Posterior superior iliac spine3/23/2023 ![]() Theses written in connection with obtaining a degree in an academic program were also excluded. Review articles and validity studies related to PSIS palpation were excluded, as were articles concerned with pelvic landmarks other than the PSIS. Reliability could pertain to assessing the location of a single PSIS, or to assessing the bilateral symmetry of the PSISs on the superior-inferior axis (i.e., assessing whether one PSIS was caudal to the other). Inclusion criterion for an article to be included in this review was that it concerned the intraexaminer or interexaminer reliability of static palpation of the PSIS(s) and was published in an English language peer reviewed journal. Thumbs probe relative depth of the sacroiliac joints.Īsymmetry indicates inter-innominate sacral base rotation 13 ![]() PSIS identification to allow sulcus depth determination Tenderness of PSIS on palpation indicates sacroiliac dysfunction 12 Lack of excursion during active or passive sacroiliac movement indicates restriction hard end-feel with digital pressure indicates fixation 10, 11 Seated or standing, examiner observes or palpates for sacroiliac excursion during movement (sitting flexion test 8, step test 9, etc.) or endfeel with digital pressure. Vertical PSIS displacement seated compared with standing displacement.Īny difference in vertical PSIS displacement seated compared with standing displacement suggests anatomical LLI 6, 7 Palpation of PSIS Y-axis unleveling, seated vs. Using a PSIS landmark may increase accuracy of numerating lumbar segments 4, 5 Prone PSIS identification as anatomical landmarkĮxaminer identifies PSIS in relation to sacrum. ![]() Inferior PSIS –> posterior innominate rotation Superior PSIS–>anterior rotation 2, 3 Figure 1 depicts the muscular and ligamentous attachments to the PSIS.Įxaminer places thumbs on PSISs, assessing for vertical displacement. As the most posterior projection of the iliac crest, it serves for the attachment of the long posterior sacroiliac ligament, which blends with the sacrotuberous ligament, as well as the multifidus and gluteus maximus muscles. Among the pelvic landmarks routinely palpated, the posterior superior iliac spines (PSISs) may be singled out as particularly important, in that identifying them is the starting point for a variety of patient assessment procedures (see Table 1). The anatomical landmarks that are commonly located and contacted to perform these tests include the anterior superior iliac spine (ASIS), the posterior superior iliac spine (PSIS), the iliac crest, the sacral sulcus, the sacral apex, and the inferior lateral angle of the sacrum (SILA). 1 Broadly speaking these procedures fall into four categories: palpation for positional asymmetry of bony landmarks, tests for joint hypomobility or hypermobility, assessment of changes in tissue texture, and tests for pain provocation and/or amelioration. Manual therapists draw upon a number of physical examination procedures to establish indications for sacroiliac interventions.
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