REIDER PART 2 28
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Chapter 5_Pelvis, Hip, and Thigh
just posterior to thc trochantcric prominence suggests the possibility of pirifortnis tendinitis.
Posterior Aspect
llium. The PSIS, located at thc posterior terminus of the iliac crest, is the primary landmark for orientation and palpation of the posterior pelvis and hip (Fig. 5-44; sec also Fig. 5-5). Immediately deep, lateral, and inferior to the PSIS, the examiner may begin to palpatc thc sacroil-iac joint (Fig. 5-44B). This usually is palpable as a ridge of bonę that can be followed inferiorly from the PSIS.
Tenderness or swelling of the sacroiliac joint may be caused by injury, infection, or an inflammatory arthritis, such as ankylosing spondylitis.
Sciatic Notch. The sciatic notch lies midway between the PSIS and the ischial tuberosity (Fig. 5-45). This deep landmark is difficult to palpate with certainty, although in thin patients the examiner may appreciate a shallow groove beneath the gluteus maximus at this location.
Hven when the outlines of the sciatic notch cannot be felt, the finding of tenderness at this location suggests the presence of sciatica, a syndrome usually caused by lumbar Figurę 5-45. Palpation of thc sciatic notch.
disk disease. The sciatic nerve may also be palpated midway between the greater trochanter and the ischial tuberosity when the patienTs hip is flexed.
Figurę 5-44. A, Palpation of the posterior superior iliac spine. B, Palpation of thc sacroiliac joint.
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