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Superior Pubic Shear

by Tyler Cymet, DO, FACOFP

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    00:01 Next problem, is the Superior Pubic Shear.

    00:05 When you check the pubic bones and there's an assymetry - one side that's high on the other, you're gonna need to fix that in order for the patient to be able to function normally and have equal leg lengths.

    00:18 So the patient is going to have to use their own muscles and the piriformis and the rectus abdominis and the internal hip flexors are good muscles to pull the pubic symphysis equal and level I use isometric counterforce and have that patient push in order to have the internal muscles restore functioning.

    00:44 I repeat several times until you have more comfort and ease of motion.

    00:50 That's the pubic shear.

    00:53 Moving on to the Innominate Shear, back to the pelvis at the junction of the sacrum and the ilium, innominate shears are very common, that's why it says "high-yield", and it's something you need to pay attention to.

    01:06 You look at the motion of the pelvic bones, and the sacrum.

    01:10 Is one locked or both moving? And a shear suggests the entire ilium on the one side is not moving well relative to the sacrum so you want to look at a shear versus a motion of the full pelvis.

    01:29 Most shears are gonna be superior and you'll see it in the top portion where the sacrum and the ilium meet.

    01:38 So superior innominate shear is going to have a lateralization when you do "hip drop test", you'll notice one side of the hip moves better than the other.

    01:49 If you do it, see the flexion that takes the hip out..

    01:52 and I'm sorry - takes the pelvis out by stabilizing the pelvis And you do a pelvic compression test or a pelvic rock test looking for motion.

    02:03 The treatment of a superior innominate shear is by putting the patient supine and grasping the medial malleolus, pulling the leg and helping internally rotate and yanking the leg in order to bring the muscles into alignment, ease the muscles and their functioning and movement of the musculoskeletal system.

    02:30 We call this a loose-pack positioning of the sacroiliac joint and is moving the joint through the hip.

    02:38 So you are going to ABduct and flex the leg in order to help facilitate motion and you do this until you engage motion, you find the barrier, and play some traction and then employ the force.

    02:56 You can also do a msucle energy here by having the patient pull for 3-5 seconds and then relax And as long as you get increased motion on each pole, you're doing good - maintain the traction, bring the joint to the barrier so that you're going to have the ability to change the musculoskeletal functioning Another way of doing this is to have the patient use a respiratory force, or cough or somehow have the respiratory force change the functioning and change the motion So when the patient is breathing in or coughing, that's when you're going to engage the barrier and have the tug.

    03:34 Recheck the leg length levels, to make sure you have evened them out and repeat the procedure again if necessary.


    About the Lecture

    The lecture Superior Pubic Shear by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by Region. It contains the following chapters:

    • Superior Pubic Shear
    • Superior Innominate Shear

    Included Quiz Questions

    1. With the patient supine, you internally rotate, abduct and flex the leg of the corresponding side of dysfunction and provide continuous traction on the leg. The patient then pulls the leg away for 3-5 seconds and then relaxes 3-5 seconds. Repeat 2-3x. Passive Stretch. Reassess.
    2. With the patient supine, you externally rotate, adduct and flex the leg of the corresponding side of dysfunction and provide continuous traction on the leg. The patient then pulls the leg away for 3-5 seconds and then relaxes 3-5 seconds. Repeat 2-3x. Passive Stretch. Reassess.
    3. With the patient supine, you internally rotate, abduct and flex the leg of the corresponding side of dysfunction and provide continuous traction on the leg. The patient then pushes the leg away for 3-5 seconds and then relaxes 3-5 seconds. Repeat 2-3x. Passive Stretch. Reassess.
    4. With the patient supine, you externally rotate, adduct and flex the leg of the corresponding side of dysfunction and provide continuous traction on the leg. The patient then pushes the leg away for 3-5 seconds and then relaxes 3-5 seconds. Repeat 2-3x. Passive Stretch. Reassess.

    Author of lecture Superior Pubic Shear

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP


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