Pelvis

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26 Terms

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Movements

• SI: nutation/contra nutation
• Pelvico-lumbo-hip complex: forward backward tilt (pelvis lumbar spine-hip are one unit; one affects the other!)

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Ligaments

• Lig. sacroiliaca anterior, posterior
• Interosseus sacroiliac ligament
• Sacrotuberal ligament
• Sacrospinous ligament
• Inguinal ligament
• Iliolumbar ligament

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SI Joint pain

initially local, after radiating- dull pain

constant pain, not related to movement, turning in bed, getting up, walking

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Symphysis pain

hurts in case of movements, not in case of rest

adductor muscle group and rectus femoris function increases; hormonal changes; gait

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Inflammatory pain

constant pain- in case of acute phase; cold is good

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Degenerative issue

Hurts on certain movements (arthrosis)

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Pathological issues in bony structures

1. Developmental disorders: congenital hip disorder
2. Traumatic injuries: fracture of a bone due to injury to other structures

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Pathological issues in SI-Joint

1. Inflammation (sacroiliitis): joint instability; hypo/hypermobility (depending on the inflammation)  pain, antalgic constraint, change in pelvic position

2. Arthrosis: joint dysfunction (in elderly patient: dehydration, overuse

3. Traumatic injury

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Pathological issues in Symphysis

1. Inflammation

2. Instability (pregnancy, delivery): hormonal changes → more elastic tissues + ligament system

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Pelvis torsion

displaced, rotated (RTG required)

1. Anterior direction: acetabulum is in a lower position, in standing position the limb is longer
2. Posterior direction: acetabulum is in a higher position, in standing/lying position the limb is shorter

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Pathological problems in ligaments

1. Inflammation: that can comes from overusing (lig. sacrotuberale, sacroiliaca ant/post)

2. Traumatic injury: strain, tear (for example: motorcycle/car accidents)

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Pathology in muscles

Muscle imbalance (muscle weakness and/or contracture): change in pelvic position → bad posture → pain → joints, ligaments are overloaded → joint dysfunction + pain → contracture is increased

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Pathology in Ischiadic nerve

It comes from the L5-S1 nerve roots

If the m. piriformis is shortened, it can cause pressure on it (radiating, numbing pain from the thigh to the toes)

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Pathology in femoral nerve

It comes from the L2-L4 nerve roots

• Runs out between the two fibres of the iliopsoas muscle (it can be shortened)
• It may come under pressure of the lig. inguinale
• Radiating pain from compression distally to the knee joint

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neurological symptoms

pain, loss of sensation, muscle weakness, loss of reflexes through motor innervation

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Lumbar spine pathology

• Frontal plane: scoliosis
• Sagittal plane: bad posture

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Lower limb pathology

Limb length difference: pelvis position also changed

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Gapping test

- anterior sacroiliacal ligament inflammation
- posterior joint surface problem

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Approximation test

- posterior sacroiliacal ligament problem
- anterior joint surface problem

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Sacral apex pressure test

- examination of the anterior ligament system

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Knee to shoulder test

- sacrotuberal ligament problem
- m. piriformis problem

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Femoral Shear test

- hip and SI joint examination (degeneration)
- sacroiliacal ligament (inflammation)
- posterior articular surface problem

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Patrick Faber Test

- adductor muscle group contracture
- hip joint problem
- anterior ligament problem
- posterior articular surface problem

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Gaenslen test

- examination of the pelvico-lumbo-hip complex

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Flamingo/Trendelenburg test

- examination of the symphysis
- examination of the integrity of m. gluteus Medius

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Supine to Long sit Up test

- examination of the pelvic torsion

Actual/apparent limb length difference