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General Orthopedics > Pelvic Girdle & Sacroiliac Joint > Flashcards

Pelvic Girdle & Sacroiliac Joint Flashcards

(50 cards)

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1
Q

Describe the anatomy of the sacroiliac joint

A
  • largest axial joint in the body
  • connects spine to pelvis
  • allows for transfer of load from lumbar spine to lower extremities
  • held together with several ligaments and fibrous capsule
  • surrounded by muscular support
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2
Q

Do any muscles act directly on the sacroiliac joint

A

No

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3
Q

How are movements of the sacroiliac joint produced

A

By muscles acting on the trunk and lower limbs

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4
Q

What type of loads do the sacroiliac joint transfers?

A

Large bending moments and compression loads

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5
Q

What type of load does the sacroiliac joint does not have much stability against

A

Shear loads

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6
Q

How is shear load resisted

A

Transverse abdominus and pelvic floor muscles (elevator ani) help apply compression load to resist shear

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7
Q

What type of force opposes shear force

A

Compression force

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8
Q

How much flexion/extension is there in sacroiliac joint ROM

A

~ 3 degrees

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9
Q

How much axial rotation in Sacroiliac joint ROM

A

~ 1.5 degrees

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10
Q

How much lateral bending at the sacroiliac joint?

A

~0.8 degrees

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11
Q

What is nutation

A

Sacral flexion
- associated with spinal extension

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12
Q

What is counternutation

A

Sacral extension
- associated with spinal flexion

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13
Q

What direction does the superior sacrum tilt in nutation

A

Anteriorly

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14
Q

What direction does the coccyx tilt in nutation

A

Posteriorly

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15
Q

What structure restricts sacral nutation

A

Sacrotuberous ligament

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16
Q

What muscle helps restrict nutation and where is its attachment

A

Biceps femoris, ichial tuberosity

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17
Q

In what sacral position is load transfer more effective

A

When the sacrum is notated or tilted forward at its superior aspect

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18
Q

Which direction does the coccyx rotate in counter nutation (from mutated state back to neutral state)

A

Rotates anteriorly

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19
Q

What direction does the superior sacrum move in sacral counter nutation

A

Posterior tilt

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20
Q

What structure restricts sacral counter nutation

A

Long dorsal sacroiliac ligament
Can also be achieved by latissimus dorsi though its attachment at the thoracolumbar fascia

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21
Q

What plane does anterior and posterior rotation of the innominate (pelvis) occur

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A

Sagittal plane

22
Q

Should anterior rotation occur during weight bearing

23
Q

During single leg stance, which direction does innominate (pelvic) rotation occur and why

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A

Posteriorly to put sacrum in mutated position - creates close pack position and maximum amount of stability in the joint

24
Q

In what plane does inflate and outflare occur?

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A

Transverse plane

25
What kind of motion/tasks do inflare and outflare occur
During rotation and lateral bending tasks
26
What is the gold standard diagnosis for SI joint pain
Fluoroscopically guided diagnostic steroid injection
27
What is the primary mechanism of SI joint injury
Combination of axial loading and abrupt rotation
28
What type of surgery can also increase angular more and stresses across the SI joint
Lumbar fusion
29
Wha are the 4 European Guidelines on the Diagnosis and Treatment of Pelvic Girdle Pain
- groin pain - pain below L5 - Pain at the region of the PSiS - Absence of midline lumbar pain
30
What are the SI joint provocation test clusters
- FABER - Distraction - Compression - Thigh thrust - Sacral thrust - Gaenslan’s test 3 positive rests required for diagnosis of SI joint pain
31
What is the FABER test ? What type of stress is applied to the SI joint?
Flexion, abduction, ER - applies tensile force on anterior aspect of SI joint - positive test = report suction of pain
32
What is the distraction test? What type of stress is applied to the SI joint?
- lateral force to bilateral ASIS - applies tensile force on anterior aspect of SI joints - positive test - reproduction of pain
33
What is Compression test What type of stress is applied to the SI joint?
- patient sidelying, with application of downward compression on ilium - applies compression force across SI joint = pain = positive test
34
What is the thigh thrust? What type of stress is applied to the SI joint?
- patient supine, with affected side flexed to 90 degrees and examiner applies axial pressure through the femur - applied anteroposterior shear stress on the SI join
35
What is the sacral thrust test? What type of stress is applied to the SI joint?
- patient laying prone, examiner applies anteriorly directed force on the sacrum - applies anterior shear forces to both SI joints
36
What is Gaenslan’s test? What type of stress is applied to the SI joint?
- symptomatic leg placed in extension off the table, opposite leg held in flexion - applies torsional stress on the SI join - modified version performed in side lying
37
Is sacral fusion recommended for SI joint pain
No - there is no evidence for sacral fusion surgery
38
Structural/true leg length discrepancy definition
Results from inequalities in boney structure
39
Functional LLD deficiency
Caused by altered mechanics of the lower extremity
40
What rotation occurs off the innominate (pelvis) and in what plane during functional LLD
Anterior rotation, sagittal plane
41
What other downstream effects we can see in function LLD? Ie how are the femur, the knee, the tibia and the foot affected
- weakness of structural mal alignment of pelvis in frontal plane - functional lengthening of the lower limb - femoral internal rotation - valgus knee aka medial knee excursion - tibial internal rotation - foot pronation
42
What is the gold standard for measuring LLD
Radiographs
43
What re the 2 different clinical measurements of LLD
- with tape measure = with a block
44
How to measure structural LLD with a tape measure
- ASIS to medial malleolus -
45
How to measure functional/apparent LLD with a tape measure
Umbilicus go medial malleolus
46
Which clinical measurement of LLD indirect and which is direct
- indirect - blocks - direct - tape measure
47
Which LLD is measured first
- structural done prior to the functional - ie ASOS to med mal done prior to umbilicus to med mal
48
What is the recommended treatment for Functional LLD?
-physical therapy to address underlying issue
49
Treatment options for true LLD?
- conservative (less than 2cm) - Surgical
50
What are they surgical treatments for LLD
- epiphesiodesis - lower limb shortening’ - Mac 3inches in femur, max 2 inches in tibia - external limb lengthening - internal limb lengthening

General Orthopedics (5 decks)

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