DOCSLIB.ORG

The Funcsonal Pelvis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Funcsonal Pelvis 14-01-05 Anatomy & Biomechanics Prepared by Michael Boni, PT, CAT(C), ATC, FCAMPT, CAFCI Boni ConsulAng Inc. The FuncAonal Pelvis • Supports & protects pelvic viscera • Supports lumbar spine (key stone) • Muscle & ligament aachment • Dynamic link b/w the spine and lower limbs • Reduces & absorbs torsional stress in gait by allowing gliding movements at SIJ & SP ‘The Sacred Bone’ Keystone of the pelvis Highly variable triangular wedged b/w innominates 1 14-01-05 Superior ArAcular Process Spinal Canal Sacral Ala Vertebral Body Sacral Promontory 2 ARTICULAR SURFACES Short Arm Long At S1 in C-C Arm plane At S2-3 in AP plane INNOMINATE Pubis • Forms the Inf/Med aspect Ishium • Forms the Inf/Lat 1/3 of the innominate • Ischial tuberosity site of strong mm & lig aachment 2 14-01-05 INNOMINATE Ilium • Fan like structure • SI arAcular surface is on the Post/Sup aspect • L-shaped arAcular surface • Surface is covered with grooves and ridges Sacroiliac Joint • Synovial joint • Sacral surface has hyaline carAlage • Ilium has fibrocarAlage • Capsule has 2 layers – outer fibrous layer – inner synovial layer • Capsule blends with deep interosseus lig post and periosteum inferiorly • Supported by lig & fascia LIGAMENTS 1. I.L ligament Sup fibres 1 2. I.L verCcal 2 fibres 3 3. Ventral S.I 4. Sacrotuberous 4 5. Inguinal 6 5 6. Sacrospinous 7. Superior Pubic 7 3 14-01-05 SI Ligaments Ventral SI Ligament • Weakest • Thickening of ant/inf parts of the joint capsule SI Ligaments Interosseous SI Lig • Very thick and strong • Fibres are mulAdirecAonal • Completely fills the space b/w the lateral sacral crest and the iliac tuberosity • Deep and superficial layers • Tightens with sacral nutaon SI Ligaments Long Dorsal Lig • AJaches to deep TDF, erector spinae apponeurosis, mulfidus and sacrotuberous lig • FuncAonal link b/w legs, spine, upper quadrant • ContracAon of lat dorsi and glut max muscles reduce tension (Vleeming 1997) • ContracAon of erector spinae & loading of the sacrotuberous lig will increase tension in the ligament (Vleeming 1997) • Source of pain in 88% of people with unilateral pelvic pain (Vleeming 1998) • Tightens with sacral counternutaon (Vleeming 1996) 4 14-01-05 SI Ligaments • AJaches to glut max. Sacrotuberous Lig biceps femoris, and deep MF 3 Bands Lateral – ischial tuberosity to PSIS, spans piriformis Medial – S3,4,5 , lower sacrum & coccyx, to IT Superior – connects coccyx & PSIS • Pierced by S2,3 cutaneous nn. • Tightens with sacral nutaon • AJaches medially to sacrum and coccyx, laterally to ischial spine • Blends with SIJ, thin and triangular • May be responsible for coccydinia, ? A degenerated part of coccygeus mm Iliolumbar Lig • Connects L4-L5 TP to ilium • Coronal and sagiJal stability of lumbosacral juncAon • Highly variable in number and form • Muscle to 3rd decade (post band = iliocostalis lumborum, ant = QL) • Calcifies aer 6th decade • Blends with QL, ventral SIJ, TLF (a) • 5 Bands 5 14-01-05 Sacral Ligaments Limits Nutaon Limits • Interosseous S.I lig Counternutaion • Sacrotuberous lig • Long Dorsal SI Lig • TDF: important in load transfer from trunk to LE • AJachments to TA, IO, G. max/med, LD, ES, MF, BF • Anterior :(thin, from QL to Lx TPs), • Middle: (Lx TPs to aponeurosis of TA), • Posterior: covers back mm, Lx SPs laterally to form lateral raphe with other facial layers Pubic Symphysis • Has a fibrocarAlaginous disk • Osseous surfaces covered by thin hyaline carAlage • Superior pubic lig • Inferior arcuate lig blends with the disk • Anterior / posterior pubic lig - ant blends with abdominals & adductor longus • EssenAal for pelvis stability 6 14-01-05 Sacrococcygeal Joint • Classified as symphysis but synovial joints found Ligaments: • Ventral / Dorsal / Lateral sacrococcygeal ligaments Myology 35 muscles aach to sacrum & innominate • Obturators • Hip adductors • Tensor Fascia Lata • Rectus femoris • Quadratus lumborum • Abdominals • Lassimus dorsi • Hamstrings Myology Muscle aaching directly to sacrum • Erector spinae • MulAfidus • Gluteals • Piriformis • Perineals • Gemelli • iliacus 7 14-01-05 Transversus Abdominis Anterior View: n Lower 6 costal carAlages, TLF, lateral inguinal lig., anterior iliac crest running transversely to linea alba and pubis n With MF, diaphragm & pelvic floor, it supports & propriocepve control for lumbo-pelvic area n Supports pelvic and abdominal contents Transversus Abdominis Posterolateral view n Fascial aachments n Acts to sAffen the spine through TLF n Acve in feed forward manner Sacroiliac Compression TA increases SIJ stability 8 14-01-05 MulAfidus Superficial Fibers Maintenance of lumbar lordosis Diaphragm Tonic acAon (never turns off) • turns on before limb movements (~TA) Contributes to spinal control by assisAng with: • pressurizaon and control of displacement of the abdominal contents Therefore • allows TA to increase tension in the TLF & generate IAP • helps to increase rigidity of the spine Pelvic Floor Levator ani muscle 1. Puborectalis 2. Pubococcygeus 3. Iliococcygeus • Ischiococcygeus 3 2 1 9 14-01-05 Pelvic Floor Pubococcygeus § From post. pubis and fascia of obturator internus to midline raphe § Laterally compresses the visceral canals § Minimal influence on SIJ § AcAvates with TA to compress symphysis pubis Pelvic Floor Puborectalis § Posterior symphysis, uniAng with other side around back of rectum § Blends with Pubococcygeus § Tightens external anal sphincter to aid in voluntary retenAon of feces § FuncAons with RA Pelvic Floor Ischio / Iliococcygeus § From ischial spine, sacrospinous ligament and fascia of obturator internus to S3 & coccyx § Same plane as piriformis § Pull coccyx forward following defecaon § Sacral counternutaon § Early research shows that they funcAon with oblique abdominals 10 14-01-05 Pelvic Floor Funcon • Supports pelvic viscera/abdominal contents • Assists with closure of visceral openings • ContracAon facilitates TA acAvity • Force couple with mulfidus to control the posiAon of the sacrum • Ilio / Ischiococcygeus counternutate the sacrum – Avoid by peri-urethral vs. peri-anal contracAon • Achieve a beJer contracAon of pelvic floor / TA, in neutral ASIS, or slight anterior Alt ArAcular Neurology • ArAcular neurology has both direct and reflex influences on muscle tone locally and globally • ArAcular afferent input contributes to percepAon of posture and moAon • dorsal SI ligaments supplied by lateral divisions of the dorsal rami of L5, S1, S2, & S3 spinal nerves • Pubic Symphysis innervated by pudendal & genitofemoral nerves ArAcular Neurology • Joint mechanoreceptors help to coordinate joint posiAon, mobility, and stability to improve biomechanical efficiency • Central effects include: reflex, perceptual, and pain suppression 11 14-01-05 Anterior Neurology • Innervaon variable– branches of the ventral rami L5-S3 Posterior • Lateral divisions of dorsal rami of L5-S3 • Variety of pain paerns with SI dysfuncAon • Pain referred to buJocks, groin, and lower quadrant but not usually below the knee • Pelvic girdle muscles supplied efferently via the spinal nerve roots from T12-S4 Blood Supply 1. Median sacral artery supplies sacrum coccyx & rectum 2. Internal iliac artery gives off the lateral sacral 1 artery which 2 anastomose with the median sacral artery They will supply the cauda equina and sacrum Later join with the post. gluteal arteries PELVIS BIOMECHANICS 12 14-01-05 The SIJ’s do move! 1. Flexion/extension in sagiJal plane on forward/ backward bending 2. Sideflexion in coronal plane in sidebending 3. Axial rotaon in coronal transverse plane during twisAng of trunk 4. A combinaon of all moAons occurs during gait. Studies by Sturesson and Jacob and Kissling found 2.5° of innominate rotaon and 0.5-1.6mm of translaon Kinemacs of Lumbo-Pelvic Region Flexion coupled with PA translaon about a dynamic coronal axis, with 1-3mm of anterior translaon. • Inferior arAcular processes of superior vertebra (L5) glide superiorly and anteriorly Sideflexion coupled with ipsilateral rotaon and mediolateral translaon. • Ipsilateral inferior arAcular process of superior vertebra (L5) glides inferiorly and posterior Extension coupled with AP translaon. • Inferior arAcular processes of the superior vertebra (L5) glide inferiorly and posteriorly Osteokinemacs of SIJ Work through moAon of innominate, sacrum and L5, relave to each other in: • Trunk flexion • Trunk extension • Trunk sideflexion • Trunk rotaon • Standing hip flexion 13 14-01-05 Osteokinemacs of SIJ Trunk Flexion • Innominate – Flexion relave to femur – Posteriorly rotated relave to sacrum • Sacrum – Remains nutated relave to innominate • L5 – Flexes and translates anterior on the sacrum (confirmed by research) Osteokinemacs of SIJ Trunk Extension • Innominate – extension relave to femur – Posteriorly rotated relave to sacrum • Sacrum – Remains nutated relave to innominate • L5 – Extends and translates posterior on the sacrum (confirmed by research) Osteokinemacs of SIJ Trunk Right Side Flexion • Innominate – Right innominate anterior rotaon – Lej innominate posterior rotaon – Lej translaon • Sacrum – Sacral base rotates lej (right sacral base nutated) • L5 – Right side flexes and rotates ??? (clinical hypothesis) 14 14-01-05 Osteokinemacs of SIJ Trunk Right RotaCon • Innominate – Right innominate posteriorly rotates – Lej innominate anteriorly rotates • Sacrum – Sacral base rotates right • L5 – Rotates right, conjunct rotaon ???? (clinical hypothesis) Osteokinemacs of SIJ Right Hip Flexion • Innominate – Right innominate posteriorly rotates relave to sacrum – The right PSIS moves down – Femur flexes relave to innominate
Load more

Recommended publications
  • Peripartum Pubic Symphysis Diastasis—Practical Guidelines
    Journal of Clinical Medicine Review Peripartum Pubic Symphysis Diastasis—Practical Guidelines Artur Stolarczyk , Piotr St˛epi´nski* , Łukasz Sasinowski, Tomasz Czarnocki, Michał D˛ebi´nski and Bartosz Maci ˛ag Department of Orthopedics and Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland; [email protected] (A.S.); [email protected] (Ł.S.); [email protected] (T.C.); [email protected] (M.D.); [email protected] (B.M.) * Correspondence: [email protected] Abstract: Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman’s body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications. Keywords: pubic symphysis separation; pubic symphysis diastasis; pubic symphysis; pregnancy; PSD 1. Introduction The proper development of a fetus is made possible due to numerous adaptive Citation: Stolarczyk, A.; St˛epi´nski,P.; changes in women’s bodies, including such complicated systems as: endocrine, nervous Sasinowski, Ł.; Czarnocki, T.; and musculoskeletal. With regard to the latter, those changes can be observed particularly D˛ebi´nski,M.; Maci ˛ag,B. Peripartum Pubic Symphysis Diastasis—Practical in osteoarticular and musculo-ligamento-fascial structures. Almost all of those changes Guidelines. J. Clin. Med.
    [Show full text]
  • Pelvic Anatomyanatomy
    PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx)
    [Show full text]
  • Gluteal Region-II
    Gluteal Region-II Dr Garima Sehgal Associate Professor King George’s Medical University UP, Lucknow Structures in the Gluteal region • Bones & joints • Ligaments Thickest muscle • Muscles • Vessels • Nerves Thickest nerve • Bursae Learning Objectives By the end of this teaching session Gluteal region –II all the MBBS 1st year students must be able to: • Enumerate the nerves of gluteal region • Write a short note on nerves of gluteal region • Describe the location & relations of sciatic nerve in gluteal region • Enumerate the arteries of gluteal region • Write a short note on arteries of gluteal region • Enumerate the arteries taking part in trochanteric and cruciate anastomosis • Write a short note on trochanteric and cruciate anastomosis • Enumerate the structures passing through greater sciatic foramen • Enumerate the structures passing through lesser sciatic foramen • Enumerate the bursae in relation to gluteus maximus • Enumerate the structures deep to gluteus maximus • Discuss applied anatomy Nerves of Gluteal region (all nerves in gluteal region are branches of sacral plexus) Superior gluteal nerve (L4,L5, S1) Inferior gluteal nerve (L5, S1, S2) FROM DORSAL DIVISIONS Perforating cutaneous nerve (S2,S3) Nerve to quadratus femoris (L4,L5, S1) Nerve to obturator internus (L5, S1, S2) FROM VENTRAL DIVISIONS Pudendal nerve (S2,S3,S4) Sciatic nerve (L4,L5,S1,S2,S3) Posterior cutaneous nerve of thigh FROM BOTH DORSAL &VENTRAL (S1,S2) & (S2,S3) DIVISIONS 1. Superior Gluteal nerve (L4,L5,S1- dorsal division) 1 • Enters through the greater 3 sciatic foramen • Above piriformis 2 • Runs forwards between gluteus medius & gluteus minimus • SUPPLIES: 1. Gluteus medius 2. Gluteus minimus 3. Tensor fasciae latae 2.
    [Show full text]
  • Role of Greater Sciatic Notch in Sexing Human Hip Bones
    International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 7, Issue 3, 2013 pp 119-123 Role of Greater Sciatic Notch in Sexing Human Hip Bones Rajashree Sheelawant Raut 1*, Prakash B. Hosmani 2, P. R. Kulkarni 3 1Assistant Professor, Department of Anatomy, B. J. Government Medical College, Pune, Maharashtra, INDIA. 2Associate Professor, Department of Anatomy, Dr. V. M. Government Medical College, Solapur, Maharashtra, INDIA. 3 Professor and Head, Department of Anatomy, Government Medical College, Latur, Maharashtra, INDIA. *Corresponding Address: [email protected] Research Article Abstract: Identification of the deceased person from bones is the in archaeological collections that they cannot be used for most critical problem faced by anatomist, forensic science experts sex determination. When pubic material is not preserved, & anthropologists. Skeletal remains have been used for sexing the sex determinations must be made using other less individual as bones of the body are last to perish after death. Hip bone, especially t he greater sciatic notch is valuable in deformed diagnostic features. The greater sciatic notch is especially bones because it is highly sexually dimorphic, is resistant to valuable in such situations because it is highly sexually damage, and thus can often be scored in poorly preserved dimorphic, is resistant to damage, and thus can often be skeletons. In present study one hundred and eighty three adult hip scored in poorly preserved skeletons[3]. Many attempts bones of known sex (125 male and 58 female) are studied for have been made to describe sex differences in the sciatic various parameters of greater sciatic notch.
    [Show full text]
  • Lower Back Pain and the Sacroiliac Joint What Is the Sacroiliac Joint?
    PATIENT INFORMATION Lower Back Pain and the Sacroiliac Joint What is the Sacroiliac Joint? Your Sacroiliac (SI) joint is formed by the connection of the sacrum and iliac bones. These two large bones are part of the pelvis Sacroiliac and are held together by a collection of joint ligaments. The SI joint supports the weight of your upper body which places a large amount of stress across your SI joint. What is Sacroiliac Joint Disorder? The SI joint is a documented source of lower back pain. The joint is the most likely source of pain in 30% of patients with lower back pain. Pain caused by sacroiliac joint disorder can be felt in the lower back, buttocks, or legs. Sacroiliac joint fixation is indicated in patients with severe, chronic sacroiliac joint pain who have failed extensive conservative measures, or in acute cases of trauma. What are potential symptoms? • Lower back pain • Lower extremity pain (numbness, tingling, weakness) • Pelvis/buttock pain • Hip/groin pain • Unilateral leg instability (buckling, giving away) • Disturbed sleep patterns • Disturbed sitting patterns (unable to sit for long periods of time on one side) • Pain going away from sitting to standing How is Sacroiliac Joint Disorder diagnosed? Sacroiliac joint disorder is diagnosed by the patient’s history, physical findings, radiological investigations and SI joint injections. Sacroiliac injection, which is the gold standard for confirming SI joint disorder will be delivered with fluoroscopic or CT guidance to validate accurate placement of the needle in the SI joint. What is the Orthofix SambaScrew®? Your surgeon has chosen the SambaScrew because it utilizes a minimally invasive surgical technique to sacroiliac fixation.
    [Show full text]
  • Lab #23 Anal Triangle
    THE BONY PELVIS AND ANAL TRIANGLE (Grant's Dissector [16th Ed.] pp. 141-145) TODAY’S GOALS: 1. Identify relevant bony features/landmarks on skeletal materials or pelvic models. 2. Identify the sacrotuberous and sacrospinous ligaments. 3. Describe the organization and divisions of the perineum into two triangles: anal triangle and urogenital triangle 4. Dissect the ischiorectal (ischioanal) fossa and define its boundaries. 5. Identify the inferior rectal nerve and artery, the pudendal (Alcock’s) canal and the external anal sphincter. DISSECTION NOTES: The perineum is the diamond-shaped area between the upper thighs and below the inferior pelvic aperture and pelvic diaphragm. It is divided anatomically into 2 triangles: the anal triangle and the urogenital (UG) triangle (Dissector p. 142, Fig. 5.2). The anal triangle is bounded by the tip of the coccyx, sacrotuberous ligaments, and a line connecting the right and left ischial tuberosities. It contains the anal canal, which pierced the levator ani muscle portion of the pelvic diaphragm. The urogenital triangle is bounded by the ischiopubic rami to the inferior surface of the pubic symphysis and a line connecting the right and left ischial tuberosities. This triangular space contains the urogenital (UG) diaphragm that transmits the urethra (in male) and urethra and vagina (in female). A. Anal Triangle Turn the cadaver into the prone position. Make skin incisions as on page 144, Fig. 5.4 of the Dissector. Reflect skin and superficial fascia of the gluteal region in one flap to expose the large gluteus maximus muscle. This muscle has proximal attachments to the posteromedial surface of the ilium, posterior surfaces of the sacrum and coccyx, and the sacrotuberous ligament.
    [Show full text]
  • Curvature of the Greater Sciatic Notch in Sexing the Human Pelvis HIDEO TAKAHASHI1*
    ANTHROPOLOGICAL SCIENCE Vol. 000, 000–000, 2006 Curvature of the greater sciatic notch in sexing the human pelvis HIDEO TAKAHASHI1* 1Department of Anatomy, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotuga-gun, Tochigi, 321-0293 Japan Received 11 November 2005; accepted 26 January 2006 Abstract The maximum curvature of the greater sciatic notch and two standardized indices were cal- culated for use in the sexing of human hip bones. This was done by means of quadratic regression of the contour points of the greater sciatic notch. The new variables are not directly affected by the osteo- metric landmarks (e.g. ischial spine, tubercle of the piriformis, and posterior inferior iliac spine) which determine the greatest width of the notch. These landmarks are, however, known to be ill-defined on occasion, but nevertheless have been used to derive the conventional depth-to-width index and angles of the sciatic notch. The curvature parameter and its new indices were applied to the sciatic notch of 164 Japanese hip bones of known sex (104 males and 61 females). The accuracy of the new variables in the determination of sex was assessed and compared with that of the conventional indices and angles of the sciatic notch. The best discriminating variable was found to be the posterior angle with an accu- racy of 91%. The new parameters of the present study that represent localized shape of the sharply curved edge of the notch diagnosed sex with an accuracy of 88%. In paleoanthropological or forensic cases, using the maximum curvature of the sciatic notch and its indices may be applicable to sexing the hip bones of specimens with postmortem damage.
    [Show full text]
  • This Article Appeared in a Journal Published by Elsevier. the Attached
    This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier’s archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright Author's personal copy Technical Note With Video Illustration Minimally Invasive Bone Grafting of Cysts of the Femoral Head and Acetabulum in Femoroacetabular Impingement: Arthroscopic Technique and Case Presentation Amir A. Jamali, M.D., Anto T. Fritz, M.D., Deepak Reddy, B.S., and John P. Meehan, M.D. Abstract: Femoroacetabular impingement (FAI) has been recently established as a risk factor in the development of osteoarthritis of the hip. Intraosseous cysts are commonly seen on imaging of FAI. In most cases these cysts are incidental and do not require specific treatment at the time of surgical treatment of hip impingement. However, in some cases the cysts may mechanically compromise the acetabular rim or femoral neck. We present a technique for treating such cysts with an all-arthroscopic technique using a commercially available bone graft substitute composed of cancellous bone and demineralized bone matrix placed within an arthroscopic cannula for direct delivery into the cysts. This technique may be of benefit to surgeons treating FAI with an all-arthroscopic technique.
    [Show full text]
  • Chronic Sacroiliac Joint and Pelvic Girdle Pain and Dysfunction
    Chronic Sacroiliac Joint and Pelvic Girdle Pain and Dysfunction Successfully Holly Jonely, PT, ScD, FAAOMPT1,3 Melinda Avery, PT, DPT1 Managed with a Multimodal and Mehul J. Desai, MD, MPH2,3 Multidisciplinary Approach: A Case Series 1The George Washington University, Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, Washington, DC 2The George Washington University, School of Medicine & Health Sciences, Department of Anesthesia & Critical Care, Washington, DC 3International Spine, Pain & Performance Center, Washington, DC ABSTRACT PGP, impairments of the SIJ are not lim- Case 2 Background and Purpose: Sacroiliac ited to intraarticular pain and often include A 30-year-old nulliparous female with joint (SIJ) or pelvic girdle pain (PGP) account impairments of the surrounding muscles or a chronic history of right posterior pelvic for 20-40% of all low back pain cases in the connective tissues, as well as, aberrant and pain following an injury as a college athlete United States. Diagnosis and management asymmetrical movement patterns within the participating in crew. She reported slipping of these disorders can be challenging due to region of the lumbo-pelvic-hip complex.7 in a boat and falling onto her sacrum. Her limited and conflicting evidence in the lit- These impairments have a negative impact previous conservative management included erature and the varying patient presentation. on the PG’s role in support and load trans- physical therapy that emphasized pelvic The purpose of this case series is to describe fer between the lower extremities and trunk. manipulations, use of a pelvic belt, and stabi- the outcome observed in 3 patients present- This ariabilityv in observed impairments lization exercises.
    [Show full text]
  • The Sacroiliac Problem: Review of Anatomy, Mechanics, and Diagnosis
    The sacroiliac problem: Review of anatomy, mechanics, and diagnosis MYRON C. BEAL, DD., FAAO East Lansing, Michigan methods have evolved along with modifications in Studies of the anatomy of the the hypotheses. Unfortunately, definitive analysis sacroiliac joint are reviewed, of the sacroiliac joint problem has yet to be including joint changes associated achieved. with aging and sex. Both descriptive Two excellent reviews of the medical literature and analytical investigations of joint on the sacroiliac joint are by Solonen i and a three- movement are presented, as well as part series by Weisl. clinical hypotheses of sacroiliac joint The present treatise will review the anatomy of motion. The diagnosis of sacroiliac the sacroiliac joint, studies of sacroiliac move- joint dysfunction is described in ment, hypotheses of sacroiliac mechanics, and the detail. diagnosis of sacroiliac dysfunction. Anatomy The formation of the sacroiliac joint begins during the tenth week of intrauterine life, and the joint is fully developed by the seventh month. The joint In recent years it has been generally recognized surfaces remain flat until sometime after puberty; that the sacroiliac joints are capable of movement. smooth surfaces in the adult are the exception. The clinical significance of sacroiliac motion, or The contour of the joint surface continues to lack of motion, is still subject to debate. The role of change with age. 2m In the third and fourth decades the sacroiliac joints in body mechanics can be illus- there is an increase in the number and size of the trated by a mechanical analogy. A 1 to 2 mm. mal- elevations and depressions, which interlock and alignment of a bearing in a machine can cause ab- limit mobility.
    [Show full text]
  • Sacroiliac Joint Dysfunction a Case Study
    NOR200188.qxd 3/8/11 9:53 PM Page 126 Sacroiliac Joint Dysfunction A Case Study CPT William Murray Pain is a widespread issue in the United States. Nine of physical therapist. She was evaluated and her treatment 10 Americans regularly suffer from pain, and nearly every consisted of a transcutaneous electrical nerve stimula- person will experience low back pain at one point in their lives. tion unit while in the PT clinic, aqua therapy, and ice Undertreated or unrelieved pain costs more than and heat application. $60 billion a year from decreased productivity, lost income, After several weeks, Ms. T returned to the primary care and medical expenses. The ability to diagnose and provide ap- provider and informed her that the pain has not decreased and “feels like that it is getting worse.” She also informed propriate medical treatment is imperative. This case study ex- the provider that she was having difficulty sleeping and amines a 23-year-old Active Duty woman who is preparing to constantly feeling tired secondary to pain. Throughout the be involuntarily released from military duty for an easily cor- next several months, the primary care provider tried nu- rectable medical condition. She has complained of chronic low merous medication trials with no relief for the patient. Ms. back pain that radiates into her hip and down her leg since ex- T gives a history of being prescribed numerous medica- periencing a work-related injury. She has been seen by numer- tions within several drug classifications. She stated vari- ous providers for the previous 11 months before being referred ous side effects that are related to the medications and to the chronic pain clinic.
    [Show full text]
  • Sacroiliac Joint Imaging
    Sacroiliac Joint Imaging Jacob Jaremko, MD, PhD Edmonton, Canada SPR, May 2017 Longview, Alberta © Overview . SI joint anatomy . Sacroiliitis pathophysiology . Sacroiliitis imaging . Disease features . Imaging protocols . Role in diagnosis of JIA / JSpA sidysfunction.com SIJ Anatomy . Largest synovial joint in the body… . but little synovium . and minimal motion . Complex shape . Restraining ligaments . Normal 2.5, 0.7 mm . (lax in pregnancy) . Sturesson et al., Spine 1969; 14: 162-5 SIJ Microscopic Anatomy . Synovial part . Ventral, inferior 1/3 – 1/2 . Traditional joint with fluid, synovium, cartilage . Unique fibrocartilage . Normally non-enhancing . Ligamentous part . Dorsal, superior ½ - d2/3 . Non-synovial; enthesis organ . Variants, vascular channels, normally enhancing . Puhakka et al., Skel Radiol 2004; 33:15–28 SIJ normal X-ray appearance . Curvilinear . Overlapping structures & bowel 1 year earlier, age 3 SIJ Pathology Abdominal pain . Case: . 4 year old boy . Post MVC . pneumothorax . liver laceration Age 4 . bony injury? MVC 1 year earlier, age 3 SIJ Trauma Abdominal pain . 4 yr M . Post MVC . Sacral fracture . Widened SI joint . Subtle on Xray Age 4 MVC Sacroiliitis . Clinical: . Deep low-back pain worst in AM, tender SIJ . Xray, CT, MRI: . Several imaging features 11 yr M, asymptomatic 12 yr M, known JSpA Sacroiliitis Pathophysiology . SI joints . Dense fibrocartilage . Bone/cartilage interface resembles an enthesis . Synovium at margins Bone Fibrocartilage Joint Synovium Sacroiliitis Pathophysiology . Initial insult = autoimmune attack of subchondral bone Bone Fibrocartilage Joint Synovium BME Sacroiliitis Pathophysiology . Initial insult = autoimmune attack of subchondral bone . Followed by destruction of cortical bone (erosion) . Opposite of RA – inflammation begins in bone, not at synovium Bone Fibrocartilage Joint Synovium Erosion Sacroiliitis Pathophysiology .
    [Show full text]