SI Joint Exam Flashcards

Question

True Leg Length Discrepancy

Answer 1

• Pt position: Supine •PT places the pt’s legs in precisely comparable positions by applying longitudinal traction at the ankles. • Measure the distance from the ASIS to the medial malleolus bilaterally • Unequal distances verify that one LE is shorter than the other • NOTE: Some believe ASIS to lateral malleolus is a more accurate measurement • Determine where the discrepancy lies by having pt lie supine with knees flexed to 90 and feet flat on mat – If knee is higher on one side, that tibia is longer – If knee is farther caudal, that femur is longer

Answer 2

• Pt supine with feet over edge of plinth •Pt bridges and then extends LE’s. PT gently pulls on both LEs at the ankles • PT then palpates inferior aspect of the medial malleoli while pulling both malleoli close to each other • Barring pelvic obliquity or true leg length discrepancy, malleoli should be even • Instruct the pt to sit up. •Monitor the medial malleoli to determine any change in their relative positions. • If any change, it is assumed that the longer leg has a posteriorly rotated ilium

Answer 3

``` Do not rely strictly on palpation Use the hands to assess bony structures and then confirm visually • Posterior – Iliac crests – ASIS – PSIS – PSIS depth – Sacrotuberous ligament – Piriformis • Anterior – ASIS – Iliac crest – Pubis ```

Answer 4

``` • Laslett’s Cluster I – Thigh Thrust – Distraction – Compression – Sacral Thrust • 2 of the 4 tests positive – Sn = 88% – Sp = 78% • Use thigh thrust and distraction tests first ```

Answer 5

``` • Laslett’s Cluster II – Thigh thrust – Distraction – Comprssion – Gaenslen’s test – Sacral Thrust • 3 out of 5 positive tests – Sn = 91% – Sp = 87% ```

Answer 6

``` • Van der Wurff’s Cluster – Thigh Thrust – Distraction – Compression – Patrick (FABER) – Gaenslen’s Test • 3 of 5 positive test – Sn = 85% – Sn = 79% ```

Answer 7

* Pt position: Standing; feet shoulder width apart, weight evenly distributed * PT position: Kneeling in front of pt * PT instruction: move the hands along the pt’s skin up the waist and move the fingers of the anterior portion of the iliac crest to the apex laterally. Posteriorly, palpate the L4 spinous process and move laterally to the crest * Assess bilateral height by placing the hand across the top of the each crest with palmar surface down

Answer 8

• Pt position: Standing with feet shoulder width apart and weight evenly distributed • PT position: Kneeling in front of pt • PT instruction: Place hands on side of waist and thumb on anterior surface of the pelvis fingers on anterior iliac crest; bring the hands upward to a bony ledge • Examine the alignment of both ASISs in relation to each other

Answer 9

• Pt Position: Standing; feet shoulder width apart, weight evenly distributed • PT position: Kneeling behind pt • PT instructions: Find the spinous process of S2 and move laterally to find a bony ledge • To assess alignment, the thumbs should be positioned so that it rests underneath and not atop the prominence • NOTE: The location of the PSIS can also be indicated by their proximity to dimples bilaterally at the level of S2 •Bring the hands down from the location of the PSIS to a position inferior and slightly medially • Refer to a skeletal model for help

Answer 10

• Pt position: prone • Palpate the position of both PSIS and PIIS bilaterally and relate to the position of the sacrum • Using the index finger between the two bones to determine if a difference is present on either side • Differences in depth can be cause by rotated ilia or a nutated sacrum

Answer 11

• Pt Position: Supine • PT Position: At the level of the T‐spine to one side facing away from the pt’s head. • PT instruction: The hands are placed over the lower abdomen with the thumbs together and FINGERS UP; proceed slowly and keep pt privacy in mind; will present as a bony ridge just proximal to the genitalia • Check whether the two sides of the joint are even from the superior and anterior aspect

Answer 12

• Pt Position: Prone or SL with upper hip flexed • Place fingers on the greater trochanter and move the thumb from the PSIS to the area of the ischial tuberosity • The tuberosity lies in the same horizontal plane as lesser trochanter when hip is flexed

Answer 13

• Runs from the sacrum to the ischial tuberosity; has a wide proximal attachment to the dorsal surface of the sacrum, coccyx, and the PSIS • Pt Position: Prone • PT Instructions: After palpating the ischial tuberosity and lateral border of the sacrum distinguish the sacrotuberous ligament between the two as a tight, band‐like structure • Compare L and R ligaments for relative depth/tension

Answer 14

• Originates on the pelvic surface of the second to fourth sacral segments, superior margin of the greater sciatic notch, and sacrotuberous ligament • Inserts on greater trochanter • Pt position: Prone • Distinguish from the fiber of Gluteus maximus by knowing the approximate location and running your fingers perpendicular to the length of the piriformis; should be able to “roll” over the muscle belly • Check for tightness and tenderness especially with sciatic involvement

Answer 15

Lumbar Spine active movements --all active movements should be performed to end of ROM ir to the point of pain --Overpressuere can be provided if no pain present at end ROM --Quadrant test --combined ext, SB, and Rotation ---have patient reach toward the back of the opposite knee Hip performed in standing with pt using the UE on table to balance or supine

Answer 16

1. Anesthetic Injection is the current gold standard for diagnosing SIJ dysfunction 2. Pain reduction if 50% is needed to confirm that the pain is originating from the SIJ 3. Not feasible for practitioners whi lack training and not cost-effective as an examination tool 4. Grouping of tests a more feasible means of diagnosis

SI Joint Exam Flashcards

(40 cards)