MS III SI jt 2

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Author:
shmvii
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243146
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MS III SI jt 2
Updated:
2013-11-10 17:07:03
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SI jt
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Rosen & Babyar fall 2013
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  1. how to palpate sacrotuberous lig
    go medial to IT, then up, -- now feel a tension/density
  2. how to palpate sciatic nerve
    • prone or side-lying
    • go between ILA and IT
    • thick ropey feel
  3. how to palpate piriformis muscle
    trace down form inferolat sacrum (really hard to feel unless inflamed)
  4. sacral sulcus
    distance/depth btwn PSIS and sacral base
  5. sacral hiatus
    the sunken section running vertically in the post midline of the sacrum
  6. how to find the ILA?
    lat to sacral hiatus
  7. piriformis attachments
    ant inferolat surface of sacrum --> greater trochanter

    nerve to the piriformis, L5, S1, S2
  8. how to palpate QL
    • prone, find bottom of ribs, have pt hip hike to confirm
    • sensitivity at inf aspect of last rib indicates spasm or muscle contraction

    nerve: T12-L4
  9. symptomology of SI dysfunction
    • pseudo sciatica
    • low back pain
    • pseudotrochanteric bursitis
    • hip pain
    • inguinal lig / groin pain
    • butt pain (walking around with knuckle in butt)
    • pain w staying too long in one pos or in transitioning btwn pos
    • pelvic floor pain
  10. what you're looking for in a static pelvic exam
    ART: asymmetry, ROM abnormality, tissue texture alteration
  11. a posterior inom on R side --> what LLD?
    • R leg appears shorter bc the R acetabulum goes sup
    • an ANT inom --> longer leg on that side

    sooo, if you're looking for true leg length, don't go from ASIS, go from greater troch to med malleolus
  12. seated flexion test
    same rules as standing forward flexion test, but sitting so to take the LE out of the equation.... side that moves first and furthest is hypomobile

    this seems to look more at sacral issues, while the standing looks at inom issues?
  13. what to look for in supine (first time)
    • iliac crests
    • pubs
    • inguinal lig
    • SI jt provocation / stability (push ASISes both lat, then both med -- looking for more give on one side, or pain)
  14. what to look for in prone
    • sacral position
    • sacral base
    • ILA
    • ITs
    • tension of ST lig
    • PSISes
    • lumbar curve (is it flat?)
    • leg length
    • gluteal tone
    • sacral spring test
    • lumbar curve spring test
  15. what to look for in supine (second time)
    • residual innominate dysfunctions
    • ASISes
    • LLD -- do long sitting test (not too reliable)
  16. long sit test
    • start supine, roll up to long sit
    • see if it looks like one leg got longer
    • a short leg will look longer if there's a POST INNOM because that hip will have had to rotate further to get the IT down (so the acetabulum will move more)
  17. Gaenslen's test
    • supine, one leg bent, other hanging off side of table in abd and ext
    • + sign is pain in SI -- indicates pubic symph instability or fem n stretch (doesn't differentiate)
  18. thigh thrust test -- aka ST stress test aka POSH test (post sheer)
    • pt supine, PT standing on unaffected side, painful hip flexed to 90
    • put hand under sacrum, press leg to table along line of femur (wrap around the leg so you're pressing around, not on, the patella)
    • + sign is reproduction of symptoms
  19. squish test
    • pt supine, PT hands on B ASISes, press post/med toward SI jts
    • + sign is pain, less mobility, harder end feel
  20. is there more in the slides?
    So glad you asked! yes, there's more. It's stuff I think you know,but you'll def want to review before an exam.
  21. 3 signs of R sup pub dysfunction
    • + R standing forward flexion test
    • sup R pubic tubercle
    • inguinal lig tender on R
  22. R inf pubic dysfunction
    3 signs
    • + standing forward flexion test
    • pubic tubercle low on R
    • tender R inguinal lig
  23. 5 signs of R ant innominate
    • + R standing forward flexion test
    • R ASIS inf
    • R PSIS sup
    • long R med malleolus (in standing and in 2nd look at supine)
    • prone sacral sulcus shallow on R
  24. R post innominate 6 signs
    • + fabere (w pressure)
    • + standing forward flexion test on R
    • sup R ASIS
    • inf R PSIS
    • short R leg (med malleolus)
    • deeper sacral sulcus on R
  25. R outflared innominate 5 signs
    • + standing forward flexion test
    • R ASIS is lat
    • R PSIS is medial
    • R sacral sulcus is decreased
    • + AIF (piriformis test)

    R inflared is the opposite for ASIS, PSIS, and sulcus
  26. R sup shear / upslip
    6 signs
    • + R standing forward flexion test
    • sup R ASIS
    • sup R PSIS
    • short R leg
    • sup R IT
    • lax R ST lig

    looks even in standing due to trunk compesation, so must observe in non wt bearing positions
  27. R inf shear/downslip
    6 signs
    • + standing forward flexion test
    • inf R ASIS
    • inf R PSIS
    • longer R leg
    • inf R IT
    • tight R ST lig
  28. unilat flexed sacrum / inf shear on R
    7 signs
    • + seated R flexion test
    • base of sacrum - ant R
    • inf R ILA
    • convex R lumbar scoliosis (L side bending)
    • lumbar lordosis -- normal to increased
    • long R leg in PRONE
    • + backward bend test
  29. backward bending test
    pt stands, your thumbs are medial to PSISesthumbs should move antif they don't indicates hypomobility
  30. R unilat extended sacrum /sup sheer
    6 signs
    • + R seated flexion test
    • pot R base of sacrum
    • sup R ILA
    • lumbar lordosis decreased
    • lumbar convex on L
    • shorter R leg in PRONE
  31. ant torsion, R on R
    8 signs
    • + L seated flexion test
    • ant L base of sacrum
    • post R ILA
    • ILA motion increase on R on FB
    • lumbar scoliosis - convex on L
    • increased lumbar lordosis
    • short R leg
    • worse asymmetry in lumbar flexion than ext
  32. R on L backward torsion
    8 signs
    • + R seated flexion test
    • post R base of sacrum
    • post R ILA
    • ILA motion -- R increased on BB
    • lumbar scoliosis - convex L
    • lordosis reduced
    • short R leg (bc it's in a kind of counter nutation)
    • looks more asymmetrical in ext than flex (test this in prone-prop)
  33. diff btween R post sheer and R on L backward torsion
    • in post sheer the R ILA goes sup
    • in backward torsion it goes post
  34. signs of B flexed sacrum
    signs of B ext sacrum
    • F & E: + seated flexion test - bilaterally
    • F: ant base of sacrum
    • E: post base of sacrum
    • F: ILAs post
    • E: ILAs ant
    • F: Increased lordosis
    • E: decreased lordosis
    • F & E: even leg lengths (look at it prone for E)

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