Sacroiliac Dysfunction

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/SymptomsTable 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
• Gaenslens 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
Patricks 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
Gaenslens test

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

10
Long Sit Testp. 365, Box 10-21

• Monitor apparent leg length to determine SIJ
  mobility
• Supine
• AROM testno assistance by UEs
• 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