Pelvic structure & Motion & Evaluation

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1 Pelvic structure & Motion & Evaluation
과목 : 임상 생체 역학 실습 발표일 : 발표자 : 오종남

2 Function of the pelvis To link the lower extremity with the trunk
To transmit the load of the trunk to the lower extremity To absorb the shock from the ground To protect the internal organ

3 Osteology consist Sacrum Coccyx Innominate Joint relate with pelvis
Sacroiliac joint Pubic symphysis Sacrococcyseal joint Lumbosacral junction Hip joint

4 Osteology

5 Osteology 여성과 남성의 골반 입구 : 원형/삼각형 천골 : 평균/전방형 하치골궁 : 경사가 곡선 / 경사가 곧음
천좌결흔 : 보통크기 / 좁다

6 Joint of pelvis Sacroiliac joint Pubic symphysis Coccygeal joint
The first three sacral 부분과 ilium Pubic symphysis non-synovial amphiarthrodial joint Fibrocartilage Hyaline cartilage Coccygeal joint Sacrum : convex / coccyx:concave ant, post gliding 임신시에 증가

7 Joint of pelvis(sacroiliac joint)

8 Ligaments of Pelvis Sacroiliac joint lliolumbar ligament
Aterior sacroiliac ligament Posterior sacroiliac ligament Sacrotuberous ligament Sacrospinous ligament

9 Ligament of pelvis Pubic symphysis Sacrococcygeal joint
Inguinal ligament Superior pubic ligament Inferior pubic ligament Sacrococcygeal joint Ant sacrococcygeal ligament Post sacrococcygeal ligament Lateral sacrococcygeal ligament

10 Ligament of pelvis

11 Muscular of pelvis Trunk muscles Hip muscle Abdominalis
Quadratus lumborum Erector spinae Hip muscle Iliopsoas Sartorious Tensor fasciae lataes Gluteus maximus Hip adductor Hip abductor External rotator & piriformis Rectus femoris Hamstring

12 Muscular of pelvis

13 Motion of pelvis Occurring between the lumbar spine and pelvic and hip joint as a result of coordination Tilting : sagital plan Anterior tilting/Posterior tilting Lateral tilting : frontal plan Pelvic elecation/Pelvic drop Rotation : transeverse plan Forward rotation Backward rotation

14 Motion of pelvis

15 Anatomy of pelvis Anterior surface Iliac crest
Ant. Superior iliac spine(ASIS) Pubic symphysis Greater trochanter Inguinal lig Mcburney point Baer’s point Femoral triangle

16 Anatomy of pelvis Posterior surface Ilica crest
post. Superior iliac spine(PSIS) Lumbosacral junction Sacral sulcus Sacral cornea Inferior lateral angle(ILA) Ischial tuberosity

17 Anatomy of pelvis

18 Anatomy of pelvis

19 1. Sacroiliac joint Nutation and Counternutation

20 Motion of pelvic girdle
Sacroiliac joint Sacroiliac sacrum과 2개의 innominate Spinal의 움직임에 의해 나타남 Iliosacral Innominate on the sacrum Lower limbs의 움직에 의해 나타남 Pubic symphysis Innominate의 움직임을 축으로 약간움직임

21 1. Sacroiliac joint Sacroiliac movement
Flexion & Extention(=nutation & counter nutation = Ant.nutation & post.nutation) Symmetrical(bilateral) Flexion Extention Asymmetrical(unilateral) Flxion

22 1. Sacroiliac joint

23 1. Sacroiliac joint Torsions Opposite side at oblique axis으로 움직임이 일어남.
Forward(anterior)sacral torsion(FST) RT LT Backward(posterior)sacral torsion(BST)

24 Torsions Forward(anterior)sacral torsion(FST)
Lt on Lt FST : sacral for ward torsion to Lt on Lt oblique axis Rt on Rt FST Backward(posterior)sacral torsion(BST) Rt on Lt BST : sacral backward torsion to Rt on Lt oblique axis Lt on Rt BST Plan on Axis : 축을 먼저 만들고 면으로 움직이면서 연습해 보세요.

25 1. Sacroiliac joint Iliosacral movrment Rotation : ant. / post.
Flare : Inflare(med rotation)/Outflare(lat. Rotation) Slip : Upslip/downslip Shear : Ant. Shear / post. shear

26 2. Pubic Symphysis movement
Superior / Inferior : 보행시 one legged stnading때 움직임이 나타나고 혼자가끔 움직일 수 있다. Anterior / Posterior : 보행시 swing phase때 나타날 수 있다.

27 Lumbo Pelvic Rhythm

28 Lumbo Pelvic Rhythm 시상면에서 움직임이 수행되는 동안, 요추와 고관절 사이의 운동형상학적 상호관계를 요추 골반 리듬이라 한다. Trunk의 Forward Bending Lumber : lodosis 감소 Pelvic girdle Ilium의 PSIS superior(hip jt에서 pelvic girle의 flex이고 ant. Tilting은 아니다. Sacrum: 초기 60도까지 nutation이 증가 하지만 그후는 Counter nutation(lumbar와 sacrum은 처음엔 같은 방향으로 움직임) hamatring의 tight, facet의 제한으로 영향을 받음

29 Lumbo Pelvic Rhythm Trunk Backward bending Lumbar : lordosis 증가
Pelvic girdle Ilium : PSIS inferior(hip jt에서 pelvic girle의 extends이고 post. Tilting은 아니다.) Sacrum: innominnutes 비례하게 nutated상태로 있음.

30 Evaluation Observation Posture Weight bearing Spine Pelvis Gait/leg
Level test(iliac crest, spine scoliosis, shoulder, greater trochanter, PSIS, ASIS등의 의치를 확인)

31 Evaluation Active movement test PSIS palpation
Sacral nutation palpation SI joint의 운동성 저하 검사 Sacrum base palpation 기타 TEST

32 Evaluation(active movement)

33 Evaluation(active movement)

34 Evaluation(active movement)

35 Evaluation Passive movement test Provocation test Joint play
Gapping test Approximation test Hibb’s test(pron gapping test) Squish test Sacroiliac rocking test Joint play

36 Evaluation (Passive movement test)

37 Evaluation (Passive movement test)

38 Evaluation Resistive test Trunk muscle Hip muscle
Muscle은 손상시 힘을 주기 어렵지만 joint는 힘을 주면서 pain을 있기때문에 isometric으로도 통증의 유무를 확인할 수 있다.

39 Evaluation Supine to Sit Test

40 참고문헌 정형도수치료 진단학/David J. Magee/현문사
Joint Structure and function/Levangie Norkin/F.A.Davis Kinesiology go the musculosleletal system/Donald A. Neumann/정담미디어 척추와 사진의 검진/Stanley hoppenfeld.MD/대학서림

41 감사합니다.