SIJ

Question 1

What does marching test test for

Answer 1

SI or pubic joint strain, fracture

Hypermobility, joint dysfunction
Ipsilateral SIJ dysfunction

Rotation of nominate bone on sacrum

Question 2

Marching test technique

Answer 2

Pt standing, hand on wall
Examiner palpates PSIS and S2 SP
Pt instructed to flex ipsilateral hip to 90- ipsilateral hip flexion, thumbs move together
Examiner observes/palpates motion of PSIS relative to S2
Examiner then instructs the Pt to flex contralateral hip to 90- contralateral hip flexion, thumbs move apart
Examiner observes/palpates motion of S2 relative to PSIS
Normal motion should move S2 away from PSIS
Repeat test on contralteral SIJ

Question 3

+ve Marching test

Answer 3

Localised P- SIJ or pubic Jt sprain, pelvic #

Excess motion- hypermobility, Jt dys
Decreased ROM- ipsilateral SIJ dys

Lack of thumb movement indicates Jt fixation

Question 4

Marching test clinical notes

Answer 4

Can modify this test by palpating the PIIS and sacral apex or S2 SP + ischial tuberosity to evaluate the lower SIJ separatley

Question 5

What does flamingo test for

Answer 5

Ipsilateral SIJ dysfunction

Question 6

Flamingo technique

Answer 6

Pt standing on one leg
Can ask P to hop to increase symptoms
Observe signs of discomfort or P

By standing on one leg pressure is increased on ipsilateral hip, SIJ and pubis symphysis

Question 7

+ve Flamingo

Answer 7

Localised P
P in pubis symphysis + SIJ= lesion in whichever structure is painful

Question 8

What does Gaenslen’s test for

Answer 8

SIJ sprain, instability

Iliopsoas contracture
Lsp or hip pain origin

Question 9

Gaenslen technique

Answer 9

Screening
Pt to edge of couch
Hold leg towards chest
Drop other off couch
Apply pressure to knee and flexed leg, to produce shearing of SIJ

Question 10

+ve Gaenslen

Answer 10

SI or ant thigh P- SIJ Jt patho (lig sprain, instability)

Elevation of extended hip, no SIJ pain- iliopsoas contracture

P may be due to ipsilateral SIJ lesion, hip pathology or L4 N root lesion

Question 11

What does thigh thrust test for

Answer 11

SIJ or hip pathology

Question 12

Thigh thrust technique

Answer 12

Hold leg to chest
Hand under sacrum/SIJ
Apply force down through knee + hip

Question 13

+ve Thigh thrust

Answer 13

P in SIJ- SIJ patho
Hip P- hip Jt patho

Question 14

Thigh thrust sens

Answer 14

80-93

Question 15

Thigh thrust spec

Answer 15

69-100

Question 16

What does compression test for sij

Answer 16

SIJ posterior ligs, fracture, SIJ dysfunction

SIJ instability

Question 17

Compression technique

Answer 17

Pt on side
Find ASIS + PSIS, apply contact medially
Apply force down through

Question 18

+ve Compression

Answer 18

P- SI sprain/strain, fracture, SIJ dys
Reduced P- SI instability (instability is also indicated if Pt stands with feet wide apart + P is reduced, abducted hips inc SIJ compression and pelvic stability)

Question 19

What does distraction test for

Answer 19

Ant SIJ or pubic Jt sprain, fracture
Test L+R SIJ simultaneously

Question 20

Distraction technique

Answer 20

Contact on both ASIS
Push outwards + down
Low couch, lean weight on to Pt

Question 21

+ve Distraction

Answer 21

Localised P

Question 22

What does sacral thrust test for

Answer 22

SIJ dysfunction

Question 23

Sacral thrust technique

Answer 23

Pt on front
No pillow under pelvis
Find apex of sacrum
Hands point towards head, flat on sacrum, reinforce with other hand
Apply force anteriorly

Question 24

+ve Sacral thrust

Answer 24

P in SIJ
Rotational shift of SIJ produces shearing of sacrum on ilium

Question 25

Active SLR procedure

Answer 25

Pt supine Examiner instructs Pt to lift affected leg 15cm off table If movement= P examiner stabilises pelvis by compressing over ASIS + asks Pt to repeat movement

Question 26

Active SLR interpretation

Answer 26

Inability to raise leg or P with pelvic stabilisation= pelvic # No P with SIJ stabilisation= sacrioilliac lesion

Question 27

Active SLR clinical notes

Answer 27

Test may be more sensitive in Pts with SIJ P during pregnancy

Question 28

Seated flexion test procedure

Answer 28

Pt seated Examiner locates the PSIS bilaterally If one PSIS is higher than other Pt instructed to lean forward

Question 29

Seated flexion test interpretation

Answer 29

Lower PSIS becomes higher with forward flexion= SIJ dys, abnormality in torsion movement P with forward flexion- SIJ dys

Question 30

Seated flexion test, false +ve

Answer 30

Potential for anatomical variation in ilium size + shape that may result in false +ve

Question 31

Seated flexion sens

Answer 31

69

Question 32

Seated flexion spec

Answer 32

98

Question 33

PSIS asymmetry procedure

Answer 33

Pt standing or seated Examiner compares PSIS height and symmetry Iliac crest height should be assessed at same time

Question 34

PSIS asymmetry interpretation

Answer 34

Standing or seated asymmetry= SI lesion, anatomical variation in osseous structure size and shape

Question 35

PSIS asymmetry clinical notes

Answer 35

Test may indicate pelvic rotation with an anterior ilium having a less prominent PSIS

Question 36

Trendelenburg test procedure

Answer 36

Pt standing is instructed to lift one leg off the ground Examiner observes for hip motion from behind

Question 37

Trendelenburg interpretation

Answer 37

Pelvic lateral tilt- weak hip abductor muscles (esp glute med), neuro or muscle conditioning deficit Sens- 73 Spec- 77 P in SI on support leg- SI patho Sens- 7-19 Spec- 98-100

Question 38

False +ve trendelenburg

Answer 38

10% of Pts with hip P will demonstrate a false +ve- muscle weakness due to P