The Pelvis / Sacrum Flashcards

1
Q

Classify the sacro-iliac joint

A

Diarthrosis = part synovial part fibrous
Forms base of the trunk and supports the abdominal contents
2 innominate bones thy contain the ilium, pubis and ischium, they fuse to make the pubis symphysis anteriorly

the SIJ posteriorly is formed by the fusion of the two bones and sacrum

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2
Q

Classify the public symphysis

A

A secondary cartilaginous joint
2 pubic rami covered in hyaline cartilage with fibrous disc inbetween

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3
Q

What are the major muscles across the pelvis and sacrum

What is their major roles and what does injury result in

A

Glut max and med
Last Dorsi
Mulifidus
Biceps femoris
Psoas
Piriformis
Transversus and obliquus abdominus

Role in locomotion and postural stability
Muscle injury usually affects weight bearing and loco-motion functions

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4
Q

What are the movement at the pelvis

A

Pelvic tilt
Forward / anterior = combo of hip flexion and lumbosacral hyper extension
Back/posterior = combo of hip extension and lumbosacral flexion
Right lateral tilt = combo of left lateral flexion of LS flex, abd of right hip and adduction of left hip
Left lateral tilt = combo of opposite to above

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5
Q

What are the movements of the sacro-iliac joint

A

Nutation and counternutation

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6
Q

How is the pelvic stabilised

A

Through the muscle system that crosses over and is used to aid stability around the pelvic region
Contralateral muscles but work in unison

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7
Q

How can we understand the affect that muscular dysfunction has in the pelvic girdle

A

We need to understand how the muscles work togther to aid stability to the pelvic girdle through 2 systems

The anterior oblique system of the outer unit
The posterior oblique system of the outer unit

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8
Q

What is the anterior oblique system of the outer unit

A

This system creates movement and stability around the pelvis when functioning properly
It includes the internal and external obliques, the contralateral adductors of the thigh and the intervening anterior abdominal fascia.
These muscles are contralateral but work in unison

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9
Q

What is the posterior oblique system of the outer unit

A

This includes the latissimus dorsi, glute max and the intervening thoracodorsal fascia

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10
Q

What is the inner unit of the body
What effect does it have on training

A

The abdominals
Activation of these muscles is caused when contracting the pelvic floor
If you incorporate the abdominal wall into training there is better ability to isolate the muscles of the pelvic floor

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11
Q

What are potential causes of pain in the pelvis / groin

A

Muscle strain
Ligament sprain
PG pain
Lymph node infection
Kidney stones
Legg-calve-perthes disease
Referred pain from lumbar region
SIJ dysfunction
Stress fracture
Bursitis
Synovitis of hip joint capsule

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12
Q

What are the symptoms of pelvic girdle pain (PGP)

A

Pain is experienced between the posterior iliac crest and gluteal fold
The pain may radiate into the posterior thigh
There is non-dermatomal pattern of pain described

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13
Q

What populations are vulnerable of pelvis pain

A

Women - pregnant and child birth
Sports that cause fatigue, asymmetry, impact, sustained posture or torsion to area
Trauma / RTA victims
Inflammatory / reactive arthritis / AS
Metabolic disease / infection
Post surgerical L gynaecological

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14
Q

What are subjective clues for sacro-iliac joint - pain discription

A

Unilateral pain
Dull ache
Not usually below the knee
Pain is localised over sacral sulcus and typically referred to groin, buttock and thigh

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15
Q

What are the aggs and eases in subjective examination for pelvic pain

A

Aggs = standing on one leg / turning over in bed / getting in or out of bed / stepping up on affected side / walking up or downhill

Eases = pelvic support belt

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16
Q

Are there any AM symptoms with pelvic pain

A

In anklylosing spondylitis the cardinal sign is erosion of the sacro iliac joints
Often this is pain and stiffness in the first few hours of the morning

17
Q

What should be observed in objective examination of pelvic pain

A

Gait deviation
Stance abnormalities
Unequal weight distribution side to side
Difficult moving around from sitting to standing
Observe any hesitancy or gaurding
Check levels of ASIS and PSIS

18
Q

What are spinal movement tests in standing for pelvic patient

A

Assess lumbar flexion, extension, side flexion, Rotation in sitting

19
Q

What neurological tests can be done for patients with pelvic girdle pain

A

S1 myotome - ankle plantarflexion
Slump tests
Dermatomes of lower limb
Myotomes of lower limb
Reflexes of lower limb - patella and Achilles
Straight leg raise
Femoral nerve test

20
Q

What special tests can be done for pelvic girdle pain objective assessment

A

Modified Trendelenburg test
Leg length
SI joint compressions
Gaenslens test
Hip quadrant tests
Mobilising techniques

21
Q

What are SI joint tests when patient is supine

A

Compression - posterior force to both ASIS
Posterior gapping test - force applied to left and right ASIS to try and posh them togther
Posterior shear test - hip flexed to 90 degrees on painful side, pressure applied to flexed knee along femur

22
Q

What is the gaeslens test for special tests in patients supine objective assessments

A

Patient clasps flexed knee towards abdomen, overpressure by therapist to fix lumbar spine
Opposite thigh is slowly hyper extended by the examiner by pressure over the knee
Positive = pain felt across SI joint

23
Q

What SI joints tests are used when the patient is side lying

A

Longitudinal caudad - hip flexed to 90 degrees, longitudinal caudad force is allied to the ilium through iliac crest

Anterior rotation of the ilium = anterior pressure on the ASIS with cephalad pressure on ischial tuberosity

Posterior rotation of illium = posterior pressure on ASIS with anterior pressure on ischial tub

Compression test = painful side upmost
Apply compression force using both hands to anterior part of uppermost illium

24
Q

What are SI joint tests when patient is prone lying

A

Sacral thrust - PA pressure over sacral base, body and apex

25
Q

What are the 2 types of Cluster tests that test pain for pelvic pain

A

Cluster van der Wurff
Cluster of Laslett

26
Q

What tests are involved in the cluster Van der Wurff test

What is the sensitivity and specificity

A
  • distraction test
  • compression / approximation test
  • thigh thrust / shear test
  • gaenslen teat
  • Fabre / Patrick sign test

Sensitivity 85%
Specificity 79%

+ if 3 or more recreate patients pain on ipsiloatwral side

27
Q

What tests are included in the cluster of laslett

What is the specificity and sensitivity

A
  • distraction test
  • thigh thrust / shear test
  • compression test
  • sacral thrust test

88% sensitivity
77% specificity

+ if 2 out of 4 recreate patients pain

28
Q

What muscle flexibility tests can be used for objective assessment

A

Adductors
Hip flexor
Abductors
Rect fem

29
Q

What treatment can be given for patients with pelvic pain

A

Mobilisations
Manipulations
Massage
Functional exercise programmes
Ergonomics
Pelvic supports
Stability exercises
Myofascial and muscle energy techniques
Nuerodynamics.