Diagnosis of the Pelvis: StFT, Stork, ASIS compression

00:00 So now we're going to talk a little bit about how you're going to diagnose pelvic somatic dysfunctions. With an understanding of the anatomy of the pelvis and the motions, we could utilize our observation and landmarks to identify pelvic somatic dysfunctions. So the first thing that we want to go over is how do we localize and identify a pelvic somatic dysfunction. So, one of the tests that we could do is called a standing flexion test. With this test, what we are doing is we're going to assess whether or not there is an iliosacral dysfunction, meaning that there is a problem going on with the innominate rather than the sacrum. This is different from the seated flexion test because in the seated flexion test you are sitting on the ischial tuberosity thus locking down the innominate. So, a standing flexion test is more specific for a pelvic somatic dysfunction. So, when you're performing this test, you want your patient to be comfortable, have their legs standing about 6 to 8 inches apart, you want to get yourself eye level with the patient’s PSIS and so you're going to place your thumbs along the inferior aspect of the PSIS bilaterally. You're going to ask your patient to slowly bend forward at the waist and what you are going to note with your thumbs is you're going to follow the PSIS as they bend forward.

01:14 If they are symmetric, then that is a negative test. You have a positive test if it's asymmetric especially if the thumb that moves first and furthest is the positive side and we will name the somatic dysfunction for that positive site. So the concept is if there is a restriction that is locking the innominate to the sacrum when the patient bends forward, that side that is stuck is going to move forward first along with the rest of the spine and so if there is an innominate restriction somatic dysfunction you are going to have an asymmetry when the patient bends forward and you're observing which thumb is moving first and further. The side that moves first and further is the positive side. A different variation of this test especially when you cannot perform the standing flexion test is the ASIS compression test or also called the pelvic rock test. And so what you're doing here is that you are going to place your palms along the ASIS bilaterally and you're adding a gentle compression down towards the table. So the patient obviously is supine and you're compressing the ASIS one side at a time and what you're trying to note is whether or not there is an increase in resistance as you do this. Now, this is less specific compared to the standing flexion test. It is really just generally screening for a restriction on one side of the SI joint. It doesn't really distinguish as much whether or not it is an iliosacral or sacroiliac dysfunction, meaning is it the innominate that is the problem or is that the sacrum that is the problem. But this is an easy way to perform a screening test especially if you have a patient who has difficulty standing and bending forward or if you are in a situation like you are treating a patient in the hospital bed that you don't want to have the patient to have to come out and have them try to stand and touch their toes. So, the ASIS compression test is a good substitute to try to see if there is a restriction in the iliosacral or sacroiliac junction. Again, the positive side is the side that feels a little bit more compressed, a little bit less give so your patient is lying supine, you place your thenar and hypothenar eminence along the ASIS bilaterally and then you introduce a gentle but firm pressure merely towards the SI joint one side at a time. There is a slow motion and movement and you allow the ilia to kind of recoil against gentle pressure. Assess for the quality of motion and usually 1 side is more resistant and then you will name it for the side of resistance. Another test that we could perform to screen for sacroiliac or iliosacral dysfunctions is called the stork test. So, in this test your patient is going to stand about 6 to 8 inches with their feet apart and you are going to get your eyes level to the patient’s PSIS and you're going to place your thumbs along the inferior aspects of the PSISs on both sides. You're going to keep the side that you're testing, you're going to keep your thumb underneath that PSIS and with your other thumb you're going to move it midline on to the sacral press. This is important because you want to have a baseline to see whether or not the PSIS that you're testing is going to move posteriorly. So, you're going to ask the patient to flex their hip and knee or just tell them to raise their foot on the side that you're testing. So for testing the right side, we are going to ask the patient to pick up their right leg. Now you're observing the PSIS to see does that PSIS move inferiorly. Because what are you doing when you're asking them to pick their leg up, what you're doing is you're creating a posterior innominate rotation. So, when you pick up your leg and flex your hip, your innominate should rotate posteriorly. If there is a problem and the PSIS does not move inferiorly, then you know that that is a restricted side and that is the positive test. If the PSIS moves posteriorly without any problems, then it is a negative test indicating that there is no SI joint issue and you want to do this test on both sides. Once we determine the laterality if there is a pelvic somatic dysfunction present, what we want to do now is to check our levels performing a static examination. So, there are some key landmarks of the pelvis that will help you try to determine whether or not there is an asymmetry. So it's important for you to be familiar with these different landmarks and what we're comparing right and left. So, first we're going to compare the ASIS height. So you're going to look at the anterosuperior iliac spines on your patient on both sides. The PSIS height, so you're going to look at the level of the PSIS. Are they levelled? You're going to look at the level of the pubic tubercles and then you're going to look at the levels of the medial malleoli. This information in addition to the information you gathered with the standing flexion test will help you determine what is your pelvic somatic dysfunction.