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SIJ Exam + Interventions Flashcards

1
Q

Elimination tests for SIJ

A
  1. Active SLR Test
    • post partum pelvic pain
  2. Hip Flexion test
    • pelvic ring frx
  3. Sign of the Buttock
    • bursitis, abscess, tumor in buttock region
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2
Q

what is a positive test for the active SLR?

A

if stabilization relieves symptoms

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3
Q

research properties and clinical implications for the active SLR test

A
  1. Research
    • +LR → 1.7-14.5
    • -LR → 0.13-0.42
  2. Clinical Implications
    • utility as treatment decision modifier
    • studies in populations with PPPP
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4
Q

what is a positive test for the hip flexion test?

A

concordant pain or inability to raise leg

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5
Q

research properites and clinical utility for hip flexion test

A
  1. Research
    • +LR → 18
    • -LR → 0.10
  2. Clinical Implications
    • screening tool when Hx/interview suggests pelvic frx
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6
Q

positive test for the sign of the buttock

A

hip motion restrictions or same pain continues with last step

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7
Q

research properties and clinical implications of the sign of the buttock test?

A
  1. research
    • NONE known
  2. clinical implications
    • common screening tool w/o evidence
    • de-sentizing does not change pain
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8
Q

list bone and joint structures to palpate during SIJ exam

A
  1. L5
  2. S2 (in line with PSIS)
  3. Sacral base (sacral sulci)
    • medial and superior 1 thumb-width each PSIS
  4. Inferior lateral angle of sacrum
  5. Iliac crest
  6. PSIS
  7. ASIS
  8. Symphysis Pubis/Pubic tubercle
  9. Ischial tuberosity
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9
Q

reliability of palpating various bony structures of the pelvis

A
  1. sacral base → 0.08
  2. sacral sulci → 0.11
  3. inferior lateral angle → 0.11
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10
Q

soft tissue structures to palpate during SIJ exam

A
  1. erector spinae
  2. dorsal SI ligament
  3. glut max muscle belly
  4. glut med muscle belly and insertion
  5. area between ASIS and symphysis pubis
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11
Q

joint mobility testing for the SIJ exam

A
  1. ilium anterior rotation
  2. ilium posterior rotation
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12
Q

Confirmation tests for SIJ exam

A
  1. Thigh Thrust/4P Test
  2. Distraction Test
  3. Compression Test
  4. Gaenslen’s Test
  5. Sacral Thurst Test
  6. Partick’s Test/FABER
  7. Resisted Hip Abduction
  8. Other:
    • Long Sit Test
    • Fortin Finger Test
    • Gillet Test
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13
Q

SIJ Clusters

A
  1. Laslett’s Cluster II
  2. Van Der Wurff
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14
Q

what is a positive test for the thigh thrust/4P test?

A

concordant pain (tested side) at posterior hip/SIJ

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15
Q

research properties and clinical implications for the thigh thrust/4P test

A
  1. Research
    • +LR = 0.72-3.29
    • -LR = 0.17-1.28
  2. Clinical implications
    • best utilized with cluster
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16
Q

positive test for distraction test

A

concordant pain

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17
Q

research properties and clinical implications for distraction test

A
  1. research
    • +LR = 3.2-1.24
    • -LR = 0.5-0.94
  2. clinical implications
    • best used with clusters
18
Q

postive test for compression test

A

concordant pain provocation

19
Q

research properties and clinical implications for compression test

A
  1. Research
    • +LR = 1.6-3.95
    • -LR = 0.4-0.92
  2. Clinical Implications
    1. best used with cluster
20
Q

positive test for Gaenslen’s Test

A

concordant pain provocation

21
Q

research properities and clinical implications for the Gaenslen’s Test

A
  1. Research
    • +LR → 1.02-2.29
    • -LR → 0.65-1.11
  2. Clinical Implications
    • best used with cluster
22
Q

positive test for the Sacral Thrust test

A

concordant pain provocation

23
Q

research properties and clinical implications for the Sacral Thrust Test

A
  1. Research
    • +LR → 0.74-4.39
    • -LR → 0.49-1.62
  2. Clinical Implications
    • best used with cluster
    • avoid placing force far superior, as this will likely extend the L/S and alter the test
24
Q

postive test for Patrick’s Test/FABER Test

A

concordant POSTERIOR/SIJ-AREA pain provocation

25
research properties and clinical implications for Patrick's Test/FABER Test
1. Research * +LR → 0.82-1.43 * -LR → 0.64-1.94 2. Clinical Implications * best used with cluster * careful not to confuse with hip distribution of pain
26
positive test for resisted hip abduction
SIJ pain provocation
27
research properties and clinical implications for the hip abduction resisted test
1. Research * +LR → 2.0 * -LR → 0.80 2. Clinical implications * consider potential provocation test
28
Laslett's Cluster II
1. Thigh Thrust Test 2. Distraction test 3. Sacral Thrust 4. Compression Test 5. Gaenslen's Test
29
notable observations and research properties of Laslett's Cluster II
1. Apply after having ruled out L/S origin (centralization) 2. Research * +LR → 4.16 * -LR → 0.11
30
Van Der Wuffs Cluster
1. Thigh Thrust 2. Distraction Test 3. Patrick's Sign 4. Compression test 5. Gaenslen's Test
31
Confirmation tests → Functional Movements
1. Sit to Stand 2. Deep Squat 3. Step-Up Test * 6 inch step w/symptomatic LE onto anterior box
32
T/F: the long sitting test has strong evidence to support it
FALSE poor reliability and validity use with caution
33
Positive test for Fortin Finger Test
pt can localize the are of pain with one finger the indicated area is within 1cm inferiomedial to the PSIS the patient is consistent with localizing the same area with both trials
34
postiive test for Gillet Test
the PSIS ipsilateral to the lifted LE does not change position or migrates superiorly
35
Intervention planning for SIJ
1. Educate 2. Reduce Pain * manual * exercise 3. Improve Stability * internal → pelvic stabilizer coordination training * external → belt 4. Improve Functional Activity Performance and Partipicipation
36
prognostic factors for Antepartum populations
1. History of pregnancy 2. Increased BMI 3. smoking 4. work dissatisfaction 5. lack of belief of improvement
37
T/F: a lot of evidence supports the use of belts
FALSE conflicting evidence with grade D recommendation
38
support belt utilization
1. placement at the level of ASIS has demostrated increased resistance to vibration forces at SIJ 2. +Active SLR Test = positive prognostic indicator for use of support belt
39
Pelvic Floor Exercise
1. instruct how to perform 2. gradually increase timing of isometrics * gluteals and thigh muscles relaxed 3. begin to work into contraction during daily activities
40
What does research say about joint manipulation and SIJ?
clinical improvement reported with intervention position of SIJ not altered with manipulation
41
List joint mobilizations for the pelvic girdle and lumbpelvic spine
1. Oscillations and Sustained Hold mobilizations * innominate anterior rotation * innominate posterior rotation 2. Thurst manipulations * long leg distraction * supine lumbopelvic thrust manipulation 3. Other * adduction isometric of the pubic symphysis

MSK 2 (20 decks)

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