Pelvis and Hip Intro - SIJ

Question 1

What kind of joint is the SIJ?

Answer 1

synovial, non-axial

Question 2

What composes to make the SIJ?

Answer 2

Sacrum and two ilial bones

Question 3

Is the SIJ a stable joint?

Answer 3

Yes

Question 4

What makes the SIJ stable?

Answer 4

• irregular articular surfaces
• keystone sacrum
• fibrous capsule reinforced by ligaments in multiple directions

Question 5

Where is the pubic symphysis?

Answer 5

• located in the midline of the body

Question 6

What makes up the pubic symphysis?

Answer 6

right and left pubic bones joined with fibrocartilage disc and ligaments

Question 7

What kind of joint is the pubic symphysis?

Answer 7

Amphiarthrodial joint

Question 8

Where is the superior pubic ligament? Where does it strengthen the joint?

Answer 8

• attaches the pubic tubercles on each side
• strengthens the joint superiorly and anteriorly

Question 9

Where is the inferior pubic ligament? Where does it strengthen the joint?

Answer 9

• attaches between the two inferior pubic rami
• strengthens the joint inferiorly

Question 10

What is the motion of the SIJ?

Answer 10

• little mobility
• tiny movements that may be clinically undetectable

Question 11

What is the SIJ designed for?

Answer 11

stability

Question 12

Do those with SIJ dysfunction have more movement?

Answer 12

still tiny movement!!!!

Question 13

What is SIJ movement confirmed by?

Answer 13

RSA, a highly accurate technique of imaging 3D position and motion

Question 14

What percentage of SIJ dysfunction happens during pregnancy?

Answer 14

20%

Question 15

What percentage of SIJ dysfunction occurs with those not pregnant with LBP?

Answer 15

• 13%

Question 16

What are risk factors for SIJ dysfunction?

Answer 16

• laxity and hormonal changes
• during pregnancy
  > prior LBP
  > prior pelvic trauma

** none located for those not pregnant

Question 17

What is the etiology of SIJ dysfunction?

Answer 17

• peri-partum (time in and around pregnancy)
• immature skeletons
• trauma

Question 18

When is the skeleton ‘immature’?

Answer 18

under 8 years old due to lack of bony irregularity and congruency

Question 19

What are the pathomechanics of SIJ dysfunction?

Answer 19

hypermobility/instability

Question 20

What are symptoms of SIJ dysfunction?

Answer 20

• localized to SIJ 100% of time
• Gluteal region and lateral hip
• possible pubic symphysis pain
• like hypermobility/instability

Question 21

What are some hypermobility / instability symptoms we can have with SIJ dysfunction?

Answer 21

• Hurts when I…
• static positions painful
• catching w quick motions
• self manipulation
• prefer gentle movement

Question 22

What will we see with thoracolumbar A/PROM with SIJ dysfunction?

Answer 22

• no consistent pattern with just SI dysfunction
• may have concurrent lumbar condition

Question 23

What will we find with resisted testing/MMT with SIJ dysfunction?

Answer 23

• impaired local muscles
• weak anti-gravity hip muscles

Question 24

What will we find with stress tests with SIJ dysfunction?

Answer 24

• SI provocation tests
  > at least 3 positive

** lack support unless clustered together!!

Question 25

What are some palpation special tests for SIJ dysfunction?

Answer 25

- palpation for position * unreliable for poor studies for SIJ * leg length discrepancy clinical methods questionable at best and unacceptable for clinical decision making

Question 26

How can we diagnose a leg length discrepancy?

Answer 26

- standing x-ray

Question 27

What is a motion special test for SIJ dysfunction?

Answer 27

- positive March or Gillet test = MOST useful but still unreliable - others even more unreliable

Question 28

What other possible positive special tests can be found?

Answer 28

- positive ASLR - Positive FABER

Question 29

Is imaging diagnostic for those with SIJ dysfunction?

Answer 29

NOT diagnostic!!!!

Question 30

What is the gold standard for diagnosis for SIJ dysfunction?

Answer 30

SI block (Injection)

Question 31

What is the PT rx for SIJ dysfunction?

Answer 31

- POLICED - STM/ Muscle energy techniques / modalities / acupuncture for SHORT TERM pain/muscle guarding - pelvic belt

Question 32

What are JM used for with SIJ dysfunction?

Answer 32

- improved symptoms and clinical test findings - positive soft tissue and muscle influence from manipulation

Question 33

What do JM NOT do for SIJ dysfunction?

Answer 33

- alter positions per RSA imaging

Question 34

What is the focus of MET for SIJ dysfunction?

Answer 34

- stabilization!!!

Question 35

What hip muscles blend with sacrotuberous ligament?

Answer 35

hamstrings and glute max

Question 36

What hip muscles does the thoracolumbar fascia blend with?

Answer 36

- Lat, TA, erector spinae, and iliolumbar ligaments

Question 37

What pt education can we do for SIJ dysfunction?

Answer 37

- reduce fear - early mobilization without provocation - general anatomy, biomechanics, benefits of coordination and there x - reassurance of good prognosis

Question 38

What should we know about injections for SIJ dysfunction?

Answer 38

- intra-articular SIJ injections NOT recommended unless for SI jt pain associated with ankylosing spondylitis

Question 39

What has SHORT term benefit for SIJ dysfunction?

Answer 39

- pain/anti-inflammatory meds

Question 40

What is there NO EVIDENCE FOR with SIJ dysfunction?

Answer 40

prolotherapy or fusion

Question 41

What is the prognosis for SIJ dysfunction after pregnancy?

Answer 41

- declines during first 3 months after pregnancy

Question 42

What percentage of people have "serious pain" during pregnancy with symptoms 2 years later?

Answer 42

21%