quiz #2 - pelvis

Question 1

what type of joint is the SI joint?

Answer 1

part synovial & part syndesmosis

sometimes called amphiarthrosis (slightly movable) joints

normal motion = about 7º

Question 2

limit anterior pelvic rotation or sacral counternutation

Answer 2

long posterior SI ligaments

Question 3

limits all pelvic & sacral movement

Answer 3

short posterior SI ligament

Question 4

limit nutation & posterior innominate rotation, provide vertical stability

Answer 4

sacrotuberous & sacrospinous ligaments

Question 5

stabilizes L5 on the ilium

Answer 5

iliolumbar ligament

Question 6

major connection between the sacrum &, ilium, one of the strongest ligaments in the body

Answer 6

interosseous SI ligament

Question 7

refers to the close packed position, no outside forces are necessary to hold the joint stable

Answer 7

form closure

nutation (sacral locking)

Question 8

loose packed position, effect of changing joint reaction forces generated by tissue tension, resulting in a self-bracing mechanism

Answer 8

force closure

Question 9

forward motion of the base of the sacrum into the pelvis OR the backward rotation of the ilium on the sacrum

Answer 9

nutation (sacral locking)

-ilia move closer together & ischial tuberosities move farther apart
-MOST stable
-post pelvic tilt

Question 10

nutation is limited by which ligaments?

Answer 10

anterior SI ligaments
sacrospinous ligament
sacrotuberous ligament

Question 11

anterior rotation of the ilium on the sacrum OR backward motion of the base of the sacrum out of the pelvis

Answer 11

counternutation (sacral unlocking)

-liac bones move farther apart & ischial tuberosities approximate
-“lordotic” or “anterior pelvic tilt”
-resisted by long posterior SI ligament supported by multifidus

Question 12

if the ASIS & PSIS on one side are higher than the ASIS & PSIS on the other

Answer 12

“up slip” of ilim on sacrum on high side

-short leg on opposite side
-on affected side, ASIS tends to be higher & slightly forward

Question 13

if ASIS is higher on one side & PSIS is lower at the same time

Answer 13

“anterior torsion”

may result in a spinal scoliosis, altered functional leg length or both

Question 14

sacrum is lower on the side of the pelvis that has rotated backward (following a posterior horizontal thrust of the femur)

Answer 14

anterior rotational dysfunction

Question 15

most common rotation of the innominate bones, result of falling on an ischial tuberosity, lifting when the body is forward flexed with the knees straight

Answer 15

left posterior torsion or rotation

Question 16

condition that is a result of pressure or entrapment of the lateral femoral cutaneous nerve near the ASIS because the nerve passes under the inguinal ligament

Answer 16

Meralgia Paresthetica

-from trauma such as that caused by a seat belt in a car accident, during delivery, surgery
-nerve = sensory only, sensory alteration/ burning pain on lateral aspect of thigh

Question 17

nerve that lies within transverse abdominus mm, may be compressed by spasm of mm, sensory only, sensory alteration/ pain occur in superior aspect of anterior thigh (in L1 dermatome) as well as in scrotum of labia

Answer 17

Ilioinguinal nerve

Question 18

common, secondary to disorders that limit ROM, associated with structural asymmetry (i.e. scoliosis) or hip disease, iliac surface affected first, fibrous ankylosis is physiologic not pathologic

Answer 18

pelvic degeneration

Question 19

pelvic degeneration differential diagnosis

Answer 19

Osteitis Condensans Ilii: non-inflammatory bone formation on iliac side of SIJ
Inflammatory Disease/Infection: AS/ STI
Pubic Symphysis Syndrome: subluxation/ separation

Question 20

minor vs. stable pelvic fracture Tx

Answer 20

minor = only symptomatic Tx

unstable = external/ internal fixation

Question 21

Sx for pelvic fractures

Answer 21

-groin / LB pain
-compression of pubic symphysis or both ASISs usually painful, (severe Fx), may indicate instability
-may or may not be able to walk
-signs of GU and/or gynecologic (usually vaginal)

Question 22

contributing factors to SI joint sprain

Answer 22

-congenital hypermobility
-history of SI joint sprains
-altered biomechanics
-leg length discrepancy
-CT pathologies
-RA
-rotational stress
pregnancy

Question 23

can be secondary to instability of symphysis pubis, occurs predominantly in athletes, may be complicated by a mechanical lesion of lumbar spine or one or both SIJ, associated with osteitis condensans ilii

Answer 23

sacroiliac joint hypermobility

can occur in young women, usually during/ soon after pregnancy as ligaments can remain lax for 6-12 weeks after delivery or longer
-symphysis may become a truly mobile joint, with pelvic instability as a result

Question 24

Sx for SI joint sprain

Answer 24

• SIJ pain (dull ache, refer to LB & glutes)
  -Iliopsoas tenderness
  -P increases with position changes
  -using stairs, sit to stand, turning over in bed
  -P may increase with prolonged postures
  -possible sacral edema /heat (bruising less likely)
  -mm spasm/HT/TP in glutes, LB & iliopsoas
  -pelvic dysfunction likely present

Question 25

special tests for SI joint sprain

Answer 25

Gapping/Squish Gaenslen’s Yeoman’s Hibbs Thigh Thrust Sacral Rocking Flamingo Gillet’s Forward Flexion Backward Bending

Question 26

treat with fiber for _____ and cross fiber for _____ joint play beyond the capsule for _____ and within the capsule for _____

Answer 26

hypomobility; hypermobility hypomobility; hypermobility

Question 27

compression of the sciatic nerve by the piriformis muscle

Answer 27

piriformis syndrome

Question 28

sensory & motor function to skin & mm of posterior thigh, most of leg & foot L4-S2 or S3 nerve roots two peripheral nerves: common peroneal & tibial nerve

Answer 28

sciatic nerve

Question 29

piriformis origin & insertion

Answer 29

O: ant. surface of sacrum, S1-S4, (runs in a horizontal orientation) I: medial superior aspect of greater trochanter of femur

Question 30

functions of piriformis

Answer 30

-restrain rapid/ vigorous int.R of hip -ext.R femur when hip is extended/ in neutral -horizontally ABD thigh when hip flexed 90º -int.R femur when hip is fully flexed

Question 31

TP referral in piriformis syndrome

Answer 31

refer to SI region, buttocks & over hip joint P from nerve entrapment goes down posterior thigh to calf & sole of foot

Question 32

causes of piriformis syndrome

Answer 32

-anomalies in course of nerve -direct & indirect trauma -inflammation -overuse -postural & positional concerns -anything that leads to/ aggravates TPs

Question 33

Sx for piriformis syndrome

Answer 33

-P increased by sitting/ any position with prolonged hip flexion, ADD & med rotation, by arising from seated position/ by standing -P often decreases with ext.R of hip -weakness in performing ABD, flexion & int.R of affected hip

Question 34

piriformis syndrome special tests

Answer 34

Pace abduction test Piriformis length test is positive SI joint motion = restricted

Question 35

with pelvic degeneration, what structure is usually affected first?

Answer 35

iliac surface

Question 36

SI joint sprain homecare

Answer 36

-P-free hip & lumbar ROM -strengthening pelvic floor, diaphragm, multifidi & transverse abdominus -strengthen obliques, erector spinae & glutes -stretching restricted mm