Pelvic motion

Sjodahl, C. et al, Pelvic motion in trans-femoral amputees in the frontal and transverse plane before and after special gait re-education, Prosthet. Orthop. Int., 27,227,2003. 

A 20-year-old female presents to the ER with complaints of fever, pelvic pain, and some nansea and vomiting increasing over the last 2 days. She denies diarrhea or sick contacts. She is cnrrently sexually active with a new partner. On examination she has a temperatnre of 38.9°C (102°F) and appears ill. She has moderate bilateral lower abdominal tenderness and minimal guarding without rebound or distention. Bowel sounds are present and normal. Pelvic exam revealed a foul-smelling discharge through cervix with severe cervical motion tenderness and bilateral adnexal tenderness. Cervical cnltnres were obtained. Patient was begnn on a qninolone antibiotic. 

Summary A 20-year-oId female with history of new sexual partner, fever, abdominal and pelvic pain, foul-smelling discharge through cervical os, and severe cervical motion tenderness. 

The hip joint is a ball-and-socket joint, which derives its stability from congruity of the implants, pelvic muscles, and capsule. The prosthetic hip components are optimized to provide a wide range of motion... 

Proper use of lap and shoulder belts is critical to protecting passengers in automobiles seats. A similar level of crash protection is required for individuals who remain in their wheelchairs during transportation. Wheelchairs are flexible, higher than a standard automobile seat, and not fixed to the vehicle. The passenger is restrained using a harness of at least one belt to provide pelvic restraint and two shoulder or torso belts that restrain both shoulders. A head support may also be used to prevent rearward motion of the head during impact or rebound. A three point restraint is the combination of a lap belt and a shoulder belt (e.g., pelvic torso restraint, lap-sash restraint, lap-shoulder restraint). 

The routine administration of a spasmolytic agent (Buscopan or Glucagon) is recommended for all pelvic MR examinations to reduce peristalsis-related motion artifacts, unless patients have contraindications to these agents. A longer-lasting effect is achieved with the IM injection of 40 mg Buscopan as compared with IV administration of this spasmolytic... 

Functional cine MRl of the pelvic floor can be explained as the conjunction of a static morphological imaging modality and an adequate functional examination with a freezing of motion. The term functional in this context should not be confused with dynamic MRl using intravenous or arterial contrast media or even functional imaging for metabolic activity. 

Posterior Pelvic Rotation Theory This concept grows out of an appreciation for the dynamic forces that are applied to the lumbosacral joint when the human body is in motion. After reading this article, you have had some exposure to the complexity of the interactions which are occurring at the lumbosacral junction. It is an amazing mechanical system that is able to function and transfer enormous loads applied in a repetitive, pulsating fashion (Fig. 6). 

The sacrum rocks on a transverse axis through the articular pillar of the second sacral segment posterior to the sacral canal. This motion must be differentiated from respiratory sacral motion, which is caused by spinal motion and contraction of the pelvic diaphragm. The axis of involuntary sacral motion lies anterior to the sacral canal and passes through the body of S2 at the junction of the short and long arms of the L-shaped sacral articulation. 

During these motions, the lumbar spine rotates to the right and flexes laterally to the left, compensating for the right sacral flexion created by pelvic rotation toward the left with right pelvic tilt The relationship of the rotated right L5 to the left-on-left sacral rotation completes the picture... 

The diagnosis of pelvic dysfunction concentrates on two aspects of the innominate the ilium and the pubic components. Generally, the landmarks of the posterior superior iliac spine (PSIS), anterior superior iliac spine (ASIS), pubic rami, and their other relative structures can give some static findings as to the diagnosis. As with other regions of the body, motion testing indicates the side of the dysfunction. 

Pubic dysfunctions are iikewise named for die positive motion tests. The pubic ramus typically follows the position of the ASIS, but this is not always the case. The plasticity of bone may allow for some warping, opposite to the ASIS finding. Before drawing a conclusion, examination must be performed. A superior pubic shear and an inferior pubic shear may occur in the expected ASIS direction. They can be opposite. There are also torsions possible, as well as adducted and abducted pubes. Childbirth, wherein cartilage is softened by relaxin, is probably the greatest predisposing factor for abducted pubic dysfunction. Adducted pubes may be trauma or rebound related. Sometimes the only indications that there is a dysfunction when the pubic rami appear symmetrical are the symptoms of the patient Aseptic cystitis, pubic pain, prostatitis, pelvic paresthesias, enuresis, or other symptoms may also be betier indicators of pubic dysfunction. 

When prescribing an exercise program for dysfunctions of the muscles in the pelvic region, consideration must be given to the fact that its gross motions Involve other body regions. Dysfunctions will often involve pelvic tilt and lateral muscle hyper/hypotonicity... 

Proper sacral and pelvic joint motion should be achieved in all gait, posture, and spinal motion problems. Because the sacrum Is closely associated with cranial motion, the sacrum must be evaluated as pan of the cranial motion evaluation. Lower extremity dysfunction often results from or may cause pelvic dysfunctions. 

The gluteus maximus follows the law oj muscle detorsion. Therefore, to increase hip extension, as in ballet movement, the ilium must be rotated. Somatic dysfunction of the lumbar spine will limit lumbar regional motion, pelvic rotation, and hip extension... 

The question that must be answered when this diagnosis is made is, what was the underlying condition that caused this condition The function of the bursa is in relationship to muscle function. The muscle(s) involved include those used for hip motion as well as knee motion. Pelvic function and balance is involved as well. Somatic dysfunctions are a common finding and must be addressed. The finding of an anatomical short leg should be sought. Simply treating the local symptoms will not "cure" the condition. 

An osteopathic structural examination revealed the following somatic findings the most severe restrictions to motion were found at the facilitated segments of T2 to T4 on the left, oc-cipitoatlantal joint, thoracic inlet, thoraco-ab-dominal and pelvic diaphragms, and the lower ribcage. These findings may place an extra workload on an already compromised cardiac pump. 

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