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Questions and Answers
What is the primary issue that defines sacroiliac joint (SIJ) dysfunction?
What is the primary issue that defines sacroiliac joint (SIJ) dysfunction?
Which pain areas may be affected by sacroiliac joint dysfunction?
Which pain areas may be affected by sacroiliac joint dysfunction?
What happens to the sacrum's structure in the case of lumbarization of S1?
What happens to the sacrum's structure in the case of lumbarization of S1?
How does the lumbosacral angle affect shear stresses at the lumbosacral joint?
How does the lumbosacral angle affect shear stresses at the lumbosacral joint?
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What happens to the movement of the sacroiliac joints from childhood to adulthood?
What happens to the movement of the sacroiliac joints from childhood to adulthood?
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What characteristic do the articular surfaces of the sacroiliac joint exhibit in pre-pubertal children?
What characteristic do the articular surfaces of the sacroiliac joint exhibit in pre-pubertal children?
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Which technique is specifically aimed at increasing range of motion and decreasing pain at the sacroiliac joint?
Which technique is specifically aimed at increasing range of motion and decreasing pain at the sacroiliac joint?
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What type of cartilage covers the iliac surfaces of the sacroiliac joint?
What type of cartilage covers the iliac surfaces of the sacroiliac joint?
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What is the primary purpose of Grade III mobilization?
What is the primary purpose of Grade III mobilization?
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What structural change occurs in the sacroiliac joint post-puberty?
What structural change occurs in the sacroiliac joint post-puberty?
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Which of the following muscles is commonly tight in cases of unilateral anterior tilt?
Which of the following muscles is commonly tight in cases of unilateral anterior tilt?
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What is the technique called that involves gliding the iliac crest posteriorly to correct an anterior rotation positional fault?
What is the technique called that involves gliding the iliac crest posteriorly to correct an anterior rotation positional fault?
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Which treatment method has shown to be less effective in managing sacroiliac joint issues?
Which treatment method has shown to be less effective in managing sacroiliac joint issues?
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What is the main function of the sacroiliac joint?
What is the main function of the sacroiliac joint?
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Which ligament connects the ischial spines to the lateral borders of the sacrum and coccyx?
Which ligament connects the ischial spines to the lateral borders of the sacrum and coccyx?
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What is the range of rotational motion available at the sacroiliac joint?
What is the range of rotational motion available at the sacroiliac joint?
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Which position describes the close pack position of the sacroiliac joint?
Which position describes the close pack position of the sacroiliac joint?
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What characterizes the effect of pregnancy on the ligaments of the pelvis?
What characterizes the effect of pregnancy on the ligaments of the pelvis?
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Which ligaments limit nutation at the sacroiliac joint?
Which ligaments limit nutation at the sacroiliac joint?
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What indicates a pathological occurrence of nutation on one side?
What indicates a pathological occurrence of nutation on one side?
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What occurs during counternutation of the sacrum?
What occurs during counternutation of the sacrum?
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Which of the following ligaments is the strongest compared to the others mentioned?
Which of the following ligaments is the strongest compared to the others mentioned?
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Which type of movement is best characterized as very slight at the sacroiliac joint?
Which type of movement is best characterized as very slight at the sacroiliac joint?
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What occurs during pathological counternutation on one side?
What occurs during pathological counternutation on one side?
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What is form closure in the context of SIJ stability?
What is form closure in the context of SIJ stability?
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Which muscle is NOT mentioned as reinforcing the sacroiliac ligaments for active stability?
Which muscle is NOT mentioned as reinforcing the sacroiliac ligaments for active stability?
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What role do the hamstrings, specifically the biceps femoris, play in SIJ stability?
What role do the hamstrings, specifically the biceps femoris, play in SIJ stability?
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What is a major precipitating factor for SIJ disorders related to muscle imbalance?
What is a major precipitating factor for SIJ disorders related to muscle imbalance?
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The anterior oblique muscle system includes muscles from which part of the body?
The anterior oblique muscle system includes muscles from which part of the body?
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What effect does body weight have on the sacrum in terms of stability?
What effect does body weight have on the sacrum in terms of stability?
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Which muscle group does NOT participate in the force closure of the SIJ?
Which muscle group does NOT participate in the force closure of the SIJ?
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What does leg length imbalance primarily affect in relation to SIJ disorders?
What does leg length imbalance primarily affect in relation to SIJ disorders?
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Which option best describes the stability provided by SIJs?
Which option best describes the stability provided by SIJs?
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What is the test position for the Sacroiliac Joint Stress Test when the subject is side-lying?
What is the test position for the Sacroiliac Joint Stress Test when the subject is side-lying?
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What does a positive finding during the Sacroiliac Joint Stress Test indicate?
What does a positive finding during the Sacroiliac Joint Stress Test indicate?
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In the Patrick or FABER Test, what indicates a tight iliopsoas muscle?
In the Patrick or FABER Test, what indicates a tight iliopsoas muscle?
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What is the primary action performed by the examiner during Gaenslen’s Test?
What is the primary action performed by the examiner during Gaenslen’s Test?
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What does a downward pressure applied during the Patrick or FABER Test indicate?
What does a downward pressure applied during the Patrick or FABER Test indicate?
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What is the recommended number of positive tests for high levels of sensitivity and specificity for SI joint dysfunction?
What is the recommended number of positive tests for high levels of sensitivity and specificity for SI joint dysfunction?
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In the supine position during the Sacroiliac Joint Stress Test, how is pressure applied?
In the supine position during the Sacroiliac Joint Stress Test, how is pressure applied?
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What indicates possible sacroiliac joint dysfunction during the Gaenslen’s Test?
What indicates possible sacroiliac joint dysfunction during the Gaenslen’s Test?
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Which of the following movements is performed in the Patrick or FABER Test?
Which of the following movements is performed in the Patrick or FABER Test?
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Which anatomical structure is likely involved when a positive stress test is observed?
Which anatomical structure is likely involved when a positive stress test is observed?
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Study Notes
Sacroiliac Joint (SIJ) Dysfunction
- The sacroiliac joint (SIJ) is a pain generator.
- Refers to abnormal function (hypo- or hypermobility) due to altered mechanics, placing stress on structures leading to pain and discomfort.
- Contributes to lumbar, buttock, hamstring, or groin pain.
Sacral Vertebrae
- Five sacral vertebrae fuse to form a triangular or wedge-shaped bone called the sacrum.
- The base supports two articular facets for articulation with the fifth lumbar vertebra.
- The apex, formed by the fifth sacral vertebra, articulates with the coccyx.
S1 Segment and Lumbosacral Angle
- The S1 segment can be mobile, known as lumbarization of S1, resulting in a sixth lumbar vertebra.
- The fifth lumbar segment can fuse to the sacrum or ilium resulting in sacralization.
- Measuring the angle formed by a line parallel to the superior aspect of the sacrum and a horizontal line determines the lumbosacral angle.
- Shear stresses at the lumbosacral joint increase with an increased lumbosacral angle.
Sacroiliac Joint
- The two SIJs are articulations between the first three sacral segments and the two ilia of the pelvis.
- The sacrum's auricular (C)-shaped surface on its sides is concave and covered with hyaline cartilage, thicker than the iliac cartilage.
- The ilium has a convex surface covered with fibrocartilage.
SIJ Development
- The SIJ structure and function change significantly from birth to adulthood.
- Relatively mobile in young people, becoming stiffer with age.
- Child and pre-pubertal: the articular surfaces are flat and smooth, allowing gliding motion in all directions.
- Post-pubertal: the joint surfaces become irregular, with the ilium developing a central ridge that fits into grooves on the sacrum.
SIJ Ligaments
- Interosseous SI Ligament: strong and massive with superficial and deep portions
- Anterior Sacroiliac Ligament: attaches between the sacrum and ilium
- Posterior Sacroiliac Ligament: stronger than the anterior ligament, connecting the sacrum to the PSIS
- Sacrospinous Ligament: connects the ischial spines to the lateral borders of the sacrum and coccyx, forming the inferior border of the greater sciatic notch.
- Sacrotuberous Ligament: connects the ischial tuberosities to the lateral sacrum and coccyx, forming the inferior border of the lesser sciatic notch.
SIJ Function
- Connects the spine to the pelvis.
- Absorbs vertical forces from the spine, transmitting them to the pelvis and lower extremities.
- Close pack: Nutation, where the base moves forward and the apex moves posterior.
- Loose pack: Counter-nutation.
SIJ Kinematics
- Very slight motion, considered a stress-relieving joint.
- Rotational motion: 2.5 degrees.
- Translation motion: 0.3 to 0.7 mm or 1 cm.
- SIJ linked to symphysis pubis, where any motion in one joint is accompanied by motion at SIJ.
- During pregnancy, increased ROM occurs as ligaments loosen due to hormones.
SIJ Movements
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Nutation (sacral locking): Forward motion of the sacrum's base into the pelvis or backward rotation of the ilium on the sacrum.
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Most stable SIJ position, limited by:
- Anterior sacroiliac ligaments
- Sacrospinous ligament
- Sacrotuberous ligament
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If nutation occurs only on one side, the ASIS will be higher and the PSIS will be lower on that side, resulting in a functional short leg.
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Counternutation (sacral unlocking): The opposite of nutation, an anterior rotation of the ilium on the sacrum or a backward motion of the sacrum's base.
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Limited by the posterior sacroiliac ligaments.
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Occurs when assuming a lordotic or anterior pelvic tilt position.
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Pathological counternutation on one side results in a lower ASIS and higher PSIS on that side.
SIJ Stability
- SIJ stability is crucial, as the joints support a significant portion of body weight.
- Form closure: Stability provided by the specific shapes of the joint surfaces.
- Force closure: Additional stability from external compressive forces.
- Body weight creates a nutation torque on the sacrum.
- Ligamentous tension and reinforcing muscles provide SIJ stability.
Active Stability of SIJ
- Sacroiliac ligaments are reinforced by:
- Quadratus lumborum
- Erector spinae
- Gluteus maximus
- Gluteus minimus
- Piriformis
- Iliacus
- Connection between biceps femoris muscle and the sacrotuberous ligament helps with SIJ stability.
- Shortened biceps femoris can compensate for SIJ instability.
SIJ Cross-Like Configuration
- Demonstrates force closure of the SIJ.
- Load transfer is crucial during trunk rotation, stabilizing the lower lumbar spine and pelvis.
- Posterior oblique system: includes latissimus dorsi, gluteus maximus, and thoracolumbar fascia.
- Anterior oblique system: includes external and internal obliques, transverse abdominals with contralateral adductors of the thigh, and anterior abdominal fascia.
SIJ Disorders Precipitating Factors
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Muscle Imbalance:
- Hip flexors and extensors: tight psoas and rectus femoris are common.
- Hip external and internal rotators.
- Leg Length Imbalance.
SIJ Tests
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Sacroiliac Joint Stress Test (Compression in sideling):
- Position: Subject side-lying.
- Action: Apply downward pressure on the iliac crest.
- Positive finding: Increased pain, possible involvement of the posterior SI ligament.
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Sacroiliac Joint Stress Test (Compression in supine):
- Position: Subject supine.
- Action: Apply inward and downward pressure on the iliac crests.
- Positive finding: Increased pain, possible involvement of posterior SI ligaments.
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Patrick or FABER Test:
- Position: Subject supine.
- Action: Flex, abduct, and externally rotate the involved leg, placing the foot on top of the uninvolved knee. Then slowly abduct the involved leg towards the table.
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Positive finding: The involved leg doesn't abduct below the level of the uninvolved side.
- Iliopsoas tightness.
- Pain with downward pressure indicates SIJ problem.
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Gaenslen’s Test:
- Position: Subject supine, near the edge of the table.
- Action: Slide the patient towards the edge, pull the far knee to the chest, let the near leg hang over the edge, and apply downward pressure on the near leg, forcing it into hyperextension.
- Positive finding: Pain in the SI region on the hyperextended side, indicating SIJ dysfunction.
SIJ Clinical Prediction Rule (CPR)
- Helps estimate the probability of SIJ disorders.
- Three or more positive tests have high sensitivity and specificity.
SIJ Treatment
- Muscle energy techniques
- Joint mobilization
- Joint manipulation
- Muscle stretching
- Trunk stabilization (core stability)
- Sacroiliac belts are not particularly helpful.
SIJ Soft Tissue Abnormalities
- Unilateral anterior tilt often involves tight psoas and rectus femoris muscles.
SIJ Mobilization Techniques
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Aims to:
- Increase SIJ ROM.
- Decrease pain.
- Increase accessory motion at the SIJ.
- Correct positional faults.
- Examine for SIJ impairments.
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Grades of Mobilization:
- Grade I: Small amplitude movement at the beginning range of joint play.
- Grade II: Large amplitude movement at the midrange of the joint play.
- Grade III: Large amplitude movement at the end-range of joint play.
- Grade IV: Small amplitude movement at the end-range of joint play.
Posterior Glide of the Iliac Crest
- Corrects an ilio-sacral joint anterior rotation positional fault.
- The mobilizing hand glides the ASIS and anterior surface of the iliac crest posteriorly, while the guiding hand guides the ischium anteriorly.
Anterior Glide of the Iliac Crest
- Corrects an ilio-sacral joint posterior rotation positional fault.
- The mobilizing hand glides the iliac crest anteriorly, while the guiding hand guides the anterior and lateral surface of the pelvis posteriorly.
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Description
Test your knowledge on sacroiliac joint dysfunction and the structure of the sacral vertebrae. This quiz covers important concepts like lumbarization, sacralization, and the lumbosacral angle. Enhance your understanding of these key anatomical features and their implications in pain generation.
