SIJ Exam

Question 1

Describe a common mechanism for sacral stress fractures. What MOIs are typically associated with this force?

Answer 1

repetitive torsional stresses
ex. running/walking

Question 2

Describe 3 populations that would be at the greatest risk for developing sacral stress fractures

Answer 2

-Athletes: esp distance runners
-Older Adults: fused SIJ & diminished BMD (OP), trauma (falls)

OP that is steroid-induced, irradiation-induced, or related to malignancy

Question 3

What are the most common/ likely aggravating and alleviating factors that someone with a mechanical SIJ dysfunction would report? Other symptoms?

Answer 3

alleviating: rest?
aggravating: walking w/ long strides, getting in<>out cars, anything torsional

other: pain in buttock, groin and thigh

Question 4

What structures (muscles, ligaments, etc.) are most commonly/ likely involved with mechanical SIJ dysfunction?

Answer 4

muscles: TA (decreased stabilization)
ligaments: Ant SI lig, sacorspinous, sacrotuberous, long/short posterior SI, interosseous SI

Question 5

SIJ dysfunction is strongly advocated as a diagnosis of exclusion. What needs to be excluded, and how would you go about doing this?

Answer 5

-Must rule out L spine and hip pathologies first and patient’s symptoms do not describe anything else; LQS+ CPA/UPA, ROM + resistive testing

Question 6

What is the best application of special tests regarding SIJ dysfunction?

Answer 6

-Perform these after ruling out L-Spine origin
-Clusters of (+) tests has better validity than individual (+) Tests→ Laslett’s Cluster II & Van der Wurffs Cluster

mechanical SIJ dysfn (+ or -) LRs are not indicative of strong evidence

Question 7

Aside from special test clusters, what other physical examination findings would support mechanical SIJ dysfunction?

Answer 7

asymmetry in boney landmarks, TTP @ stabilizers, provocation with area stress

Question 8

A PT comes to you for advice. He is examining a patient and suspects a mechanical SIJ dysfunction. He bases this on asymmetries in the ASIS and PSIS heights in standing and positive Long Sitting, Fortin Finger, FABER, Sacral Thrust, and Gaenslen’s Tests. What would you advise him to consider as he interprets his examination findings and continues on with his intial examination?

Answer 8

Need to rule out other body regions first
-Consider LRs of special test, can be more helpful is findings are in a cluster
this discrepency might not be the primary source of their pain

Question 9

How might activity type/ intensity and age affect risk for stress fx? Why?

Answer 9

type: risk inc w/ activity age: dec BMD and OP risk

Question 10

Describe the gold standard test for mechanical SIJ dysfunction.

Answer 10

gold standard dx: anesthetic block; if numbing a potential source works, it’s probably the problem

Question 11

Describe differences between the classifications for peri-partum Pelvic Pain.

Answer 11

** Pelvic Girdle syndrome: pain in both SIJs + the pubic symphysis**
* symphysiolitis
* One-sided SIJ Dysfunction:
* Double-sided SIJ Dysfunction:
* Miscellaneous

Question 12

describe the most common location and orientation of sacral stress fractures.

Answer 12

vertical @ ala (parallel to SIJ)

Question 13

A sacral stress fracture can look very similiar to other pathologies such as _(3). In a physical examination we might expect antalgic gait, TTP and NORMAL lumbar ROM

Answer 13

HNP, stenosis, tumor

Question 14

_ are thought to be a primary contributor to mechanical SIJ dysfn.

Answer 14

Capsule tears

Question 15

What special tests are included in Laslett’s cluster?

“Sarah and Pat don’t compete, they guarantee”

they don’t really guarante, they support but it fits the acronym lol

Answer 15

sacral thrust
distraction test
compression test
thigh thrust test
gaenslen’s test

Question 16

What special tests are included in Van De Wuff’s cluster?

Answer 16

Patrick FABER sign
distraction test
compression test
thigh thrust test
gaenslen’s test

Question 17

Athletic pubalgia, or osteitis pubis, is common in males in their 20s/30s and proposed to come from what? (3)

Answer 17

• imbalanced force transmission between LS and hip that > inflammation (from stress and shear load)
• weakness of posterior wall (IO/TrA)

often relate to sports inj and cutting activity

Question 18

what s/s might a pt with athletic pubalgia report?

Answer 18

• chronic regional p! (unilat»bilat)
• weakened lower abs and prox ADD (no hernia)
• assoc w/ hip patho (FAI)

Question 19

After ruling out L-spine and hip pathology and noting TTP and weak ADD, what other physical examination components might lean your differential dx towards athletic pubalgia?

Answer 19

squeeze test, active SLR, pain w/ resisted sit up

Question 20

What are the SIJ-specific questions you should include in your subjective interview? (4)
*in addition to Hx of disease/steroid use/ infecetion)

Answer 20

pregnancy/delivery hx
trauma
recent stress fracture in the area
longer hx of lumbar fusion

Question 21

what 5 outcome measures might you use to collect info on SIJ pain?

Answer 21

PSFS,
Owestry Disability Index
Rowland Morris Questionnaire
FABQ
Pelvic Floor Impact Quesitonnaire

Question 22

What are our 3 “rule out” tests for SIJ pain and what do they relate to?

Answer 22

• active SLR (4P)
• Hip flexion test (pelvic ring fracture
• Sign of the buttock (bursitis, abscess, tumor)

Question 23

What are our “rule in” tests for SIJ pain and what do they relate to?

Answer 23

• Thigh Thrust/4P test

-Mechainical SIJ Dysfunction:
* Laslett and Vander Wuff’s Clusters
* resisted ABD
* Long sit test
* Gillet
* Fortin Finger

Question 24

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in addiiton of a hx of recent pregnancy and findings consistent withmechanical SIJD, what else might a 4P patient present with?

Answer 24

• • active SLR
• lumbar and bilat SIJ p!

Question 25

list the 5 types of urinary incontinence.

Answer 25

1. stress
2. urge (hyperactive bladder)
3. mixed (urge and stress)
4. overflow (dribbling>fixed w/ scheduling)
5. functional incontinenc (ex. AMS, w/c bound)

Question 26

reversible causes of urinary incontinence include DIAPERS, cog/psych deficits, infection, reduced mobility, and what else? (3)

Answer 26

atrophic vaginitis/ urethritis
drugs/chemicals
stool impaction

Question 27

what 3 components of a physical exam might suggest issues with urinary incontinence?

Answer 27

• weak/incoordinated Kegal
• bearing down w/ cough stress test
• inability to regulate abdominal pressure

Question 28

When trating a pt with diastasis recti, intervention strategies often include TA stabiliation, PF strengthening and surgery. What are pt education points that are also key for this population?

Answer 28

avoiding heaving lifting, log rolling and inc abdominal pressure