mob tcd pubic symphysis and sacroiliac joint professor emeritus moira o’brien frcpi, ffsem, ffsem...
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MOB TCD
Pubic Symphysis and Sacroiliac Joint
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
Pubic Symphysis
• Secondary cartilagenous joint
• Articular surface of medial aspect of body of pubis
• Covered with hyaline articular cartilage
• Disc of fibrocartilage in between
MOB TCD
• A cavity may develop in the disc, but it is not lined with synovial membrane
• The arcuate or inferior ligament is stronger than the superior pubic ligament
Pubic Symphysis MOB TCD
Secondary Changes in Symphysis
• There is normally very little movement at the pubic symphysis, except during the latter months of pregnancy
• Infection, e.g. Reiter’s syndrome
• Loss of hip mobility, especially internal rotation
Fricker, 1997
MOB TCD
Sacroiliac Joint
• Modified synovial plane joint • The auricular articular surfaces
of the sacrum and the Ilium • The hyaline cartilage on the
articular surfaces is rough• The capsule is attached just
beyond the articular margin• The interosseous sacroiliac
ligament is one of the strongest ligaments in the body and is posterior to the joint
• This articulation is almost immobile
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Sacroiliac Joint Accessory Ligaments
• Sacrotuberous ligaments• Sacrospinous ligaments• Iliolumbar ligaments• Posterior superior iliac spine is
middle of the joint posteriorly, it is superficial
• During gait, the amount of accessory movement at the sacroiliac joint helps to protect the lumbar intervertebral discs
MOB TCD
• Decreasing the torsional stresses associated with pelvic rotation
• Movement at the sacroiliac joint also helps to decrease forward shearing at the L5/S1 junction during the hip extension phase of gait
• More movement during pregnancy
Tigney & Lindsay et al., quoted in DeMann, 1997
Sacroiliac Joint MOB TCD
• Secondary changes may arise in the joint due to anatomical malalignments and biomechanical factors
• Leg length discrepancies• Poor running technique • The arms swing across the front of
the body, causing stress at the joint
Sacroiliac Joint MOB TCD
“BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved.”
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