Motion Palpation of the Pelvis
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Chapter 6: Motion Palpation of the Pelvis
Differentiating Sacroiliac from Lumbar Fixations
To differentiate sacroiliac from lumbar fixations, Faye offers the following comments for consideration.
With the patient sitting and their hands placed behind their head, rotate the patient’s trunk first to the right and then to the left. Special care should be taken not to lift the patient’s pelvis. Motion restriction of the patient’s left lumbar facets or left sacroiliac joint will reduce rotation to the left (positive theta Y). Motion restriction of the patient’s right lumbar facets or right sacroiliac joint will inhibit rotation of the patient’s trunk to the right (negative theta Y).
To discern between a lumbosacral or sacroiliac lesion, the patient is allowed to relax against the doctor (patient’s hands are still behind their head). In this position, the lumbosacral joint is relatively stress free. Next, twist the patient’s trunk into posterior rotation on the right until the patient’s left ischial tuberosity lifts slightly (buttocks remaining on palpation stool). In this position, there is a marked posterior torsion strain on the right sacroiliac joint. If pain arises in the right sacroiliac that can be relieved by pushing the left ilium posteriorly, then the pain can be assumed to arise from the right sacroiliac joint. Reverse the doctor-patient positions to differentiate fixations on the left. This is Mennell’s modified Kemp’s test for the lumbosacral area.
Here are some helpful clues: The patient suffering from sacroiliac dysfunction gets up in the morning with stiffness that improves with activity. The patient suffering with facet inflammation and/or an IVD lesion arises improved, but the condition worsens as the day goes on. Fixation produces a sharp pain on certain movements that is relieved when the site is not stressed. Other points characteristic of a sacroiliac lesion are:
- There is usually unilateral pain in the sacroiliac joint.
- The patient may describe an onset involving a lifting or twisting maneuver upon which a “catch” in the back is felt.
- The patient has difficulty rising from bed, and the disability is worse in the morning, improving with activity.
- The patient has difficulty getting into or rising from a chair because the joints fail to accommodate the normal pelvic changes that occur from changing from a sitting to standing posture.
- The associated pain may refer to the
(a) ipsilateral buttock,
(b) ipsilateral posterior thigh
(usually no further than the knee),
(c) ipsilateral groin, and/or
(d) ipsilateral anterior thigh (rare).
See Figure 6.15.
- The pain is usually an “achy” type, but it may be sharp on certain movements.
- There is usually no severe pain on coughing or sneezing.
- There is usually no abnormal neurologic signs, but there may be some current or recent history of paresthesia in the ipsilateral buttock and thigh.
- The most common sites of pelvic fixation are found within the sacroiliac joints themselves or the hip joints.
- A corrective adjustment frequently results in dramatic relief immediately.
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