Diagnosing pelvis somatic dysfunction
Notes
Pelvis
Diagnosing pelvis somatic dysfunction
Diagnosing pelvis somatic dysfunction
- Begin with a standing flexion test (Figure 1) to determine laterality of the dysfunction. The side of the dysfunction is determined by the superior PSIS. Alternatively, perform the ASIS compression test, with the patient supine, by compressing bilaterally anterior to posterior at the ASIS. Lack of spring or restricted motion indicates a positive test on that side. This test may be performed in place of the standing flexion test
- Lay the patient supine and “reset the pelvis” by instructing the patient to perform a gluteal bridge and then straightening the legs and returning to supine
- Hook your thumbs under each ASIS to assess their relative level (Figure 2). Determine if the dysfunctional side is superior or inferior relative to the “normal” side
- Assess the distance from the ASIS to the umbilicus. If the positive side is relatively farther or closer to the umbilicus, this indicates an outflare or inflare, respectively
- Place fingers on the superior aspects of the pubic rami to determine whether one ramus is relatively superior or inferior to the other (Figure 2). Palpate the pubic symphysis and assess for bulging, sinking, and tenderness
- Lay the patient prone and again “reset the pelvis” by lifting their lower extremities up off the table, then returning them to prone
- Hook your thumbs under each PSIS and each ischial tuberosity to assess their relative level (Figure 2). Determine if the dysfunctional side is superior or inferior relative to the “normal” side
Figure 1. Seated / standing flexion test with a positive result on the left: the left PSIS moved upward relative to the right during seated flexion.
Figure 2. Assessing anterior (ASIS, pubic rami) and posterior (PSIS, ischial tuberosities) pelvis landmarks.
DIAGNOSING PELVIS SOMATIC DYSFUNCTION | |||||||
| DIAGNOSIS | SFT | ASIS | PSIS | ISCH. TUB. | PUBIC RAMUS | ||
| Superior R innominate shear | + on R | Superior on R | Superior on R | Superior on R | Level | ||
| Superior L innominate shear | + on L | Superior on L | Superior on L | Superior on L | Level | ||
| Inferior R innominate shear | + on R | Inferior on R | Inferior on R | Inferior on R | Level | ||
| Inferior L innominate shear | + on L | Inferior on L | Inferior on L | Inferior on L | Level | ||
| Superior R pubic shear | + on R | Level | Level | Level | Superior on R | ||
| Superior L pubic shear | + on L | Level | Level | Level | Superior on L | ||
| Inferior R pubic shear | + on R | Level | Level | Level | Inferior on R | ||
| Inferior L pubic shear | + on L | Level | Level | Level | Inferior on L | ||
| R anterior innominate rotation | + on R | Inferior on R | Superior on R | Level | Level | ||
| L anterior innominate rotation | + on L | Inferior on L | Superior on L | Level | Level | ||
| R posterior innominate rotation | + on R | Superior on R | Inferior on R | Level | Level | ||
| L posterior innominate rotation | + on L | Superior on L | Inferior on L | Level | Level | ||
| R innominate outflare | + on R | Lateral on R | Medial on R | Medial on R | Level | ||
| L innominate outflare | + on L | Lateral on L | Medial on L | Medial on L | Level | ||
| R innominate inflare | + on R | Medial on R | Lateral on R | Lateral on R | Level | ||
| L innominate inflare | + on L | Medial on L | Lateral on L | Lateral on L | Level | ||
| Pubic compression or distraction | + or - | Level | Level | Level | Tender bilaterally, sunken (compression) or bulging (distraction) symphysis | ||
* R = right, L = left
+ = positive, - = negative
SFT = standing flexion test
Isch. tub. = ischial tuberosity
Figure 3. Innominate rotation is diagnosed by evaluating the movement of the ASIS and PSIS. Anterior innominate rotation: ASIS is inferior, PSIS is superior. Posterior innominate rotation: ASIS is superior, PSIS is inferior.
Figure 4. Sacral diagnosis flow chart.
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Illustrator: Abbey Richard
Illustrator: Jillian Dunbar
Editor: Robyn Hughes, MScBMC