Si joint dysfunction
- 1. SACRO ILIAC JOINT DYSFUNTION (PROF.)DR. DEEPAK RAGHAV PRINCIPAL SANTOSH COLLEGE OF PHYSIOTHERAPY SANTOSH MEDICAL AND DENTAL COLLEGE HOSPITAL GHAZIABAD
- 3. ANATOMY • Plane synovial joint → modified amphiarthrodial joint • Stable, rigid; relatively immobile; allowing effective load transfer • Each of two SI joints are about 1-2 mm wide
- 4. ANATOMY • The sacroiliac joint can be considered as two joints: the iliosacral and the sacroiliac • The term iliosacral implies the innominates moving on the sacrum. Conversely, the term sacroiliac implies the sacrum moving within the innominates.
- 5. LIGAMENTS Primary Ligaments a. Anterior sacroiliac b. Posterior sacroiliac c. Interosseous
- 6. LIGAMENTS Secondary Ligaments a. Sacrotuberous b. Sacrospinous
- 7. PUBIS SYMPHYSIS • Cartilaginous joint • Joins 2 ends of pubic bones • 3 ligaments associated are • - superior pubic ligament • - inferior pubic ligament • - posterior ligament
- 10. FUNCTION • Connects spine to pelvis • Absorbs vertical forces from spine and transmitting them to pelvis and lower extremities
- 11. AXIS OF SI JOINT
- 12. MOVEMENT OF SI JOINT Physiologic 1. Bilateral anterior sacral nutation 2. Bilateral posterior sacral nutation
- 13. MOVEMENT OF SI JOINT Physiologic 3. Left sacral torsion on left oblique axis 4. Right sacral torsion on right oblique axis
- 14. MOVEMENT OF SI JOINT Physiologic 5. Anterior sacral nutation with exhalation 6. Posterior sacral nutation with inhalation
- 15. Non physiological movt. • Left sacral torsion on right oblique axis • Right sacral torsion on left oblique axis • Left unilateral anterior nutation • Right unilateral anterior nutation • Left unilateral posterior nutation • Right unilateral posterior nutation MOVEMENT OF SI JOINT
- 16. MUSCLES THAT REINFORCE AND STABILIZE SIJ • Erector Spinae • Lumbar multifidi • Abdominal muscles: External & Internal obliques • Rectus abdominis • Transversus abdominis • Hamstrings such as biceps femoris
- 17. CAUSES OF SACROILIAC DYSFUNCTION • TRAUMATIC • MECHANICAL a) HYPOMOBILE or SUBLUXATED b) HYPERMOBILE or MICROTRAUMATIC • SYSTEMIC
- 18. SYSTEMIC CAUSES OF SACROILIAC DYSFUNCTION • Inflammatory conditions Ankylosying spodylitis, Rheumatoid Arthritis • Joint infections Brucellosis, Tuberculosis • Metabolic disorders Gout, Hyper parathyroidism • Miscellaneous Osteitis condensans illi, Paget’s disease • SACROILIAC DYSFUNCTION
- 19. CLINICAL SIGNS OF SACROILIAC DYSFUNCTION • Stiffness and pain with walking • Pain opposite side with walking • Pain same side with walking • Unilateral pain below L5 • Pain with sit to stand • Coccydynia (torsions) • Groin pain
- 20. SACROILIAC SOMATIC DYSFUNCTIONS • Forward sacral torsion • Backward sacral torsion • Bilateral sacral anterior nutation • Bilateral sacral posterior nutation • Unilateral sacral anterior nutation • Unilateral sacral posterior nutation
- 21. EXAMINATION ANTERIOR GAPPING TEST test is positive if unilateral gluteal or posterior leg pain is produced indicating a sprain of the anterior sacroiliac ligaments.
- 22. FABER (PATRICK'S) TEST positive test is indicated by the test leg's knee remaining above the opposite straight leg.
- 23. PRONE LIMB LENGTH TEST
- 24. GILLET TEST (ONE-LEG STORK TEST) If the SIJ on the side on which the knee is flexed moves slightly or in a superior direction, the joint is considered hypomobile, which indicates a positive test
- 25. PIEDALLU'S SIGN OR SEATED FLEXION TEST If one PSIS, usually the painful one, is lower than the other, the patient is asked to perform trunk flexion while remaining seated. If the lower PSIS becomes the higher one on forward flexion, the test is positive.
- 26. GAENSLEN'S TEST pain indicates positive test pain caused by ipsilateral si joint lesion, hip pathology, or L4 nerve root lesion.
- 27. Yeoman's Test Pain localized to the SIJ indicates pathology of the anterior sacroiliac ligaments.
- 28. Prone Knee Bending (Nachlas) Test If the problem is a hypomobile SIJ, the ipsilateral ASIS rotates forward, usually before the knee reaches 90 degrees flexion
- 29. DYSFUNCTIONS 1. ROTATORY DYSFUNCTION OF INNOMINATE a) ANTERIOR OR FORWARD ROTATED INNOMINATE
- 30. DYSFUNCTIONS 1. ROTATORY DYSFUNCTION OF INNOMINATE b) POSTERIOR OR BACKWARD ROTATED INNOMINATE
- 31. 2. SACRAL BASE DYSFUNTION a) BASE ANTERIOR
- 32. 2. SACRAL BASE DYSFUNTION • a) BASE POSTERIOR
- 33. 3. SACRAL TORSIONS • They occur as fixations on either of the oblique axes, usually during the gait cycle, and are held in this dysfunctional position by the piriformis. • Torsions might be thought of as half the sacrum flexing and the other half extending on one of the two oblique axes.
- 34. 3. SACRAL TORSIONS • Forward torsion to the Left on the Left oblique axis. (LOL)
- 35. 3. SACRAL TORSIONS • Forward torsion to the Right on the Rt. oblique axis.(ROR)
- 36. 3. SACRAL TORSIONS • Backward torsion to the Right on the left oblique axis.(ROL)
- 37. 3. SACRAL TORSIONS • Backward torsion to the Left on the Right oblique axis.(LOR)
- 38. 4. UNILATERAL SACRAL FLEXIONS • Sacral flexion lesions might be thought of as failure of one side of the sacrum to extend (counter nutate) from the flexed (nutated) position. Rt. And Lt. flexion
- 39. 5. PUBIC SHEAR LESIONS a) SUPERIOR PUBIC SHEAR b) INFERIOR PUBIC SHEAR • Pubic shears are sliding of one joint surface in relation to the other in either a superior or an inferior direction.
- 40. 6. INNOMINATE SHEAR Superior Innominate Shear (Upslip) Inferior Innominate Shear (Downslip)
- 41. TREATMENT
- 42. EXERCISE
- 43. SURGICAL Rx
- 44. SLEEPING POSITION IN SI JT. PAIN
- 46. THANK YOU