Sacroiliac Joint Dysfunction Quiz

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Questions and Answers

What type of pain is classically described as deep, dull, and unilateral in SIJ pain?

Sharp and radiating pain

Superficial and localized pain

Deep, dull, undefined pain (correct)

Nerve pain with tingling sensations

Which mechanism of injury is associated with SI joint dysfunction?

Prolonged sitting without movement

Stepping off a curb or fall on the buttocks (correct)

Sudden twisting of the torso

Repeated high-impact jumping

Which condition is NOT typically associated with pain or dysfunction of the sacroiliac joint?

Postpartum ligament changes

Osteoporosis (correct)

Rheumatoid arthritis

Ankylosing spondylitis

Which of the following symptoms is likely to occur with prolonged walking or standing?

Stiffness and pain, especially unilateral Signup and view all the answers

Which inspection evaluation should be performed to assess leg length discrepancy?

Levels of iliac crests, ASIS, and PSIS Signup and view all the answers

Which of the following reflects a potential psychosocial issue related to SI joint pain?

Anxiety and depression Signup and view all the answers

Which of the following is NOT a functional test associated with SIJ evaluation?

Palpation of the Achilles tendon Signup and view all the answers

What is the effect of relaxin hormones on postpartum women regarding SI joints?

Softens ligaments supporting the SIJs and symphysis pubis Signup and view all the answers

What characterizes pathological counternutation on one side?

The ASIS is lower and the PSIS is higher on one side. Signup and view all the answers

What does 'form closure' in relation to the SIJs refer to?

Stability gained from the articulation of joint surfaces. Signup and view all the answers

Which muscles reinstate the active stability of the sacroiliac joint?

Quadratus lumborum, gluteus maximas, and piriformis. Signup and view all the answers

What role does the biceps femoris muscle play concerning the sacroiliac joint?

It contributes to intrinsic stability via connection to the sacrotuberous ligament. Signup and view all the answers

Which of the following best describes the function of the cross-like configuration at the SIJ?

It aids in load transfer critical during trunk rotation. Signup and view all the answers

What is the most common muscle abnormality related to muscle imbalance for SIJ disorders?

Tight psoas and rectus femoris muscles. Signup and view all the answers

Which muscle is NOT typically associated with the active stability of the SIJ?

Biceps brachii. Signup and view all the answers

What defines 'force closure' in the context of the sacroiliac joints?

Stability achieved through external compression forces. Signup and view all the answers

What is the primary purpose of the Forward Flexion Test?

To test mobility of the sacroiliac joint Signup and view all the answers

What does the Seated Flexion Test evaluate?

The mobility of the sacrum moving on the ilium Signup and view all the answers

Which test is specifically aimed at identifying sacroiliac hypomobility?

Gillet’s (Sacral Fixation) Test Signup and view all the answers

What indicates a positive finding in the Anterior Gapping (Distraction) Test?

Unilateral pain at the SI joint or gluteal region Signup and view all the answers

During the Gillet’s Test, what movement of the examiner’s thumb indicates a fixed joint when the patient raises their leg?

Thumb moves upward Signup and view all the answers

What procedure follows after a patient extends their spine during the passive hip quadrant test?

The examiner provides overpressure while the patient rotates to the affected side Signup and view all the answers

What does the term 'sacroiliac joint dysfunction' specifically refer to?

Insufficient movement or abnormal movement at the SI joint Signup and view all the answers

What positioning is required for a patient during the Anterior Gapping Test?

Supine with legs extended Signup and view all the answers

What position should the subject be in during the sacroiliac joint stress test involving downward pressure at the iliac crest?

Side-lying with examiner beside Signup and view all the answers

What indicates a positive finding in the sacroiliac joint stress test when applying inward and downward pressure?

Increased pain in the sacroiliac joint Signup and view all the answers

Which specific action is performed during the Patrick or FABER test that helps to identify sacroiliac joint issues?

Flexing, abducting, and externally rotating the involved leg Signup and view all the answers

During Gaenslen’s test, what does a positive finding indicate about the sacroiliac joint?

Dysfunction in the sacroiliac region Signup and view all the answers

What is the significance of having three or more positive tests according to the clinical prediction rule for sacroiliac joint dysfunction?

High levels of sensitivity and specificity Signup and view all the answers

What position should the subject be in during the Gaenslen’s test?

Supine close to the edge of the table Signup and view all the answers

What does pain with downward pressure during the FABER test indicate?

Iliopsoas tightness or sacroiliac joint problem Signup and view all the answers

What is the primary action performed by the examiner during the sacroiliac joint stress test in sidelying?

Applying downward pressure Signup and view all the answers

What is the primary goal of SIJ mobilization techniques?

To increase ROM at the sacroiliac joint Signup and view all the answers

Which grade of joint mobilization is associated with small amplitude movement at the end-range of joint play?

Grade IV Signup and view all the answers

Which technique primarily aims to correct an ilio-sacral joint anterior rotation positional fault?

Posterior glide of the iliac crest Signup and view all the answers

What muscle abnormalities are commonly identified with unilateral anterior tilt?

Tight psoas and rectus femoris muscles Signup and view all the answers

In which grade of mobilization is large amplitude movement at the midrange of the joint play utilized?

Grade II Signup and view all the answers

Which of the following treatments is NOT shown to be effective?

Sacroiliac belts Signup and view all the answers

What is NOT a goal of SIJ mobilization techniques?

To improve energy levels Signup and view all the answers

What does sustained longitudinal pressure aim to achieve in the context of psoas muscle treatment?

Increase muscle extensibility Signup and view all the answers

What is the primary consequence of sacroiliac joint dysfunction?

Pain and discomfort in the lumbar region and lower extremities Signup and view all the answers

Which of the following describes the effect of lumbosacral angle on shear stresses?

Increased lumbosacral angle leads to increased shear stresses Signup and view all the answers

What changes occur in the sacriliac joint structure from childhood to adulthood?

The joint becomes less mobile and more irregular Signup and view all the answers

What is lumbarization of S1?

Development of an extra lumbar vertebra from the sacrum Signup and view all the answers

How are the articular surfaces of the sacrum and ilium characterized in pre-pubertal children?

Flat and smooth, resembling plane synovial joints Signup and view all the answers

Which description best fits the shape of the sacrum?

Triangular or wedge-shaped Signup and view all the answers

What type of cartilage covers the ilia in the sacroiliac joint?

Fibrocartilage Signup and view all the answers

Which of the following options best describes the mechanism of stress generation in SIJ dysfunction?

Stress occurs due to altered mechanics leading to hypo- or hypermobility Signup and view all the answers

Study Notes

Sacroiliac Joint (SIJ) Dysfunction

The sacroiliac joint (SIJ) is a pain generator, characterized by abnormal function (e.g., hypo- or hypermobility) at the joint.
Altered mechanics stress structures around the joint, causing pain and discomfort.
SIJ dysfunction can contribute to lumbar, buttock, hamstring, or groin pain.

Sacrum Vertebrae

Five sacral vertebrae fuse to form the sacrum, a triangular or wedge-shaped bone.
The sacrum's base supports two articular facets that face posteriorly, articulating with the inferior facets of the fifth lumbar vertebra (which face anteriorly).
The sacrum's apex articulates with the coccyx.

Lumbosacral Angle

The lumbosacral angle is determined by measuring the angle between a line parallel to the superior aspect of the sacrum and a horizontal line.
Increased lumbosacral angle correlates with increased shear stresses at the lumbosacral joint.

Sacroiliac Joint Articulation

The two sacroiliac joints (SIJs) are articulations between the first three sacral segments and the two ilia of the pelvis.
The sacrum's articular surfaces are auricular (C)-shaped and concave, covered with hyaline cartilage (thicker than iliac cartilage).
The iliac surfaces are convex and covered with fibrocartilage.

SIJ Mobility

SIJs are relatively mobile in young people but become progressively stiffer with age.
In children and pre-puberty, the articular surfaces are flat and smooth, functioning as a plane synovial joint with gliding motion in all directions.
After puberty, the joint surfaces become irregular, with the ilium developing grooves that fit into the sacrum, resembling puzzle pieces.

SIJ Ligaments

The sacroiliac and iliolumbar ligaments reinforce the sacroiliac and lumbosacral articulations, respectively.
The sacrospinous ligament forms the inferior border of the greater sciatic notch, and the sacrotuberous ligament forms the inferior border of the lesser sciatic notch.
Other SIJ ligaments include the interosseous sacroiliac ligament (strong and massive), anterior sacroiliac ligament, and posterior sacroiliac ligament (stronger than the anterior ligament).

SIJ Function

The SIJ connects the spine to the pelvis, absorbing vertical forces from the spine, transmitting them to the pelvis and lower extremities.
This absorption helps relieve stress.
Nutation is the most stable position of the SIJ (sacral locking), with the base of the sacrum moving forward and the apex moving posteriorly.
Sacral locking is limited by the anterior sacroiliac ligaments, the sacrospinous ligament, and the sacrotuberous ligament.
Counternutation (sacral unlocking) is the opposite movement, with the base of the sacrum moving out of the pelvis (posterior rotation).

SIJ Kinematics

The SIJ exhibits very slight motion, primarily a stress-relieving joint.
The rotational motion is approximately 2.5°, while translational motion ranges from 0.3 mm to 0.7 mm (or 1 cm).
SIJs are linked to the symphysis pubis, and any movement at the symphysis pubis accompanies movement at the SIJs.

SIJ during Pregnancy

During pregnancy, the range of motion (ROM) at the SIJs increases due to hormonal influences, loosening ligaments of the pelvis to facilitate fetal delivery.

Pathological Nutation

If nutation occurs only on one side, it is atypical.
Normally, it should occur bilaterally.
In unilateral cases, the anterior superior iliac spine (ASIS) is typically higher, while the posterior superior iliac spine (PSIS) is lower on that side, creating a functional short leg on the same side.

Pathological Counternutation

Counternutation (sacral unlocking) is abnormal when excessive and unilateral.
This is characterized by the ASIS being noticeably lower and the PSIS being higher than average on the involved side.

SIJ Movement Summary

Nutation (sacral locking): base moves forward/ilium rotates backward
Counter-nutation (sacral unlocking): base moves posteriorly/ilium rotates anteriorly.

Precipitating Factors for SIJ Disorders

Muscle imbalance: tight hip flexors, extensors (psoas and rectus femoris), and hip external/internal rotators.
Leg length imbalance: true leg length discrepancies cause asymmetry and pain, while functional leg length discrepancies stem from SIJ or pelvic dysfunction.

Clinical Evaluation of SIJ Pain

SIJ pain is typically deep, dull, and undefined.
Pain often radiates to the low back (below L5), buttocks, groin, and posterolateral thigh.
A detailed history, including onset (acute or insidious), injury mechanism, and any prolonged stress, is essential.

Additional SIJ Disorder Causes

Biomechanical abnormalities (e.g., excessive subtalar pronation, scoliosis).
Postpartum women: ligament recovery may take 3-4 months or more.
Inflammatory conditions (e.g., rheumatoid arthritis, ankylosing spondylitis).
Psychosocial issues (e.g., anxiety, depression).

SIJ Symptoms

Stiffness and pain with prolonged standing or walking (often unilateral).
Difficulty climbing/descending stairs, pain in getting in/out of bed or stepping.
Tenderness over SI joints and PSIS.
Pain reproduction over the pubic symphysis.

SIJ Assessment Methods

Inspection: assess iliac crests, ASIS, PSIS, and leg length discrepancies.
Palpation: palpate SI joints and PSIS for tenderness.
Functional tests & neurological testing: evaluate hips, lumbar spine, lower quarter screen
Special tests (e.g., mobility tests, pain provocation tests, FABRE, Gaenslen's, quadrant tests, anterior gapping/distraction, compression).

SIJ Treatment

Muscle energy techniques.
Joint mobilization.
Joint manipulation.
Muscle stretching.
Trunk stabilization (Core stability).
Sacroiliac belts are not generally effective.

SIJ Mobilization Techniques.

Aims include increasing range of motion (ROM) and decreasing pain.
May include accessory motion increases and positional fault corrections.
Treatment utilizes Maitland's grading system for mobilization, ranging from small amplitude movements (Grade I) to larger amplitude end-range movements (Grade IV or V).

Iliac Crest & Sacrum Glide Treatments

Procedures for anterior or posterior glidings, are specific for both iliac crests and sacral glidings.

L/S Flexion Mobilization

From a long seated position or standing position.
Treatment specifics for anterior nutated and posterior nutated sacrums are separate.

Clinical Prediction Rule (CPR)

The use of three or more positive tests in conjunction with other factors is highly indicative of SIJD based on high sensitivity and specificity.

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Description

Test your knowledge on sacroiliac joint (SIJ) pain and dysfunction with this comprehensive quiz. Explore various aspects such as symptoms, mechanisms of injury, and relevant tests associated with SIJ evaluation. This quiz includes key concepts related to the evaluation and treatment of SIJ conditions.