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Sacroiliac Joint Dysfunction Assessment

Mar 28, 2025

Examining the Pelvis: Sacroiliac Joint Dysfunction

Overview

  • Focus on examining the pelvis, particularly the sacroiliac (SI) joint.
  • Evaluation does not break down by pathology but rather by assessing the sacrum.
  • Purpose: Determine type of rotary instability or dysfunction to create treatment.

Key Examination Points

  • Determine if there's equal or unequal movement on the right and left sides of the pelvis.
  • Assess whether movement is increased or decreased.
  • Check for tissue contractures, such as muscle spasms at the distal erector spinae.
  • Look for localized swelling over the sacrum and lumbar spine.

Sacral Joint Movements

  • Movements are small and difficult to see compared to larger joints (ankle, knee, hip).
  • Minimal visible movement; more reliant on palpation.

Testing for Sacroiliac Joint Dysfunction

  • Tests are imprecise; sensitivity and specificity not high.
  • Often requires clustering multiple tests to confirm pathology.
  • Multiple muscles and ligaments around the spine complicate precise assessments.

Types of Stability

  1. Form Closure

    • Refers to the closed pack position (nutation of the sacrum).
    • No external forces applied to the pelvis.
    • Evaluates static structures and joint shape.

  2. Force Closure

    • Opposite of form closure (counter-nutation).
    • Evaluates how dynamic structures create stability under extrinsic forces.
    • Special tests applied during this unstable joint phase.

Movement Assessment

  • Active movements: patient's ability to perform.
  • Consider form and force closure, and patient's ability to stabilize during dynamic tasks.

Sacrum Movements

  • Nutation: Sacrum moves into a "locked" position during initial forward flexion.
  • Counter Nutation: Occurs after 60 degrees of forward flexion, sacrum moves oppositely when ilium rotates anteriorly.

Clinical Application

  • Palpate PSIS (posterior superior iliac spine) with patient standing.
  • Assess PSIS movement during forward/backward bending, side flexion, and hip flexion.
  • Movement patterns can indicate hypomobility or other dysfunctions.

Sacrum and Hip Flexion

  • PSIS should move slightly inferiorly with hip flexion (indicates healthy movement).
  • Position of the sacrum assessed by palpating the inferior lateral angle.
  • Done in both seated and prone positions.

Passive Movements and Special Tests

  • Special tests are used to provoke pain and stress the SI joint.
  • Tests aim to rule in or rule out specific pathologies.

Conclusion and Lab Preparation

  • No single specific pathology for SI joint; it's about identifying dysfunction cause (e.g., tight hamstrings, stagnation in sacrum or ilium movement).
  • Prepare for lab to assess and predict specific SI joint dysfunctions.

These notes provide an overview of assessing and understanding sacroiliac joint dysfunction, highlighting the complexity of its diagnosis and the necessity for a comprehensive evaluation strategy.

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