The Sacroiliac Joint PDF

Preview

Summary

The Sacroiliac Joint...

Description

Examination of the Sacro-iliac Joint Give special att attention ention to the Sacroiliac Join Jointt (SIJ) when:    

Pain is unilateral rather than bilateral or central, and is not of typical “root” pain quality. There are no lumbar articular signs or symptoms, and the lumbar spine is clear on palpation. There are no signs and symptoms in lower limb attributable to lumbar spine Asymmetry of ASIS and pubis (being no longer in the same plane).

History - Special points:      

Dull buttock, groin or posterior thigh ache (NB check hip) Subjective heaviness, “dullness” of limb. Turning over in bed, or getting on plinth, or stepping up with the affected leg produces twinges of pain. Recent pregnancy, recent falls, twists, strains. Sloppy standing, habitual work stance, “twisted sitting” postures. Nature of sport (e.g. fast bowlers) and other activities.

Observation Observation:: Patient stands with feet almost together and parallel:  Any pelvic rotation?  Buttock contour symmetrical? Level of gluteal folds?  Level of iliac crests?  PSIS levels from behind?  ASIS levels from in front?  ASIS in same plane as Pubis?  Lateral pelvic tilt?  Real leg shortening? Testing mo movements vements & P Palpation: alpation: Step tests (Gillet test) = Bend hip and knee repetitively to above 90 whilst physio is palpating PSIS and spinous process of S1 or S2. Compare movement on (L) and (R). Compare ipsilateral with contralateral side. Positive test = Anterior rotation / ROM is low Patient bends forwar forward d Observe skyline view of gluteal mass. Observe and palpate PSIS for symmetry.

Seated forwar forward d flexion test (Piedallu’ (Piedallu’ss Sign) Physio puts thumbs on PSIS and S2 spineous process. Patient bends forward whilst sitting. Repeat on other side Positive test = PSIS moves more superiorly than the other Patient lies supine. Check leg lengths and “set” of pelvis. Hips Abd with foot alongside opposite knee. Limited? Extension/MR. Limited? Static tests of hip abductors and adductors. Pain? Flex/add test. Pain in groin/buttock? Add pressure down length of femur in flex/add. Pain? Repeat iliac compression/gapping with flat hard pillow under patient’s spine. SIJ

Palpate in sulcus of same side while repeatedly flexing and Flex/add hip.

Palpation

Baer’s point (Iliacus spasm and tenderness). Adductor insertion. Acetabulum region Configuration of symphysis pubis. Muscle tightness –psoas, ITB, abdominal wall.

Patient lies prone, with arms by side. Hip

Press heel to buttock.

SIJ

Flex near knee to 90º and MR near hip. Palpate opposite sulcus Repeatedly lift ASIS of opposite side and palpate sulcus. Rock sacrum by repetitive pressures on its apex: compare movements at sulci. Pain?

Palpation

Relative depth of sulci. Medial to PSIS Sacrotuberous ligaments, through gluteal mass Piriformis.

The Sacroiliac Joint Tests Compression

Thomas’s Test.

Distraction

Yo-yo sign.

Step test (Gillet)

Sacral Mobility tests

Seated flexion test (Piedallu’s sign).

Hibb’s test

S.L.R. Proprioception

Dysfunctions

ASIS Iliac Crest

Anterior R Rotation otation Ilium rotated anterior on sacrum Lower than PSIS on affected side Even bilaterally

Pos Posterior terior Ro Rotation tation Unslip Ilium rotated Pelvis slipped up posteriorly on sacrus relative to sacrum Higher than PSIS on ASIS ans PSIS vary affected side Even bilaterally Iliac crest and ischial tuberosity superior on affected side

Anterior rotation Caused by;  Fall / Sustained postures / Repetitive jumping on 1 leg / Twisting Features;  Restricted hip F / Posterior buttock tension / Longer leg Pos Posterior terior rotation Caused by;  Repetitive or sustained postures / Scoliosis Features;  Restricted hip E / Shorter leg / Facet impingement Unslip Caused by;  Fall / Uneven running / Leg length discrepancy...