Sacrum and Innominate Quiz

Case one

You have a 45 y/o female present to your office complaining of low back pain and hip pain.  She was out hiking the week prior and stepped in a hole on the trail.  Her pain has been getting increasingly worse since then.  You do a thorough exam and work up on her and her osteopathic findings are below.

Standing flexion test:   Positive on the right
Seated flexion test:       Negative
Pubes:                                Level     
ASIS:                                   Inferior in the left           
PSIS:                                    Inferior in the left

Case two (use for questions 2 - 3)

 A 25 y/o male presents to your office with low back pain.  He has had this pain ever since he was a child and it has been getting steadily worse since then.  In the course of your exam you do a standing x-ray and find the patient has a short leg.  You give the patient a heel lift and treat him osteopathically.  You do your exam and have the following findings.

Standing flexion test:                     Positive on the right
Seated flexion test:                        Positive on the right
Pubes:                                                  Negative
ASIS:                                                      Superior on the left
PSIS:                                                      Inferior on the left
Sacral base:                                        Deep right
ILA:                                                        Posterior/inferior left
Spring test:                                         Negative
Sphinx test:                                        not done                                            
L5:                                                          unknown

2- What is the patient's innominate diagnosis?

What is the patient's sacral diagnosis?

Case three (questions 4 - 6)

 You have a new 55 y/o patient in your office seeking to establish treatment with you.  She has a history of several car accidents in her youth and has had low back pain since her 20’s.  You do a full history and physical on her and in your osteopathic screen you note the findings below.

 Standing flexion test:    Positive on the left
Seated flexion test:         Positive on the right
Pubes:                                  Superior on the right
ASIS:                                    Superior on the left
PSIS:                                     Normal
Sacral base:                       Deep on the right
ILA:                                      Posterior/inferior on the right
Spring test:                        Positive
Sphinx test:                      Unequivocal
L5:                                        Rotated right

4- In what order do you treat this patient's somatic dysfunction?

When you treat your patient's pubic symphysis and re-check. When doing so you receive these findings:

Standing flexion test:     Positive on the left
Seated flexion test:         Positive on the right
Pubes:                                  Normal
ASIS:                                    Superior on the left
PSIS:                                     Inferior on the left
Sacral base:                        Deep on the right
ILA:                                      Posterior/inferior on the right
Spring test:                        Unknown
Sphinx test:                       Unknown
L5:                                         Rotated right

5-What is the patients innominate diagnosis?

What is the patient's sacral diagnosis?

Case Four

You have a patient present to your office with low back and hip pain.   You do a focused history and physical along with an osteopathic screen.  The results of the screen are below.

Standing flexion test:    Positive on the right
Seated flexion test:         Negative
Pubes:                               Normal
ASIS:                             Normal
PSIS:                              Normal

You do notice the left ASIS is closer to the umbilicus than the right.  What is your diagnosis?