3 bones of innominate? 3 joints?
ilium, ischium, pubis- fusion begins around age 16
- involves three major joints: SI, pubic symphysis, acetabulum
- the arrangment creates a compressive lateral force and friction to withstand the vertical load
three types of movements
1-2 are physiologoic motions
- Rotation: anterior and posterior
- Flaring: lateral and medial
3: non-physiological motion shearing: superior/inferior
If Standing flexions test positive on right…. what are findings for right anteriorly rotated innominate
ASIS: inferior on right
PSIS: superior on right
Pubic tubercle: inferior on right
S/I innominate shears
- non-physiologic motions- painful and indicative of compensated ligaments - looks as though one innominate is posterior or inferior on the SI joint
innominate flares
- Lateral position change: ASIS medial or lateral compared to usual position- may be though of as rotation of an innominate along a vertical axis
pubic symphysis shears
- can be superior, inferior or compressed- generally seen with saddle injuries or other trauma
- happens with extension of hip
- standing flexion test positive-
ASIS moves inferiorly (caudad)- PSIS moves superiorly (cephalad)-
etiology: tight quads, leg length discrepancy- Patient may c/o hamstring tightness, spasm or even sciatica
anterior rotation of innominate
- happens with flexion of the hip
+ standing flexion test - ASIS superior (cephalad)- PSIS inferior (caudad)- superior pubes-ipsilateral-
Patient may c/o: inguinal/groin pain due to rectus femoris dysfunction, medial knee pain due to sartorius dysfunction
posterior rotation
Standing flexion + on right
ASIS: superior right
PSIS: inferior right
Pubic tubercle: superior right
right posteriorly rotated innominate
+ standing flexion test ipsilateral
- ASIS medial- PSIS lateral
- patient c/o pelvic or sacroiliac joint pain- tender sacroiliac ligaments and inguinal ligaments,
tender point on pubic symphysis.
Medial flare: Innominate Inflare
+ standing flexion test ipsilateral
- ASIS lateral- PSIS medial
- patient c/o pelvic or sacroiliac pain
tender sacroiliac ligaments and inguinal ligaments
Lateral flare: Innominate outflare
(+) Standing Flex test-ipsilateral
ASIS superior, PSIS superior, Pubic tubercle superior
Patient may c/o pelvic pain
Palpatory findings: Tissue texture changes and tenderness at ipsilateral SI and pubes
superior innominate shear: “upslip”
Diagnostic Criteria on Side of Restriction:
(+) Standing Flex test-ipsilateral
ASIS inferior, PSIS inferior, Pubic tubercle inferior
Patient may c/o pelvic pain.
Palpatory findings: Tissue texture changes and tenderness at ipsilateral SIJ and pubes.
Inferior innominate shear: “downslip”
(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle superior
Patient may c/o pelvic pain or pubic arch pain
Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes- often happen with saddle injuries or mountain biking
superior pubic shear
(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle inferior
Patient may c/o pelvic pain or pubic arch painHypertonic adductors
Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes
inferior pubic shear
(+) Standing Flex test-ipsilateral
ASIS and PSIS level
Ipsilateral pubic tubercle level, but very tender
Patient may c/o pelvic pain or pubic arch pain (runners, extreme athletes…)
Palpatory findings: Tissue texture changes and tenderness at ipsilateral pubes
compressed pubic symphysis
what axis does anterior/posterior rotation occur around?
inferior transverse aka iliosacral axis
anterior rotation happens with….posterior rotation happens with…..
- anterior happens with extension of hip- posterior happens with flexion of hip
what flare happens when walking?
Inflaring happens with extension of the hip, or anterior innominate rotation
Outflaring happens with flexion of the hip, or posterior innominate rotation
when do bones of inomms fully fuse?
teenage years
ddx of pelvis?
perform standing flexion test
reset patients hips
perform pelvic compression test (side meeting restriction first is dysfunctional)
- assess ASIS, pubic symphysis, PSIS
order of tx:
- area of greatest restriction
- pubic bone dys.
- innominate shears, flares, then rotations
what can cause false positive in standing flexion test?
ipsilateral quadratus lumborum: pulls inom up
contralateral hamstrings: holds opposite innominate down
MET for inferior innominate shear?
ddx: right inferior innom. shear
physician is on dysf. side, patient is in supine position
with hand contact pubic symphasis - laterally distract the right innom from SI joint then push anteriorly while having patient inhale and exhale
MET for superior innom. shear?
stand at foot of table, contact the patients dysfunctional leg,
hold ankle. abduct and flex or extend leg until SI joint is decompressed and tension is relaxed
internally rotate leg to close-pack the femoral heead into the acetabulum,
apply traction to leg by slowly leaning back
instruct patient to pull their hip cephalad and to take 3-4 deep breaths
have patient relax, then repeat
