Innominate Shears, Inflares, and Outflares

by Sheldon C. Yao, DO

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    00:00 Let’s take a look at innominate shears. So, innominate shears occur when the entire ilium shifts inferior or superiorly in relation to the sacrum. Usually, it's due to some sort of trauma. A common one that I see is when a patient is driving, they have their leg on the break and they are rear-ended and so that kind of drives the innominates superiorly or you are walking down steps and all of a sudden you kind of missed a step and you kind of stumble and really jammed down on the leg.

    00:32 That could also cause some sort of force driving the innominate superiorly or sometimes you could have a bad force pulling the innominate down where you're kind of walking and you tripped and your legs get dragged posteriorly a little bit yanking the leg inferiorly. So, certain traumas and forces could cause the entire innominate to shift and here you have some examples where you have a a positive standing flexion test demonstrating the site of the problem and then you could either have an inferior or superior shift based on that. So, here is an example of a left superior innominate shear. If we take out our finger models, you have a standing flexion test that's positive on the left side. Your ASIS and PSIS are now all going to be superior, your pubic tubercle is going to be superior, and the malleoli will also be superior because everything is being driven up towards the ceiling. So, patients with superior shear can sometimes complain about pelvic pain.

    01:33 Again, your palpatory findings, they may have tissue texture changes at the ipsilateral SI joint or pubic bones and then the motion testing will have freedom of motion to superior translation.

    01:47 Here we have an example of a left inferior innominate shear. Again, taking out our hand models, positive on the left side so we want to name everything for the left side. Our ASIS is now inferior, the PSIS is also inferior compared to the right, your pubic tubercle is going to be inferior typically and your medial malleoli is going to be inferior also following the acetabulum. Again, patients may complain about pelvic pain and again SI joint tissue texture changes or pubic bone changes. So let’s practice the information. I have a positive ASIS compression test on the left.

    02:24 My right ASIS is higher and my right PSIS is higher. What is our dysfunction? So remember that the standing flexion test where the ASIS compression test all will indicate the laterality of the problem. So here, we have a positive ASIS compression test on the left. So we have to name the somatic dysfunction for the side of the problem which is the left even though the findings are given on the right side. So if I take out my hand models, if the right ASIS and right PSIS are both higher on one side that means the left ASIS and the left PSIS is more inferior on the left side and since the problem is on the left side that's why we have a left inferior innominate shear in this case. Another somatic dysfunction that could occur at the pelvic region is innominate inflares and outflares and so your innominates could kind of externally rotate or internally rotate sometimes due to trauma, sometimes due to muscle imbalance and so the way to diagnose this is to check your ASIS distance to midline. So you're going to draw a line from the ASIS to the midline and you can then compare the distance and if the ASIS is closer then you have an inflare and if the ASIS is further away then that's considered an outflare. The positive side will be the side of the positive standing flexion test. So here, outflares, again the ASIS is going to look like it's a little bit further away from midline. Sometimes you may have more compression of the SI joint and more pain and then with inflare the ASIS is going to appear a little bit more closer to midline and is associated with an anterior rotation most of the time due to the shape of the SI joint. Patients may complain about any sort of pelvic or SI joint pains.

    About the Lecture

    The lecture Innominate Shears, Inflares, and Outflares by Sheldon C. Yao, DO is from the course Osteopathic Diagnosis of the Pelvic Region. It contains the following chapters:

    • Innominate Shears
    • Left Superior Innominate Shear
    • Left Inferior Innominate Shear
    • Innominate Inflare/Outflare

    Included Quiz Questions

    1. Innominate shear
    2. Right posterior rotation
    3. Left posterior rotation
    4. Left anterior rotation
    5. Right anterior rotation
    1. Left superior innominate shear
    2. Right inferior innominate shear
    3. Right posterior innominate rotation
    4. Right anterior rotation
    5. Left anterior rotation
    1. ASIS (anterior superior iliac spine)
    2. PSIS (posterior superior iliac spine)
    3. Pubic tubercle
    4. AIIS (anterior inferior iliac spine)
    5. Ischial tuberosity

    Author of lecture Innominate Shears, Inflares, and Outflares

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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