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Sacroiliac Dysfunction

Sacroiliac Dysfunction. Chapter 10 p. 361. SI Joint: Overview. Articular joint NL= 1 º - 2º of motion Functions: Shock absorption for pelvis Transfer & buffer stress from hips to spine Hip fx risk increases as SI mobility decreases Kinematic chain: Hip-SI-lumbar spine

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Sacroiliac Dysfunction

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  1. Sacroiliac Dysfunction Chapter 10 p. 361

  2. SI Joint: Overview • Articular joint • NL= 1º - 2º of motion • Functions: • Shock absorption for pelvis • Transfer & buffer stress from hips to spine • Hip fx risk increases as SI mobility decreases • Kinematic chain: • Hip-SI-lumbar spine • No isolated injury

  3. SI Joint: Overview • Innervation • Sacral/Obturator plexus • Shares innervation with hip rotators • Dysfunction spasm in rotators • Arthrokinematic reflex • Referred pain pattern

  4. Signs/Symptoms:Table 10-14, p. 361 • Acute or insidious onset • Unilateral/bilateral • Often improves with walking & worsens with sitting • Radiating pain down anterior thigh proximal To knee • SIJ tenderness

  5. Special Tests for SI Dysfunction • SI Compression • SI Distraction • Patrick's test/ FABER test • Gaenslen’s test • Rotation test • Knee lift test • Sidebending test

  6. SI Compression Test • P.362, Box 10-18 • (+) for SI dysfunction • Compresses joint to elicit pain • Spreading the ASIS compresses SIJ while supine

  7. SI Distraction • P. 363, Box 10-18 • (+) for SI dysfunction • Opens joint to elicit pain • Closing the ASIS spreads the SIJ while side-lying

  8. Patrick’s test/FABER test • Box 10-19, p. 363 • (+) for hip & SIJ pathologies • Flexion-Abduction-ER • Overpressure to hip while in figure-4 (FABER) position • (+) = pain in ant. hip OR in SIJ

  9. Gaenslen’s test • P. 364, Box 10-20 • Modified Thomas test with over pressure • Prevent lumbar ext • Rotation+ compression of SIJ • (+) = SIJ pain

  10. Long Sit Test—p. 365, Box 10-21 • Monitor apparent leg length to determine SIJ mobility • Supine • AROM test—no assistance by UE’s • Leg-lengthening=(+) test

  11. Single Leg Stance Test • Examiner behind pt. • Standing on 2 feet • Raise hip to 90 deg • Move into trunk extension • Repeat on opposite leg • Pain in lumbar/SI

  12. Eval of SI Dysfunction • Look for symmetry • ASIS • PSIS • Iliac crests • Leg length • Trunk ROM

  13. Sciatica – Tension Sign • supine • Raise involved side limb to 90 hip flex. • Extend knee to terminal while palpating tibial sciatic nerve • Assess bilaterally • + = PAIN

  14. Femoral Nerve Stretch Test • Prone w/pillow under pelvis • Passive hip extension w/knee at 90 degrees • Look for pain in anterior/lateral thigh • Nerve impingement of L2,L3, L4 • Assess bilaterally

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