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OS II Exam 1 > Sacrum > Flashcards

Sacrum Flashcards

1
Q

What common complaints require evaluation of the sacrum

A 
Abdominal pain
Pelvic pain
Dysmenorrhea
Lower back pain
Urinary tract complaints
Lower GI issues
Neuralgia of lower extremities
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2
Q

Anterior sacral landmarks

A

Sacral base
Sacral promontory
Sacral apex

Sacral ala
Coccyx
Anterior sacral foramen
Pelvic brim landmark
Transverse lines
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3
Q

Posterior sacral landmarks

A

Coccyx
Inferior lateral angle

Superior articular facets
Sacral canal
Auricular surface
Posterior sacral foramina
Sacral hiatus
Sacral tuberosities
Spinous tubercles
Sacral cornu
Intermediate sacral crest
Median sacral crest
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4
Q

Lowest portion of spinal column composed of 4 vertebra that are sometimes fused

A

Coccyx

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5
Q

The sacrum is formed by the union of ____ modified vertebra from 35 ossification centers as well as additional centers for ______ elements which develop within a cartilaginous model along with the vertebral arch and centrum

There are two _____ _____ for each lateral surface which separate adjacent segments and fuse sequentially after puberty with the lowest segments first

A

Five; costal

Epiphyseal plates

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6
Q

The dura attaches at the level of the ____ sacral segment

A

Second

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7
Q

Bony articulations of the sacrum

A

Fifth lumbar vertebra superiorly
Coccyx inferiorly
Two os coxae through C shaped SI articulations

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8
Q

Sacral joints AP

A

Right SI joint
Left SI joint
L5-S1 intervertebral disc
Sacrococcygeal joint

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9
Q

SI joint characteristics in males vs. females aftery puberty

A

Males: SIJ ligaments well developed and strong

Females: SIJ ligaments less developed, allowing mobility required during childbirth

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10
Q

SI joint characteristics in the second decade of life

A

Crescent shaped ridge develops along iliac surface that interdigitates with a depression on the sacral side, which adds stability and limits mobility

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11
Q

SI joint characteristics in the 3rd decade of life, particularly in males

A

Crescent shaped ridge becomes more pronounced decreasing ROM

Males: degenerative changes may begin to occur on the iliac side

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12
Q

SI joint characteristics in 4th and 5th devades of life, particularly in males

A

Males: degenerative changes begin on the sacral side

Fibrous ankylosis may further limit joint motion

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13
Q

SI joint characteristics of sacral surface vs. iliac surface

A

Sacral surface: generally smooth, hyaline cartilage, decreases in width inferior and is consequently wedged between 2 ilia

Iliac surface: anteriorly smooth, posteriorly fibrous, giving rise to the interosseous ligaments, fibrocartilage

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14
Q

The SI joint is described as either L or C shaped; contoured with a ______ upper arm and a ______lower arm, with a junction occurring at approximately ____

The apex points _____

A

Shorter; longer; S2

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15
Q

The SI joint is considered to be _____ bc it contains synovial fluid and matching articular surfaces

A

Diarthrodial

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16
Q

What makes the SI joint different from any other joint in the body?

A

One side is hyaline cartilage and the other is fibrocartilage

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17
Q

What ligament has inferior fibers from the third and fourth sacral segments ascending to the PSIS and posterior end of the internal lip of the iliac crest?

A

Posterior sacroiliac ligament

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18
Q

The posterior sacroiliac ligament blends with the _____ and the ____ fascia

A

STL; thoracolumbar

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19
Q

Which is thicker, anterior or posterior SI ligaments?

A

Posterior

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20
Q

What ligament connects the third sacral segment to the lateral side of the preauricular sulcus?

A

Anterior SI ligament

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21
Q

The anterior sacroiliac ligament blends with what other ligament?

A

Iliolumbar ligament

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22
Q

What ligament forms the major bond between the sacrum and ilium, filling the irregular space posterosuperior to the joint?

A

Interosseous sacroiliac ligament

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23
Q

What covers the interosseous sacroiliac ligament posteriorly?

A

Posterior SI ligament

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24
Q

What ligament connects the PSIS to the lateral aspect of the third and fourth sacral segments?

A

Long dorsal SI ligament

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25
The long dorsal SI ligament is in close anatomic relationship with what 3 structures?
Erector spinae mm group Posterior layer of thoracolumbar fascia Sacrotuberous ligament
26
What effect does nutation have on the STLs and sacrospinous ligaments?
Stretches them
27
What ligament is stretched in counternutation, such as early stages of pregnancy, aging, or backward torsions or sacral extensions?
Long dorsal SI ligament
28
What ligaments are stretched by nutation?
STLs | Sacrospinous
29
What small muscle runs and blends with the STL and sacrospinous ligaments?
Coccygeus m
30
What ligament extends from ischial spine to lateral margins of the sacrum where it blends with the sacrotuberous ligament and forms part of the origin of the coccygeus m?
Sacrospinous L
31
What ligament runs from lower sacral tubercles to ischial tuberosity and forms part of gluteus maximus attachement, tendon of biceps femoris attachment, and connects with the fascia of the pelvis?
STL
32
What ligaments stabilize to limit posterior-superior rotation of the sacral apex around a transverse axis?
Sacrospinous | Sacrotuberous
33
Origin/insertion/innervation/action of piriformis m
Origin from anterior surface of 2-3-4 lateral masses of the sacrum and sacrotuberous ligament Insertion upon superior border of greater trochanter Innervation: ventral rami of 1 and 2 sacral plexus Action: externally rotates thigh when hip joint is extended; abducts thigh when hip joint is flexed; assists in holding femoral head in acetabulum
34
Hypertonicity of the piriformis may lead to what condition?
Sciatica
35
What muscles make up the pelvic diaphragm?
Levator ani (puborectalis, pubococcygeus, ileococcygeus) Obturator internus Ischiococcygeus Piriformis
36
What 3 plexuses are associated with the sacrum?
Lumbar plexus L1-4 Sacral plexus L5-S4 Coccygeal plexus S5-coccygeal n
37
What 3 ganglia are important in innervation surrounding the sacrum?
Inferior mesenteric ganglion Superior hypogastric ganglion Ganglion impar
38
What is the significance of the ganglion impar?
It joins the 2 sides of ganglia along the sacrum at the apex
39
The self-locking mechanism of the sacrum is critical for resistance against ______, the result of: ______ = the specific properties of the articular surfaces of the SIJ requiring the proper size, shape, and attitude of the articulating surfaces ______ = the compression produced by body weight, muscle action, and ligament force
Shear Form closure Force closure
40
____ closure is due to how the joint fits together ____ closure is due to gravity and loading forces - muscles, fascia, and ligaments
Form Force
41
How are the 2 oblique axes of sacral motion named?
According to the side of the body toward which the superior end of the oblique axis is located
42
What are the 3 transverse axes of motion associated with the sacrum?
ST (respiratory) axis - level of S2 MT (postural) axis - level of S2 IT (pelvic/ilial) axis - level of S3
43
Describe movement of the sacrum (including base vs. apex) in counternutation
Sacral extension Base moves posteriorly Apex moves anteriorly
44
Describe movement of the sacrum (including base vs. apex) in nutation
Sacral flexion Base moves anterior Apex moves posterior
45
All movements of the sacrum on the ilium are _____ movements including flexion, extension, rotation, SB, and upward/downward motion
Gliding
46
Downward force transmitted from the lumbar region glides the sacrum downward and causes ________ Traction applied from above the LS junction glides the sacrum upwards and causes _____
Nutation Counternutation
47
Rotation applied through the lumbar spine causes the sacrum to rotate toward the _____ side and sidebends towards the ____ side
Ipsilateral; contralateral
48
Sidebending applied through the lumbar spine causes the sacrum to sidebend towards the ______ side...but rotation during sidebending may be inconsistent
Ipsilateral
49
T/F: flexion/extension and gliding upward/downward ROM is less than rotation or sidebending
False; greater than rotation or sidebending
50
T/F the ilium always moves in the same direction as the sacrum but to a lesser degree
True
51
A restricted inferior occipital condylar part is related to what dysfunction of the sacrum?
Lowered sacral base on that side
52
_____ = a transitional segment in which the first sacral segment becomes like an additional lumbar vertebra articulating with the second sacral segment
Lumbralization
53
______ = incomplete separation and differentiation of the fifth lumbar vertebra such that it takes on characteristics of a sacral vertebra OR when transverse proces of the fifth lumbar vertebra are atypically large, causing pseudoarthritis with the sacrum and/or ilia referred to as a batwing deformity if bilateral
Sacralization
54
Static testing methods for sacrum
Sacral sulcus L5 rotation ILA 4 point eval
55
Active motion testing of the sacrum
Backward bending test Respiratory motion test
56
Passive motion testing of the sacrum
Lumbosacral spring test 4 point PROM Oblique axis passive motion
57
In a torsion, the lateralization test will be _____ on the opposite side of the axis
Positive
58
The sacral base should move ____ during inhalation and _____ during exhalation
Posteriorly; anteriorly
59
Innominate rotation occurs around what sacral axis?
Inferior transverse axis (S3)
60
How should rotation of the sacrum relate to rotation of L5?
L5 rotates opposite the direction of the sacrum (if not rotated, it is uncompensated and should be tx before the sacral dysfunction)
61
A flexed sacrum means a _____ L5; an extended sacrum means a _____ L5
Neutral (type 1); non-neutral (type 2)
62
How does L5 sidebend in relation to an oblique axis of a torsion?
L5 sidebends toward the oblique axis of a torsion
63
Which side of the SI joint should be gapped to facilitate flexion?
Anterior SI
64
Which side of the SI joint should be gapped to facilitate extension?
Posterior
65
For bilateral sacral flexion HVLA, on what respiratory cycle is thrust applied?
Inhalation

OS II Exam 1 (4 decks)

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