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SACRO ILIAC JOINT
DYSFUNTION
(PROF.)DR. DEEPAK RAGHAV
PRINCIPAL
SANTOSH COLLEGE OF PHYSIOTHERAPY
SANTOSH MEDICAL AND DENTA...
ANATOMY
• Plane synovial joint → modified amphiarthrodial
joint
• Stable, rigid; relatively immobile; allowing effective
l...
ANATOMY
• The sacroiliac joint can be considered as two
joints: the iliosacral and the sacroiliac
• The term iliosacral im...
LIGAMENTS
Primary Ligaments
a. Anterior sacroiliac
b. Posterior sacroiliac
c. Interosseous
LIGAMENTS
Secondary Ligaments
a. Sacrotuberous
b. Sacrospinous
PUBIS SYMPHYSIS
• Cartilaginous joint
• Joins 2 ends of pubic bones
• 3 ligaments associated are
• - superior pubic ligame...
SACRALISATION
UNILATERAL BILATERAL
LUMBARIZATION
FUNCTION
• Connects spine to pelvis
• Absorbs vertical forces from spine and
transmitting them to pelvis and lower
extremi...
AXIS OF SI JOINT
MOVEMENT OF SI JOINT
Physiologic
1. Bilateral anterior
sacral nutation
2. Bilateral posterior
sacral nutation
MOVEMENT OF SI JOINT
Physiologic
3. Left sacral
torsion on left
oblique axis
4. Right sacral
torsion on right
oblique axis
MOVEMENT OF SI JOINT
Physiologic
5. Anterior sacral
nutation with
exhalation
6. Posterior sacral
nutation with
inhalation
Non physiological movt.
• Left sacral torsion on right oblique axis
• Right sacral torsion on left oblique axis
• Left uni...
MUSCLES THAT REINFORCE
AND STABILIZE SIJ
• Erector Spinae
• Lumbar multifidi
• Abdominal muscles:
External & Internal
obli...
CAUSES OF SACROILIAC
DYSFUNCTION
• TRAUMATIC
• MECHANICAL
a) HYPOMOBILE or SUBLUXATED
b) HYPERMOBILE or MICROTRAUMATIC
• S...
SYSTEMIC CAUSES OF
SACROILIAC DYSFUNCTION
• Inflammatory conditions
Ankylosying spodylitis, Rheumatoid Arthritis
• Joint i...
CLINICAL SIGNS OF
SACROILIAC DYSFUNCTION
• Stiffness and pain with walking
• Pain opposite side with walking
• Pain same s...
SACROILIAC SOMATIC
DYSFUNCTIONS
• Forward sacral torsion
• Backward sacral torsion
• Bilateral sacral anterior nutation
• ...
EXAMINATION
ANTERIOR GAPPING TEST
test is positive if unilateral gluteal or posterior leg pain is
produced indicating a sp...
FABER (PATRICK'S) TEST
positive test is indicated by the test leg's knee remaining
above the opposite straight leg.
PRONE LIMB LENGTH TEST
GILLET TEST (ONE-LEG STORK TEST)
If the SIJ on the side on which the knee is flexed moves
slightly or in a superior direct...
PIEDALLU'S SIGN OR SEATED FLEXION TEST
If one PSIS, usually the painful one, is lower than the other, the
patient is asked...
GAENSLEN'S TEST
pain indicates positive test pain caused by ipsilateral si joint
lesion, hip pathology, or L4 nerve root l...
Yeoman's Test
Pain localized to the SIJ indicates pathology of the
anterior sacroiliac ligaments.
Prone Knee Bending (Nachlas) Test
If the problem is a hypomobile SIJ, the ipsilateral ASIS rotates
forward, usually before...
DYSFUNCTIONS
1. ROTATORY
DYSFUNCTION OF
INNOMINATE
a) ANTERIOR OR
FORWARD ROTATED
INNOMINATE
DYSFUNCTIONS
1. ROTATORY
DYSFUNCTION OF
INNOMINATE
b) POSTERIOR OR
BACKWARD ROTATED
INNOMINATE
2. SACRAL BASE DYSFUNTION
a) BASE ANTERIOR
2. SACRAL BASE DYSFUNTION
• a) BASE POSTERIOR
3. SACRAL TORSIONS
• They occur as fixations on either of the
oblique axes, usually during the gait cycle, and
are held in...
3. SACRAL TORSIONS
• Forward torsion to the Left on the Left oblique axis. (LOL)
3. SACRAL TORSIONS
• Forward torsion to the Right on the Rt. oblique axis.(ROR)
3. SACRAL TORSIONS
• Backward torsion to the Right on the left oblique axis.(ROL)
3. SACRAL TORSIONS
• Backward torsion to the Left on the Right oblique axis.(LOR)
4. UNILATERAL SACRAL FLEXIONS
• Sacral flexion lesions might be thought of as failure of one
side of the sacrum to extend ...
5. PUBIC SHEAR LESIONS
a) SUPERIOR PUBIC
SHEAR
b) INFERIOR PUBIC
SHEAR
• Pubic shears are sliding
of one joint surface in
...
6. INNOMINATE SHEAR
Superior Innominate Shear (Upslip)
Inferior Innominate Shear (Downslip)
TREATMENT
EXERCISE
SURGICAL Rx
SLEEPING POSITION IN SI JT. PAIN
THANK
YOU
Si joint dysfunction
Si joint dysfunction
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Si joint dysfunction

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SACROILIAC JOINT DYSFUNCTION AND TREATMENT

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Si joint dysfunction

  1. 1. SACRO ILIAC JOINT DYSFUNTION (PROF.)DR. DEEPAK RAGHAV PRINCIPAL SANTOSH COLLEGE OF PHYSIOTHERAPY SANTOSH MEDICAL AND DENTAL COLLEGE HOSPITAL GHAZIABAD
  2. 2. 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
  3. 3. 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.
  4. 4. LIGAMENTS Primary Ligaments a. Anterior sacroiliac b. Posterior sacroiliac c. Interosseous
  5. 5. LIGAMENTS Secondary Ligaments a. Sacrotuberous b. Sacrospinous
  6. 6. PUBIS SYMPHYSIS • Cartilaginous joint • Joins 2 ends of pubic bones • 3 ligaments associated are • - superior pubic ligament • - inferior pubic ligament • - posterior ligament
  7. 7. SACRALISATION UNILATERAL BILATERAL
  8. 8. LUMBARIZATION
  9. 9. FUNCTION • Connects spine to pelvis • Absorbs vertical forces from spine and transmitting them to pelvis and lower extremities
  10. 10. AXIS OF SI JOINT
  11. 11. MOVEMENT OF SI JOINT Physiologic 1. Bilateral anterior sacral nutation 2. Bilateral posterior sacral nutation
  12. 12. MOVEMENT OF SI JOINT Physiologic 3. Left sacral torsion on left oblique axis 4. Right sacral torsion on right oblique axis
  13. 13. MOVEMENT OF SI JOINT Physiologic 5. Anterior sacral nutation with exhalation 6. Posterior sacral nutation with inhalation
  14. 14. 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
  15. 15. MUSCLES THAT REINFORCE AND STABILIZE SIJ • Erector Spinae • Lumbar multifidi • Abdominal muscles: External & Internal obliques • Rectus abdominis • Transversus abdominis • Hamstrings such as biceps femoris
  16. 16. CAUSES OF SACROILIAC DYSFUNCTION • TRAUMATIC • MECHANICAL a) HYPOMOBILE or SUBLUXATED b) HYPERMOBILE or MICROTRAUMATIC • SYSTEMIC
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. EXAMINATION ANTERIOR GAPPING TEST test is positive if unilateral gluteal or posterior leg pain is produced indicating a sprain of the anterior sacroiliac ligaments.
  21. 21. FABER (PATRICK'S) TEST positive test is indicated by the test leg's knee remaining above the opposite straight leg.
  22. 22. PRONE LIMB LENGTH TEST
  23. 23. 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
  24. 24. 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.
  25. 25. GAENSLEN'S TEST pain indicates positive test pain caused by ipsilateral si joint lesion, hip pathology, or L4 nerve root lesion.
  26. 26. Yeoman's Test Pain localized to the SIJ indicates pathology of the anterior sacroiliac ligaments.
  27. 27. 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
  28. 28. DYSFUNCTIONS 1. ROTATORY DYSFUNCTION OF INNOMINATE a) ANTERIOR OR FORWARD ROTATED INNOMINATE
  29. 29. DYSFUNCTIONS 1. ROTATORY DYSFUNCTION OF INNOMINATE b) POSTERIOR OR BACKWARD ROTATED INNOMINATE
  30. 30. 2. SACRAL BASE DYSFUNTION a) BASE ANTERIOR
  31. 31. 2. SACRAL BASE DYSFUNTION • a) BASE POSTERIOR
  32. 32. 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.
  33. 33. 3. SACRAL TORSIONS • Forward torsion to the Left on the Left oblique axis. (LOL)
  34. 34. 3. SACRAL TORSIONS • Forward torsion to the Right on the Rt. oblique axis.(ROR)
  35. 35. 3. SACRAL TORSIONS • Backward torsion to the Right on the left oblique axis.(ROL)
  36. 36. 3. SACRAL TORSIONS • Backward torsion to the Left on the Right oblique axis.(LOR)
  37. 37. 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
  38. 38. 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.
  39. 39. 6. INNOMINATE SHEAR Superior Innominate Shear (Upslip) Inferior Innominate Shear (Downslip)
  40. 40. TREATMENT
  41. 41. EXERCISE
  42. 42. SURGICAL Rx
  43. 43. SLEEPING POSITION IN SI JT. PAIN
  44. 44. THANK YOU
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SACROILIAC JOINT DYSFUNCTION AND TREATMENT

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