentation of osteitis pubis

Answer 9

Inflammation around pubis
Complaint about groin or lower abdomen pain
Pain over pubis symphysis

Question 10

Prognosis for osteitis pubis

Answer 10

Can take up to 6 months
Most return by 3 months

Question 11

Illiopsoas bursitis

Answer 11

Inflammation of bursa located beneath ilioposaos muscle

Question 12

Bursa meaning

Answer 12

Fluid filled sac between bones, muscles, tendons, and skin
Provides cushion and reduces friction

Question 13

Ilioposaos bursitis epidemiology

Answer 13

Arthritis (rheumatoid, psoriatic)
Acute trauma
Oversue injury

Question 14

Age groups affected by iliopsoas bursitis

Answer 14

After age 40

Question 15

Risk factors of ilipsoas bursitis

Answer 15

Repetitive motion
Overuse joints, tendons, and muscles
Rheumatoid arthritis

Question 16

Clinical presentation of iliopsoas bursitis

Answer 16

Pain is variable
Pain and tenderness that radiates deep in groin or front of hip radiating around and down the front of the thigh towards knee
Increased pain with hip flexion

Question 17

Prognosis of iliopsoas bursitis

Answer 17

Can take several weeks to heal
Typical recovery 6-8 weeks
Anti-inflammatory drugs
Stretching of hip flexors and later stretching programme

Question 18

Piriformis syndrome

Answer 18

Conditions in which piriformis muscle spasms and causes buttock pain
Can also irritate nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into foot
Uncommon cause of sciatica
Diagnosis of exclusion- facet arthropathy, spinal stenosis, and lumbar muscle strain must be ruled out fist

Question 19

Epidemiology of piriformis syndrome

Answer 19

Injury
Swelling
Muscle spasm
Scar tissue on piriformis

Question 20

Age groups affected by piriformis syndrome

Answer 20

No particular age
Females are more likely due to anatomical differences

Question 21

Risk factors of piriformis syndrome

Answer 21

Increased BMI
Occupational related injury to piriformis (e.g., prolonged sitting, driving)

Question 22

Clinical presentation of piriformis syndrome

Answer 22

Pain in buttock with or without ipsilateral radiation, down post thigh
Pain is exacerbated with activity, prolonged sitting, or walking
Pt may walk with a limp and hold the leg in a shortened externally rotated position while supine
Tenderness of greater sciatic notch
Made worse with deep laterally directed palpation on pelvic or rectal examination
May be trigger point over piriformis with radiation down sciatic distribution

Question 23

Prognosis of piriformis syndrome

Answer 23

Most episodes go away in a few days or weeks with rest and simple treatment
Stretching

Question 24

Ischiogluteal bursitis

Answer 24

Rare
Infrequently recognised soft tissue mass of the buttock region

Question 25

Epidemiology of ischiogluteal bursitis

Answer 25

most common in people sedentary careers, constant irritation of ischial bursae due to prolonged sitting on hard surfaces

Question 26

Risk factors of ischiogluteal bursitis

Answer 26

Sitting for too long on hard surface Direct trauma to area Injury to hamstring or tendon through exercise

Question 27

Clinical presentation of ischiogluteal bursitis

Answer 27

Palpable, tender mass on buttock Pain in upper thigh following exercise or sitting for a long time

Question 28

Prognosis of ischiogluteal bursitis

Answer 28

Will not spontaneously remit Pain may be abate with a period of lay-off or treatment Reiterating activity will still lead to excessive friction on bursa, causing inflammation and pain

Question 29

Levator ani syndrome

Answer 29

Non-relaxing pelvic floor dysfunction Pelvic floor muscles are too tight Pelvic floor supports rectum, bladder and urethra

Question 30

Epidemiology of levator ani syndrome

Answer 30

Exact cause unknown Related to not urinating when needing to, continuing intercourse when its painful, injury to pelvic floor from surgery or trauma

Question 31

Who is more affected by levator ani syndrome

Answer 31

More common in women

Question 32

Risk factors of levator ani syndrome

Answer 32

Pelvic floor surgery Post vaginal childbirth

Question 33

Clinical presentation of levator ani syndrome

Answer 33

Constant or frequent dull pain in rectum caused from spasm in levator ani muscle Pain usually unilateral, more specifically on left + higher up, tends to be more tender Pain in lower back which may spread to groin or thighs May experience constipation, problems passing bowel movements or strain Additional symptoms include bloating, needing to urinate often, bladder pain with urination

Question 34

Prognosis of levator ani syndrome

Answer 34

Massage, sitz bath, muscle relaxers will improve symptoms

Question 35

Coccydynia

Answer 35

Pain in coccyx

Question 36

Coccydynia epidemiology

Answer 36

Falling back into sitting position Repeated micro trauma (e.g., prolonged sitting in inappropriate position, cycling) Degenerative changes in sacrococcygeal and intercoccygeal joints Increased muscle tightness of pelvic floor muscle

Question 37

Groups affected by coccydnia

Answer 37

Women 5x more likely than men to develop coccydynia (pregnancy related injuries, often caused by pressure from baby's head)

Question 38

Risk factors of coccydynia

Answer 38

Birth trauma Increased BMI

Question 39

Clinical presentation of coccydynia

Answer 39

Tenderness in direct touching of coccyx area, pubococygeal and sacrococcygeal ligament Pain during defecation

Question 40

Prognosis of coccydynia

Answer 40

Conservative approaches- rest, ring shaped cushions, etc Medication- NSAIDs Manual therapy

Question 41

SIJ instability Hx

Answer 41

Chronic SI P Possible repeatable 'clunk' of SIJ May occur during or shortly after pregnancy

Question 42

SIJ instability SSx

Answer 42

Inc range of motion

Question 43

SIJ instability DDx

Answer 43

SIJ dys Lsp instability

Question 44

SIJ dysfunction Hx

Answer 44

Insidious onset of local P or discomfort May be due to fall on sacrum

Question 45

SIJ dysfunction SSx

Answer 45

Tender to palp Limited Jt play Local myospasm Bone out of place

Question 46

SIJ DDx

Answer 46

Lumbar sprain/strain