Sacral Q-bank
COMLEX Style Sacrum Questions recommended by Dr. Burns.
- 1.
A 20-year old male presents with low back pain following a fall onto a concrete floor. The patient gives a history of episodic aching of the lumbar region prior to the fall. Examination of the patient in the prone position reveals a deep sulcus on the left, a posterior/inferior ILA on the right when compared to the opposite side, and a lumbosacral junction that springs freely upon compression. The most likely diagnosis is?
- A.
A forward sacral torsion on a right oblique axis
- B.
A forward sacral torsion on a left oblique axis
- C.
A backward sacral torsion on a left oblique axis
- D.
A left unilateral sacral flexion
- E.
Bilateral sacral extension
Correct Answer
A. A forward sacral torsion on a right oblique axisExplanation
In a patient with a deep left sulcus and a negative lumbosacral spring test, the left portion of the sacrum has moved anterior. Since the above patient has posterior/inferior ILA on the right this indicates that this portion of the sacrum has moved posteriorly. A forward sacral torsion on a right oblique axis (i.e. a right rotation on a right oblique axis) is the only answer that would be consistent with the above findings.Rate this question:
-
- 2.
A mildly obese patient comes to your office complaining of buttock pain. She fell on her buttocks about one week ago and she still has some residual pain. Inspection of her lumbar spine and gluteal region reveals a decreased lumbar lordosis. Standing flexion test and seated flexion test show no evidence of asymmetry. Sacral sulci are equal in depth. The lumbosacral junction does not spring. Based on the information given, what is the most likely diagnosis?
- A.
Bilateral sacral extension
- B.
Forward sacral torsion on a left oblique axis
- C.
Anterior sacral base
- D.
Unilateral extended sacrum on the right
- E.
Unilateral extended sacrum on the left
Correct Answer
A. Bilateral sacral extensionExplanation
The above patient has a bilateral sacral extension (a.ka. sacral base posterior or a posterior sacral base). The seated flexion test will be FALSELY negative-Why? Since both SI joints are restricted, asymmetry will bot be appreciated.Rate this question:
-
- 3.
In a patient with acute onset of low back pain, structural examination reveals a positive seated flexion test on the right. The left sacral base is anterior when compared to the right. The spring test is positive. Given the above information what is the most likely sacral diagnosis?
- A.
Left sacral rotation on a right oblique axis
- B.
Right sacral rotation on a right oblique axis
- C.
Right sacral rotation on a left oblique axis
- D.
Right unilateral sacral flexion
- E.
Extended sacral base
Correct Answer
C. Right sacral rotation on a left oblique axisExplanation
In sacral torsion (or sacral rotation on an oblique axis) the seated flexion test is positive on the opposite side of the axis. In this case, the right positive seated flexion test indicates a left oblique axis. A positive spring test (aka lumbosacral spring test) indicates that part of the sacral base has moved posterior. Since the left sacral base is anterior (i.e. the left sulcus is deep), then this must indicate that the right sacral base has moved posterior.Rate this question:
-
- 4.
A patient has sacral torsion that resulted in a right anterior sacral base and a negative lumbosacral spring test. Based on the information given, what is the expected somatic dysfunction at L5?
- A.
L5 N SLRR
- B.
L5 N SRRL
- C.
L5 E RRSL
- D.
L5 F RLSL
- E.
L5 F RRSL
Correct Answer
A. L5 N SLRRExplanation
If a sacral torsion is present, a right sacral base anterior (a deep right sulcus) and a negative lumbosacral spring test indicate a left on left torsion. Using the rules of L5 on the sacrum and Fryette's principles one can figure out the dysfunction of L5. When L5 is rotated, the sacrum rotates in the opposite direction. Sacrum rotated left, L5 must be rotated right. When L5 is sidebent, a sacral oblique axis is engaged on the same side as the sidebending. Sacrum has a left oblique axis, L5 must be sidebent left.Rate this question:
-
- 5.
A 46-year old male presents to your office complaining of chronic lumbo-sacral pain. There is a negative standing flexion test and a positive seated flexion test. Structural examination reveals a deep sacral sulcus on the left, posterior/inferior ILA on the right, and the lumbosacral junction springs freely upon compression. The most likely diagnosis is:
- A.
Right sacral rotation on a right oblique axis
- B.
Left sacral rotation on a left oblique axis
- C.
Right sacral shear
- D.
Right sacral rotation on a left oblique axis
- E.
Left sacral rotation on a right oblique axis
Correct Answer
A. Right sacral rotation on a right oblique axis -
- 6.
A patient is diagnosed with a right anterior innominate rotation. About which sacral axis does this rotation occur?
- A.
Inferior transverse
- B.
Oblique
- C.
Middle transverse
- D.
Sagittal
- E.
Superior transverse
Correct Answer
A. Inferior transverse -
- 7.
A female patient complains of progressively worsening low back pain. The pain is located at the lumbosacral junction. Two days ago, she vaginally delivered a 9lbs. 2 oz baby boy. On examination the seated flexion test is negative. The most likely diagnosis is:
- A.
Left on left sacral torsion
- B.
Bilateral sacral flexion
- C.
Right innominate anterior
- D.
Bilateral sacral extension
- E.
Right inferior pubic shear
Correct Answer
B. Bilateral sacral flexionExplanation
A bilateral sacral flexion occurs during the delivery phase of childbirth when the sacrum nutates (sacral base moves anteriorly) to allow more space for the fetus to pass through the pelvic outlet into the birth canal.Rate this question:
-
- 8.
A 33 year old patient with new onset left-sided low back pain comes into your office. Pain stems from the low back and radiates to the left knee. Structural examination reveals the following: A tenderpoint located at the right transverse process of L5 L5 neutral, rotated right and sidebent left Positive seated and standing flexion test on the right Deep right sacral sulcus, Left inferior lateral angle is posterior and inferior Springing at the lumbosacral junction is present PSIS on the right is caudad compared to the left PSIS with the patient in the prone position Apparent shorter leg on the right What is the most likely innominate diagnosis?
- A.
Right innominate anterior
- B.
Right innominate posterior
- C.
Right superior innominate subluxation
- D.
Right inferior innominate subluxation
- E.
There is not enough information in the question to differentiate from the above
Correct Answer
B. Right innominate posteriorExplanation
In a right posterior innominate the standing flexion test is positive on the right, the right ASIS is cephalad, the right PSIS is caudad and there is a relative short leg on the right.Rate this question:
-
- 9.
What is accepted muscle energy treatment patient position for a left sacral torsion diagnosis?
- A.
Right lateral Sims position
- B.
Right lateral recumbent with torso turned left
- C.
Left lateral Sims position
- D.
Left lateral recumbent with the torso turned right
- E.
Patient prone with right lower extremity slightly abducted
Correct Answer
C. Left lateral Sims positionExplanation
In this position, the patient is lying in the left lateral recumbent position and the torso is turned to the left so the patient is lying face down.Rate this question:
-
- 10.
A 34-year-old female enters your office complaining of hip pain following a fall off a stepladder 4 days earlier. X-rays taken in the emergency department revealed no fracture, and the patient has been very uncomfortable since the fall. The pain is localized on the left and does not radiate down the thigh. The left ASIS is cephalad, the left PSIS is caudad and the pubes are level. While performing a standing flexion test, you note that the left PSIS demonstrated greater excursion than the right. Which additional palpatory finding is most likely to be present in this patient?
- A.
Resistance to posterior compression of the right ASIS
- B.
Backward sacral torsion on a left axis
- C.
Longer leg on the right
- D.
L5 neutral sidebent left, rotated right
- E.
Exquisite pain upon palpation of the pubic symphysis
Correct Answer
C. Longer leg on the rightExplanation
The patient is left innominate posterior. A shorter leg on the ipsilateral side will be present in this dysfunction (left leg). Consequently, the contralateral leg will appear longer (right leg).Rate this question:
-
- 11.
Which of the following soft tissue dysfunctions is the most likely cause of a left innominate posterior dysfunction?
- A.
Tight quadriceps
- B.
Tight hip adductors
- C.
Tight hip abductors
- D.
Tight hamstrings
- E.
Tight piriformis
Correct Answer
D. Tight hamstringsExplanation
The hamstrings attach to the ischial tuberosity and contraction can cause the innominate to rotate posteriorly.Rate this question:
-
- 12.
Which of the following is the best statement regarding typical muscle energy treatment for a left innominate posterior dysfunction?
- A.
Hip flexors are isometrically contracted to provide the necessary force to correct this dysfunction
- B.
The patient is best treated in a seated position
- C.
The patient is treated with her hip flexed and slightly abducted
- D.
Hamstrings are activated by the patient to correct the dysfunction
- E.
Muscle energy treatment is relatively contraindicated in the above patient
Correct Answer
A. Hip flexors are isometrically contracted to provide the necessary force to correct this dysfunctionExplanation
Hip flexors are used to correct the dysfunction. With the patient supine, drop the left leg off the table to engage the restrictive barrier. Instruct the patient to flex their hip against your counterforce for 3-5 seconds.Rate this question:
-
- 13.
If a right-sided psoas syndrome is suspected in a patient with a left innominate posterior dysfunction, which lumbar dysfunction is likely to be present?
- A.
L1 Neutral, sidebent left and rotated right
- B.
L2 Extended, sidebent left and rotated left
- C.
L1 Flexed, sidebent right and rotated right
- D.
L2 Flexed, sidebent left and rotated left
- E.
L4 Neutral, sidebent right and rotated left
Correct Answer
C. L1 Flexed, sidebent right and rotated rightExplanation
In a psoas syndrome, a high lumbar dysfunction is likely to be present. Specifically, the lumbar dysfunction will be flexed, sidebent, and rotated to the side of the tight psoas. In this case, L1 would be flexed, rotated right, and sidebent right.Rate this question:
-
- 14.
Which of the following is associated with a right on left sacral torsion?
- A.
A non-neutral dysfunction of L5 that is rotated left and sidebent left; and a positive seated flexion test on the right
- B.
A non-neutral dysfunction of L5 that is rotated right and sidebent right; and a positive seated flexion test on the left
- C.
A neutral dysfunction of L5 that is rotated right and sidebent left, and a positive seated flexion test on right
- D.
A neutral dysfunction of L5 that is rotated left and sidebent right; and a positive seated flexion test on the left
- E.
A flexed dysfunction of L5 that is rotated right and sidebent right, and a positive seated flexion test on the right
Correct Answer
A. A non-neutral dysfunction of L5 that is rotated left and sidebent left; and a positive seated flexion test on the rightExplanation
A right on left sacral torsion would have an L5 that is non-neutral (meaning either flexed or extended), rotated left, sidebent left with a seated flexion test positive on the right (opposite the axis of the torsion)Rate this question:
-
- 15.
Which sacral region in a right on left sacral torsion will spring freely?
- A.
Left superior sulcus
- B.
Right superior sulcus
- C.
Left inferior lateral angle
- D.
Right inferior lateral angle
- E.
Sacral base
Correct Answer
C. Left inferior lateral angleExplanation
Springing is present over the part of the sacrum that has freedom of motion anteriorly. The left inferior lateral angle moves anterior (as the right sacral base moves posterior) and thus will spring freely in a right on left sacral torsion.Rate this question:
-
Quiz Review Timeline +
Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
-
Current Version
-
Mar 22, 2022Quiz Edited by
ProProfs Editorial Team -
Jan 21, 2011Quiz Created by
Babydoctor
Back to top