Lumbopelvic Kinematics & SI Joint Syndrome PDF

LUMBOPELVIC KINEMATICS & SACROILIAC JOINT SYNDROME INTRODUCTION SI Joint Anatomy, Biomechanics, and Prevalence: https://www.youtube.com/watch?v=D6NTMgWCSaU https://www.youtube.com/watch?v=1iwmcCw4bAw Dynamic L-S Joint Model: https://www.youtube.com/watch?v=1Ad92SI909Q...

LUMBOPELVIC KINEMATICS & SACROILIAC JOINT SYNDROME INTRODUCTION SI Joint Anatomy, Biomechanics, and Prevalence: https://www.youtube.com/watch?v=D6NTMgWCSaU https://www.youtube.com/watch?v=1iwmcCw4bAw Dynamic L-S Joint Model: https://www.youtube.com/watch?v=1Ad92SI909Q OBJECTIVES What posture predisposes the IVD’s to injury? What is a sacroiliac flexion restriction? What is a sacroiliac extension restriction? What are the indications/findings of a PI-Ilium, an AS-Ilium, SB-P (left, right, or midline)? What motion restrictions would be associated with the above static listings? What are the symptoms of sacroiliac joint syndrome? What are the advantages of using orthopedic test clusters? Are there any drawbacks? SACRAL MOTION SACROILIAC FLEXION RESTRICTION OR SACROILIAC EXTENSION MALPOSITION FLEXION RESTRICTION OF L/R-SB ROTATION RESTRICTION AROUND ROA or LOA COUNTERROTATION MALPOSITION: PS-SB DECREASED LORDOSIS→ OPEN PACKED POSITION (separation of facets) FACETS PROTECT DISC SO DISC MORE VULNERABLE if hypolordotic PSIS LESS PROMINENT GENTLE BROAD PRESSURE ON SB May RELIEVE PAIN (if SB is “stuck posterior” or RRTA/Nutation Restriction) EXTENSION RESTRICTION OF ILIUM (PSIS) decreased post-inferior glide RESTRICTION MAY BE EASIER TO PERCEIVE LIFTING ASIS A→P WHILE MONITORING THE SACRAL SULCUS MALPOSITION: AS ILIUM PSIS LESS PROMINENT SACRAL MOTION SACROILIAC EXTENSION RESTRICTION OR SACROILIAC FLEXION MALPOSITION EXTENSION RESTRICTION OF L/R-SB COUNTER-ROTATION RESTRICTION AROUND LOA or ROA ROTATION MALPOSITION: AI-SB INCREASED LORDOSIS→ CLOSED PACKED POSITION (RISK FOR FACET SYNDROME/DEGENERATION) PSIS MORE PROMINENT GENTLE BROAD PRESSURE ON SB PROVOCATIVE FLEXION RESTRICTION OF ILIUM (PSIS) decreased post-inferior glide MALPOSITION: PI ILIUM PSIS MORE PROMINENT PI ILIUM (ANT GLIDE RESTRICTION) MORE COMMON STANDING (SAME FINDINGS ON SIDE OPPOSITE AS ILIUM) LOW CREST AND PSIS → MAY CAUSE IPSILATERAL LUMBAR SCOLIOSIS HIGH ASIS SHORT LEG PRONE OR SUPINE DECREASED PRONE THIGH EXTENSION PSIS MORE PRONOUNCED PN IN LOWER HALF OF SI PRONE SACROILIAC EXTENSION PALPATION/MOBILIZATION (Ilium should flex as SB extends) FLEXION RESTRICTION OF THE ILIUM STABILIZE CONTRALATERAL SACRAL APEX & MOTION P→A ON PSIS DECREASED MOTION/HARD END-FEEL AS ILIUM (POSTERIOR GLIDE RESTRICTION) STANDING (SAME FINDINGS ON SIDE OPPOSITE PI ILIUM) HIGH CREST AND PSIS → MAY CAUSE CONTRALATERAL LUMBAR SCOLIOSIS LOW ASIS LONG LEG PRONE OR SUPINE **MUST DETERMINE IF SHORT LEG IS PI ILIUM OR IS LONG LEG AS ILIUM INCREASED PRONE THIGH EXTENSION COMPARED TO OTHER SIDE PSIS LESS PRONOUNCED PN IN LOWER HALF OF SI PRONE SACROILIAC FLEXION PALPATION/MOBILIZATION (Ilium should extend as SB flexes) EXTENSION RESTRICTION OF ILIUM (PSIS) decreased post-inferior glide LIFT ASIS A→P WHILE MONITORING THE SACRAL SULCUS FOR DECREASED MOTION/HARD END-FEEL DECREASED MOTION/HARD END-FEEL SACROILIAC JOINT SYNDROME/DYSFUNCTION PAIN ARISING FROM SACROILIAC JOINT / JOINT CAPSULE SOME STUDIES SHOW SI IS THE SOURCE OF LBP IN UP TO 50% OF CASES CHARACTERIZED BY ABERRANT MOTION OF THE SACROILIAC JOINT HYPOMOBILITY LIGAMENTOUS LAXITY (CAN LEAD TO MISALIGNMENT) PREGNANCY TRAUMA –SPRAIN/STRAIN WITH SIGNIFICANT TRAUMA (SI LIGAMENTS ARE VERY STRONG) MAY HAVE COMPENSATORY CONTRALATERAL RESTRICTION OF MOTION LEG LENGTH INEQUALITY SI JOINTS FUSE WITH AGE (MALE>FEMALE) OR SURGICALLY www.spine-health.com/video/sacroiliac-joint-dysfunction-video SACROILIAC JOINT SYNDROME - HISTORY LOCAL PAIN MAY RADIATE INTO THE LB AND BUTTOCKS (pain patterns are variable) PN IS DULL ACHE TO SHARP AND STABBING PROVOCATIVE: WEIGHT BEARING SIT→STAND MOTION/WALKING PELVIC FLEXION/EXTENSION PALLIATIVE: RECUMBENCY (LAYING DOWN) SACROILIAC JOINT SYNDROME FINDINGS: LOCAL PN/TENDERNESS LEG LENGTH INEQUALITY POSSIBLE GAURDED GAIT PALPATION OF MISALIGNMENT OR RESTRICTED MOTION/JOINT PLAY (HARD END FEEL) POSTURAL ABNORMALITIES https://www.physio-pedia.com/Sacroiliac_Joint_Syndrome ORTHOPEDIC TESTS: BELT TEST TO DIFFERENTIATE BETWEEN LBP AND SI PN- not much evidence available, not included in test cluster  SACROILIAC JOINT SYNDROME: BELT TEST BELT TEST AKA Supported Adam’s Test Indications: Helps differentiate between Lumbar spine pathology and Sacroiliac (SI) joint pathology. Procedure: Standing patient is instructed to bend forward and touch toes with knees straight and return to standing. Examiner then stabilizes the patient’s pelvis with hands and patient’s sacrum with examiner’s lateral thigh. Patient is instructed to repeat motion of touching toes. Interpretation (based on biomechanical logic, but little published evidence): *By supporting the patient’s pelvis & Sacrum the examiner should effectively prevent motion at the sacroiliac joint, thus eliminating it as a potential pain generator during supported forward flexion. *No pain with support, pain without support Sacroiliac joint pathology Pain with both supported & unsupported flexion Lumbar spine pathology SACROILIAC JOINT SPECIAL TEST CLUSTER Tests Description (Positive Findings) Distraction Pt supine. Examiner applies posterolateral directed pressure to bilateral ASIS. (Reproduction of pain) Compression Pt sidelying. Examiner compresses pelvis with pressure applied over the iliac crest directed at the opposite iliac crest. (Reproduction of symptoms) Thigh Thrust Pt supine. Examiner places hip in 90 deg flexion and adduction. Examiner then applies posteriorly directed force through the femur at varying angles of abduction/adduction. (Reproduction of buttock pain) Sacral Thrust Pt prone. Examiner delivers an anteriorly directed thrust over the sacrum. (Reproduction of pain) Gaenslen's Pt supine with both legs extended. The test leg is passively brought into full knee flexion, while the opposite hip remains in extension. Overpressure is then applied to the flexed extremity. (Reproduction of pain)  https://www.physio- pedia.com/Sacroiliac_Joint_Special_Test_Cluster Please read the article above which does contain videos for each SACROILIAC JOINT of the orthopaedic tests. What is a TIC? SPECIAL TEST What was one of the major problems with the tests in this TIC? CLUSTER What is the current ‘gold standard’ for diagnosing SI joint syndrome? What risks are associated with it? What is the benefit of using test clusters? NOW WHAT DO YOU KNOW? What posture predisposes the IVD’s to injury? What is a sacroiliac flexion restriction? What is a sacroiliac extension restriction? What are the indications/findings of a PI-Ilium, an AS-Ilium, SB-P (left, right, or midline)? What motion restrictions would be associated with the above static listings? What are the symptoms of sacroiliac joint syndrome? What are the advantages of using orthopedic test clusters? Are there any drawbacks?