Lumbopelvic Kinematics and Sacroiliac Joint Syndrome
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Questions and Answers

What is the major problem associated with the tests in the Sacroiliac Joint Special Test Cluster?

  • Inability to diagnose SI joint syndrome
  • Low inter-rater reliability (correct)
  • Lack of specificity
  • Invasive testing methods

    • What is the 'gold standard' for diagnosing Sacroiliac (SI) joint syndrome?

  • Imaging studies (e.g. MRI, X-ray)
  • Injection-based diagnostic testing (correct)
  • Invasive diagnostic testing
  • Provocation tests

    • What is the primary benefit of using test clusters in orthopedic testing?

  • Increased specificity of individual tests
  • Improved inter-rater reliability
  • Reduced testing time
  • Enhanced diagnostic accuracy (correct)

    • What posture predisposes the intervertebral discs (IVDs) to injury?

    <p>Flexion</p> Signup and view all the answers

    What is a common symptom of Sacroiliac joint syndrome?

    <p>Buttock pain</p> Signup and view all the answers

    What is a drawback of using orthopedic test clusters?

    <p>Increased testing time</p> Signup and view all the answers

    What is the primary purpose of stabilizing the patient's pelvis and sacrum during the standing flexion test?

    <p>To eliminate motion at the sacroiliac joint as a potential pain generator</p> Signup and view all the answers

    What would be the most likely interpretation of pain with support and without support during the standing flexion test?

    <p>Lumbar spine pathology</p> Signup and view all the answers

    Which of the following tests is used to assess the sacroiliac joint by applying posterolateral directed pressure to bilateral ASIS?

    <p>Distraction test</p> Signup and view all the answers

    What is the primary purpose of the Compression test in the SACROILIAC JOINT SPECIAL TEST CLUSTER?

    <p>To reproduce symptoms by compressing the pelvis</p> Signup and view all the answers

    What is the position of the patient during the Sacral Thrust test?

    <p>Prone</p> Signup and view all the answers

    What is the primary purpose of the Thigh Thrust test in the SACROILIAC JOINT SPECIAL TEST CLUSTER?

    <p>To reproduce buttock pain</p> Signup and view all the answers

    What is the position of the patient's hip during the Thigh Thrust test?

    <p>90 deg flexion and adduction</p> Signup and view all the answers

    What is the primary purpose of Gaenslen's test in the SACROILIAC JOINT SPECIAL TEST CLUSTER?

    <p>To reproduce sacroiliac joint pain</p> Signup and view all the answers

    What is the primary characteristic of sacroiliac flexion restriction?

    <p>Counter-rotation malposition: PS-SB</p> Signup and view all the answers

    What is the typical finding in a patient with a PI-Ilium?

    <p>Low crest and PSIS</p> Signup and view all the answers

    What is the purpose of the belt test in sacroiliac joint syndrome?

    <p>To differentiate between lumbar spine pathology and sacroiliac joint pathology</p> Signup and view all the answers

    What is the typical palpation finding in a patient with sacroiliac extension restriction?

    <p>Hard end-feel</p> Signup and view all the answers

    What is the common symptom of sacroiliac joint syndrome?

    <p>Dull ache to sharp pain</p> Signup and view all the answers

    What is the advantage of using orthopedic test clusters?

    <p>They are more comprehensive</p> Signup and view all the answers

    What is the typical postural abnormality in a patient with a PI-Ilium?

    <p>Ipsilateral lumbar scoliosis</p> Signup and view all the answers

    What is the primary difference between sacroiliac flexion restriction and sacroiliac extension restriction?

    <p>Degree of lordosis</p> Signup and view all the answers

    What is the typical finding on prone sacroiliac extension palpation/mobilization in a patient with a PI-Ilium?

    <p>Decreased motion/hard end-feel</p> Signup and view all the answers

    What is the common cause of sacroiliac joint syndrome?

    <p>All of the above</p> Signup and view all the answers

    What is a common indication of a sacroiliac joint syndrome?

    <p>Tenderness on the posterior superior iliac spine</p> Signup and view all the answers

    What is the primary advantage of using test clusters in orthopedic testing?

    <p>Increased accuracy in diagnosis</p> Signup and view all the answers

    What is the typical finding on palpation in a patient with sacroiliac extension restriction?

    <p>Hypomobility in the sacroiliac joint</p> Signup and view all the answers

    What is the primary purpose of the Compression test in the Sacroiliac Joint Special Test Cluster?

    <p>To apply posterolateral directed pressure to bilateral ASIS</p> Signup and view all the answers

    What is the typical postural abnormality associated with a PI-Ilium?

    <p>Rotated innominate bone</p> Signup and view all the answers

    What is the benefit of using test clusters in diagnosing sacroiliac joint syndrome?

    <p>Reduced risk of misdiagnosis</p> Signup and view all the answers

    What is the primary purpose of stabilizing the patient's pelvis and sacrum during the standing flexion test?

    <p>To eliminate the sacroiliac joint as a potential pain generator</p> Signup and view all the answers

    What is the expected outcome if the patient experiences pain with support and unsupported during the standing flexion test?

    <p>The lumbar spine is a potential pain generator</p> Signup and view all the answers

    Which of the following tests in the SACROILIAC JOINT SPECIAL TEST CLUSTER is used to assess the sacroiliac joint by applying an anteriorly directed thrust over the sacrum?

    <p>Sacral Thrust test</p> Signup and view all the answers

    What is the primary purpose of the Distraction test in the SACROILIAC JOINT SPECIAL TEST CLUSTER?

    <p>To assess the sacroiliac joint</p> Signup and view all the answers

    What is the position of the patient during the Distraction test?

    <p>Supine</p> Signup and view all the answers

    What is the expected outcome if the patient experiences pain without support during the standing flexion test?

    <p>The sacroiliac joint is a potential pain generator</p> Signup and view all the answers

    What is the primary purpose of the Thigh Thrust test in the SACROILIAC JOINT SPECIAL TEST CLUSTER?

    <p>To assess the sacroiliac joint</p> Signup and view all the answers

    What is the position of the patient's hip during the Thigh Thrust test?

    <p>90 degrees of flexion and adduction</p> Signup and view all the answers

    What is the primary characteristic of sacroiliac extension restriction?

    <p>Increased lordosis</p> Signup and view all the answers

    What is the typical finding on prone sacroiliac flexion palpation/mobilization in a patient with an AS-Ilium?

    <p>Decreased motion/hard end-feel</p> Signup and view all the answers

    What is the primary difference between a PI-Ilium and an AS-Ilium?

    <p>Anterior glide restriction vs. posterior glide restriction</p> Signup and view all the answers

    What is the typical symptom of sacroiliac joint syndrome in a patient with a PI-Ilium?

    <p>Dull, aching pain</p> Signup and view all the answers

    What is the primary purpose of stabilizing the contralateral sacral apex during prone sacroiliac extension palpation/mobilization?

    <p>To stabilize the sacrum and prevent motion</p> Signup and view all the answers

    What is the typical postural abnormality in a patient with a PI-Ilium?

    <p>Low crest and PSIS</p> Signup and view all the answers

    What is the primary advantage of using orthopedic test clusters in sacroiliac joint syndrome?

    <p>Increased sensitivity and specificity</p> Signup and view all the answers

    What is the typical finding in a patient with sacroiliac flexion restriction?

    <p>Decreased lordosis</p> Signup and view all the answers

    What is the primary cause of sacroiliac joint syndrome?

    <p>Hypomobility</p> Signup and view all the answers

    What is the typical palpation finding in a patient with sacroiliac extension restriction?

    <p>Decreased motion/hard end-feel</p> Signup and view all the answers

    No pain with support and pain without support during the BELT test aka supported Adam’s test is indicative of SI joint pathology.

    <p>True</p> Signup and view all the answers

    Which of the following are provocative factors for SI joint syndrome?

    <p>WEIGHT BEARING</p> Signup and view all the answers

    What is the ratio of male to female in terms of muscle strain?

    <p>3:1</p> Signup and view all the answers

    Which of the following characteristics is associated with a Grade 3 severe sprain or strain?

    <p>Pain with ROM</p> Signup and view all the answers

    What is the description of a Grade 2 injury?

    <p>10-50% of fibers damaged, moderate tenderness, and functional recovery in 14-40 days, no edema</p> Signup and view all the answers

    What are the characteristic symptoms of a Grade 1 mild sprain/strain of the sacroiliac joint?

    <p>Delayed muscle soreness within 24 hours, mild pain at end ROM, mild point tenderness, and no edema.</p> Signup and view all the answers

    Match the grade of sacroiliac joint injury with the corresponding percentage of fiber damage:

    <p>Grade 1 = Less than 10% fiber damage Grade 2 = 10-50% fiber damage Grade 3 = 50-100% fiber damage</p> Signup and view all the answers

    What percentage of total force in a neutral standing position is on facets?

    <p>16%</p> Signup and view all the answers

    What can hyperlordosis cause?

    <p>Excessive pressure on the facets leading to facet syndrome</p> Signup and view all the answers

    What is the symptomology of Facet syndrome?

    <p>Reactive spasm with sudden severe pain</p> Signup and view all the answers

    Facet syndrome may present with which of the following?

    <p>Antalgic posture to reduce facet syndrome</p> Signup and view all the answers

    What can increased pain with lumbar extension be indicative of?

    <p>Facet syndrome</p> Signup and view all the answers

    Study Notes

    Sacroiliac Joint Anatomy and Biomechanics

    • The sacroiliac joint is a complex structure that plays a crucial role in maintaining pelvic stability and facilitating movement.
    • The joint is formed by the articulation of the sacrum and ilium bones, with a complex system of ligaments, muscles, and fascia providing support and stability.
    • The sacroiliac joint is capable of a wide range of movements, including flexion, extension, rotation, and counter-rotation.

    Sacral Motion

    • Sacral motion can be restricted in two ways: sacroiliac flexion restriction and sacroiliac extension restriction.
    • Sacroiliac flexion restriction is characterized by a decrease in post-inferior glide, rotation restriction around the right or left oblique axis (ROA or LOA), and counter-rotation malposition of the PS-SB.
    • Sacroiliac extension restriction is characterized by a decrease in post-inferior glide, rotation restriction around the left or right oblique axis (LOA or ROA), and counter-rotation malposition of the AI-SB.

    PI Ilium (Anterior Glide Restriction)

    • PI Ilium is a type of sacroiliac joint dysfunction characterized by an anterior glide restriction of the ilium.
    • It is more common than AS Ilium and is often associated with ipsilateral lumbar scoliosis.
    • Key findings include:
      • Low crest and PSIS on the same side as the ilium
      • High ASIS on the opposite side
      • Decreased prone thigh extension on the same side as the ilium
      • PSIS more pronounced on the same side as the ilium
      • PN in the lower half of the SI joint
    • Treatment involves prone sacroiliac extension palpation and mobilization to restore normal motion.

    AS Ilium (Posterior Glide Restriction)

    • AS Ilium is a type of sacroiliac joint dysfunction characterized by a posterior glide restriction of the ilium.
    • It is less common than PI Ilium and is often associated with contralateral lumbar scoliosis.
    • Key findings include:
      • High crest and PSIS on the same side as the ilium
      • Low ASIS on the opposite side
      • Increased prone thigh extension on the same side as the ilium
      • PSIS less pronounced on the same side as the ilium
      • PN in the lower half of the SI joint
    • Treatment involves prone sacroiliac flexion palpation and mobilization to restore normal motion.

    Sacroiliac Joint Syndrome/Dysfunction

    • Sacroiliac joint syndrome is a condition characterized by aberrant motion of the sacroiliac joint, leading to pain and dysfunction.
    • It can be caused by a variety of factors, including hypomobility, ligamentous laxity, and trauma.
    • Key findings include:
      • Local pain that may radiate into the lower back and buttocks
      • Dull ache to sharp and stabbing pain
      • Provocative factors include weight-bearing, sit-to-stand, motion, and pelvic flexion/extension
      • Palliative factors include recumbency (lying down)
    • Treatment involves a combination of manual therapy, exercise, and education to restore normal motion and reduce pain and dysfunction.

    Sacroiliac Joint Syndrome - History

    • A thorough history is essential in diagnosing sacroiliac joint syndrome.
    • Key questions to ask include:
      • Where is the pain located?
      • What is the nature of the pain?
      • Are there any provocative or palliative factors?
      • Are there any associated symptoms, such as numbness, tingling, or weakness?

    Sacroiliac Joint Syndrome - Findings

    • Key findings include:
      • Local pain and tenderness
      • Leg length inequality
      • Possible gait abnormalities
      • Palpation of misalignment or restricted motion/joint play (hard end feel)
      • Postural abnormalities

    Sacroiliac Joint Special Test Cluster

    • A special test cluster is a group of tests used to diagnose sacroiliac joint syndrome.
    • The cluster includes:
      • Distraction test
      • Compression test
      • Thigh thrust test
      • Sacral thrust test
      • Gaenslen's test
    • Each test is designed to assess a specific aspect of sacroiliac joint function and can help diagnose sacroiliac joint syndrome.

    Benefits of Using Orthopedic Test Clusters

    • Using orthopedic test clusters has several benefits, including:
      • Increased accuracy in diagnosis
      • Improved treatment outcomes
      • Reduced risk of misdiagnosis
      • Improved patient satisfaction
    • However, there are also some drawbacks, including:
      • Limited evidence supporting the use of some tests
      • Variability in test performance and interpretation
      • Risk of over-testing or under-testing

    Sacroiliac Joint Anatomy and Biomechanics

    • Sacroiliac joint is a dynamic L-S joint that plays a crucial role in maintaining pelvic stability and facilitating movement
    • The joint is composed of sacrum and ilium bones, with a complex system of ligaments, muscles, and nerves that provide stability and facilitate movement

    Sacral Motion

    • Sacral motion can be restricted in two ways: sacroiliac flexion restriction and sacroiliac extension restriction
    • Sacroiliac flexion restriction is characterized by decreased lordosis, open packed position of the facets, and decreased post-inferior glide of the ilium
    • Sacroiliac extension restriction is characterized by increased lordosis, closed packed position of the facets, and decreased post-inferior glide of the sacrum

    PI Ilium and AS Ilium

    • PI Ilium is a type of sacroiliac joint dysfunction characterized by an anterior glide restriction of the ilium
    • AS Ilium is a type of sacroiliac joint dysfunction characterized by a posterior glide restriction of the ilium
    • Both PI Ilium and AS Ilium can cause leg length inequality, lumbar scoliosis, and altered gait patterns

    Sacroiliac Joint Syndrome

    • Sacroiliac joint syndrome is a condition characterized by pain and dysfunction in the sacroiliac joint
    • The condition is often caused by aberrant motion of the sacroiliac joint, which can lead to pain, inflammation, and instability
    • Sacroiliac joint syndrome can be caused by hypomobility, ligamentous laxity, pregnancy, trauma, and leg length inequality

    Orthopedic Tests for Sacroiliac Joint Syndrome

    • Orthopedic tests are used to diagnose sacroiliac joint syndrome and distinguish it from other conditions
    • The tests include distraction, compression, thigh thrust, sacral thrust, and Gaenslen's test
    • Each test is designed to assess specific aspects of sacroiliac joint function and identify patterns of pain and dysfunction

    Sacroiliac Joint Special Test Cluster

    • The sacroiliac joint special test cluster is a group of orthopedic tests used to diagnose sacroiliac joint syndrome
    • The tests in the cluster are designed to be used in combination to provide a more accurate diagnosis
    • The cluster includes distraction, compression, thigh thrust, sacral thrust, and Gaenslen's test

    Advantages and Disadvantages of Orthopedic Test Clusters

    • Advantages of using orthopedic test clusters include increased accuracy, improved diagnostic reliability, and better patient outcomes
    • Disadvantages of using orthopedic test clusters include potential for false positives, complexity of test administration, and need for specialized training

    Sacroiliac Joint Syndrome: History and Physical Examination

    • Patients with sacroiliac joint syndrome often report local pain that may radiate into the lower back and buttocks
    • Pain patterns are variable and can include dull ache, sharp stabbing pain, and numbness or tingling
    • Provocative factors include weight-bearing, sitting, standing, and motion
    • Palliative factors include recumbency (laying down)

    Grading of Sprains and Strains

    • Grade 1: mild, characterized by less than 10% fiber damage
    • Grade 2: moderate, characterized by 10-50% fiber damage
    • Grade 3: severe, characterized by 50-100% fiber damage

    Characteristics of Grade 1 Sprains and Strains

    • Delayed muscle soreness within 24 hours
    • Mild pain at end of range of motion (ROM)
    • Mild point tenderness
    • No edema
    • Mild functional loss
    • Functional recovery takes 2-14 days
    • Structural recovery takes 10-20 days
    • Neurovascular function is within normal limits (WNL)

    Characteristics of Grade 2 Sprains and Strains

    • 10-50% of fibers damaged
    • Pain at end of ROM
    • Moderate tenderness
    • No edema
    • Mild functional loss
    • Possible antalgic posture (guarding posture)
    • Functional recovery takes 14-40 days
    • Structural recovery takes 30-60 days
    • Neurovascular function is WNL

    Characteristics of Grade 3 Sprains and Strains

    • 50-100% of fibers damaged
    • Pain with ROM
    • Severe point tenderness
    • Possible edema/palpable abnormality
    • Significant loss of function
    • Antalgic posture/abnormal gait
    • Functional recovery takes 1-3 months
    • Structural recovery takes 3 months to years
    • Neurovascular function is WNL

    Additional Facts

    • Most common age range for sprains and strains is 30-50 years old
    • Disc herniation is also common in this age range
    • 60% of back injuries are sprains and strains
    • Male to female ratio is 3:1

    Pain Patterns

    • Muscle strain: active range of motion (AROM) pain > passive range of motion (PROM) pain
    • Ligament sprain: PROM pain > AROM pain
    • Joint capsule damage: pain with ROM in multiple planes

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    This quiz covers the anatomy, biomechanics, and prevalence of the sacroiliac joint, as well as lumbopelvic kinematics. It also explores dynamic L-S joint models and indications of sacroiliac joint restrictions.

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