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PubMedDate not supplied

Sacroiliac joint dysfunction: evaluation and management.

UNLABELLED: Sacroiliac joint dysfunction is believed to be a significant source of low back and posterior pelvic pain. METHODS: To assess the clinical presentation, diagnostic testing, and treatment options for sacroiliac joint dysfunction, a systematic literature review was performed using MEDLINE. RESULTS: Presently, there are no widely accepted guidelines in the literature for the diagnosis and treatment of sacroiliac instability. Establishing management guidelines for this disorder has been complicated by the large spectrum of different etiologic factors, the variability of patient history and clinical symptoms, limited availability of objective testing, and incomplete understanding of the biomechanics of the sacroiliac joint. CONCLUSIONS: A reliable examination technique to identify the sacroiliac joint as a source of low back pain seems to be pain relief following a radiologically guided injection of a local anaesthetic into the sacroiliac joint. Most patients respond to non-operative treatment. Patients who do not respond to non-operative treatment should be considered for operative sacroiliac joint stabilization.

Humans↗
PubMed2002

Disorders of the sacroiliac joint.

Controversies have surrounded the sacroiliac joint. The sacroiliac joint (SIJ) is a considerably complex and strong joint with limited mobility, mechanically serving as a force transducer and a shock absorber. Anatomical changes are seen in the SIJ throughout an individual's lifetime. The ligamentous system associated with the SIJ serves to enhance stability and offer proprioceptive feedback in context with the rich plexus of articular receptors. Stability in the SIJ is related to form and force closure. Movement in the SIJ is 3-D about an axis outside of the joint. The functional examination of the SIJ is related to a clinical triad.

Journal Article↗
PubMed1983

Post-surgical sacroiliac joint syndrome.

The sacroiliac joint can give rise to a syndrome of buttock and leg pain which is often difficult to differentiate from other causes of low--back pain. In some cases the syndrome may go unrecognized and may be a contributing factor in failed low-back surgery. The syndrome often occurs in the presence of lumbar spine disorders and may continue to cause pain after successful conservative or surgical treatment to the lumbar spine. The purpose of this paper is to review the anatomy, biomechanics, pathology, diagnosis and treatment of sacroiliac syndrome. Three case studies are presented to illustrate some of the main features of the syndrome, particularly in patients that have undergone previous spinal surgery.

Back Pain↗
PubMedDate not supplied

Physical characteristics of the axial interosseous ligament of the human sacroiliac joint.

BACKGROUND CONTEXT: Although the sacroiliac joint has occupied a place in medical literature since at least the eighteenth century, its role in normal function and dysfunction of the back and hip remains controversial. The controversy persists, because there is still no suitable method to study the role of stability and mobility at the sacroiliac joints in vivo. One cost-effective approach to understanding such complex, deeply placed structures is biomechanical modeling. Unfortunately, very few data on the mechanical properties of tissues in this region are currently available to modelers. PURPOSE: The objective of this preliminary project was to determine some mechanical properties of the axial interosseous ligament (AIL), and to investigate the histology of the ligament. STUDY DESIGN/SETTING: A modified split plot design was used in conjunction with descriptive statistics to identify AIL characteristics. PATIENT SAMPLE: This was a cadaveric study. OUTCOME MEASURES: The study used descriptive statistics to categorize the ultimate failure strength of the AIL, and to describe the macro-constituents of the ligament. METHODS: Eighteen sacroiliac joints were harvested from nine fresh female cadavers (age range, 54 to 92). Data from 10 joints submitted to mechanical testing are reported. The eight remaining joints were used for histologic analysis of the AIL by light microscopy. RESULTS: The AIL proved to be relatively weak, with a mean failure load of 381 N (SD 43.7N) and a peak stress of 1.73 MPa (SD 0.99 MPa). Histologically, the AIL contained significantly less collagen than most other "typical" ligaments. CONCLUSIONS: The AIL failure loads are just slightly higher than those for the ligamentum flavum in the spine, a tissue composed mainly of elastic fibers. In contrast, the AIL has negligible elastin content. Because the AIL represents about 14% of the total area of interosseous sacroiliac ligaments, its mechanical properties should be useful to modelers of the joint. In addition, it appears that injury to the AIL would do little to compromise the mechanical integrity of the sacroiliac joint. Further study of this ligament seems warranted.

Aged↗
PubMed1978

Applications and limitations of quantitative sacroiliac joint scintigraphy.

Evaluation of sacroiliac joint pathology by quantitative analysis of radionuclide bone scanning has been advocated as a useful technique. We have examined this technique in 61 patients and controls. The procedure was useful in detecting early sacroiliitis but was of limited value in patients with advanced sacroiliac joint findings radiographically. False positive values were found in patients with metabolic bone disease or structural abnormalities in the low back. Normative data must be determined for each laboratory.

Adolescent↗
PubMed1984

Elevated sacroiliac joint uptake ratios in systemic lupus erythematosus.

Sacroiliac joint radiographs and radionuclide sacroiliac joint uptake ratios were obtained on 14 patients with active systemic lupus erythematosus. Elevated joint ratios were found unilaterally in two patients and bilaterally in seven patients when their lupus was active. In patients whose disease became quiescent, the uptake ratios returned to normal. Two patients had persistently elevated ratios with continued clinical and laboratory evidence of active lupus. Mild sacroiliac joint sclerosis and erosions were detected on pelvic radiographs in these same two patients. There was no association between low back pain or HLA-B27 positivity and the radiographic or scintigraphic abnormalities. Elevated quantitative sacroiliac joint uptake ratios may occur as a manifestation of active systemic lupus erythematosus.

Adult↗
PubMed1996

Operative stabilization of fracture dislocations of the sacroiliac joint.

Posterior fracture dislocations of the sacroiliac joint (crescent fracture) represent a subset of lateral compression pelvic fractures. The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the inferior 1/2 of the sacroiliac joint. The posterior superior iliac spine remains firmly attached to the sacrum by the strong posterior ligaments. As a result of this combination of bony and soft tissue injury, the hemipelvis is rotationally unstable, but because the sacrospinous and sacrotuberous ligaments remain intact the involved hemipelvis is stable to vertically applied forces. Operative stabilization is necessary to restore articular congruity of the sacroiliac joint, pelvic stability, and to allow early mobilization of the patient. Stabilization of the pelvis may be achieved through either an anterior or a posterior approach with or without transarticular fixation. A posterolateral approach to the crescent fracture and a method of stabilization using extraarticular fixation, intertable lag screws and outer table antiglide plates are described. The results of using this technique in 22 patients are reviewed.

Fracture Fixation, Internal↗
PubMed2006

Sacroiliac joint tuberculosis.

Infections of the sacroiliac joint are uncommon and the diagnosis is usually delayed. In a retrospective study, 17 patients who had been treated for tuberculosis sacroiliitis between 1994 and 2004 were reviewed. Two patients were excluded due to a short follow-up (less than 2 years). Low back pain and difficulty in walking were the most common presenting features. Two patients presented with a buttock abscess and spondylitis of the lumbar spine was noted in two patients. The Gaenslen's and FABER (flexion, abduction and external rotation) tests were positive in all patients. Radiological changes included loss of cortical margins with erosion of the joints. An open biopsy and curettage was performed in all patients; histology revealed chronic infection and acid-fast bacilli were isolated in nine patients. Antituberculous (TB) medication was administered for 18 months and the follow-up ranged from 3 to 10 years (mean: 5 years). The sacroiliac joint fused spontaneously within 2 years. Although all patients had mild discomfort in the lower back following treatment they had no difficulty in walking. Sacroiliac joint infection must be included in the differential diagnosis of lower back pain and meticulous history and clinical evaluation of the joint are essential.

Adolescent↗
PubMed1990

[Stress analysis and movement in sacroiliac joints].

Biomechanical experiments were performed on sacroiliac joints of the cadaver pelvis in three different positions to determine changes in stress pattern. The infrared stress analyzing method was used. In the neutral position, principal stress was observed in the middle to upper part of the sacrum, adjacent to the sacroiliac joints, in the central area of the ilium, and in the acetabular region. In the anterior tilting position, the stress on the sacroiliac joints was smaller than in the posterior tilting position, while it was greater in the symphysis pubis area. Further experiments with dial gauges were performed to measure load-displacement value in four cadaver pelves. Vertical loads of up to 100 kg were applied to the fourth lumbar vertebra. At the maximum test loads, displacement of the anterior surface of the first sacral vertebra ranged from 0.18 mm to 0.73 mm in the anterior direction. In conclusion, it is clear that the range of movement in the sacroiliac joints is very small and that this joint plays a significant role in the maintenance of stability in the pelvic girdle.

Adult↗
PubMed2005

[Computer-assisted arthrodesis of the sacroiliac joint].

Arthrodesis of the sacroiliac joint (SI) usually requires a large surgical exposure using the lateral approach. Computer-assisted surgery based on intraoperative 3D fluoroscopy imaging can reduce the approach to stab incisions. The clinical example shows the insertion of two screws and a cylindrical bone graft to achieve an arthrodesis of the SI joint. The intraoperatively navigated placement of implants and bone graft was performed only by stab incisions.

Adult↗
PubMed2001

An electrophysiologic study of mechanoreceptors in the sacroiliac joint and adjacent tissues.

STUDY DESIGN: The somatosensory afferent units in the sacroiliac joint of an animal model were investigated using an electrophysiologic technique. OBJECTIVES: To identify the mechanosensitive receptive fields in the sacroiliac joint, and to determine their distribution and characteristics. SUMMARY OF BACKGROUND DATA: The sacroiliac joint is considered to be a source of lower back pain. Although there have been clinical studies on the diagnosis of sacroiliac joint pain, no satisfactory diagnostic method other than joint blocks has been reported. It still is not clear whether the sacroiliac joints actually transmit pain to the central nervous system. The sensory innervation of the sacroiliac joint has not been fully characterized neurophysiologically. METHODS: Experiments were performed on 10 adult cats weighing 2.6 to 4 kg. The animals were anesthetized with intravenous sodium pentobarbital. An L4-L7 laminectomy was performed. The L4-L6 dorsal roots were cut at their proximal ends, split, and draped over a bipolar recording electrode. Glass probes were used to search the sacroiliac joint and adjacent tissues for mechanosensitive units. When units were identified, they were stimulated electrically to obtain conduction velocities and by Semmes-Weinstein monofilaments to determine mechanical thresholds. RESULTS: In the sacroiliac joint and adjacent muscles, 29 discrete mechanosensitive units were identified. Of these 29 units, 26 were found in the posterior sacroiliac ligament and the remaining 3 in the adjacent muscles. Also, 16 units (55%) were identified in the proximal third of the sacroiliac joint. Conduction velocities of the units ranged from 3.1 to 22 m/second (average, 9.2 m/second), and 26 units were group III. Mechanical thresholds of the units ranged from 4.6 to 164.3 g (average, 69.7 g). Whereas 28 units (96.6%) had thresholds higher than 7 g, one unit (3.4%) had a threshold lower than 7 g. CONCLUSIONS: Group III units with mechanical thresholds higher than 7 g may serve as nociceptors, and units with thresholds of lower than 7 g may serve as proprioceptors. The current study showed that most of the units in the sacroiliac joint were high-threshold group III units that perhaps had a nociceptive function. This result suggests that the sacroiliac joint may be a source of lower back pain in humans. This study also showed that the sacroiliac joint has little proprioceptive function.

Animals↗
PubMed2003

The iliolumbar ligament: its influence on stability of the sacroiliac joint.

STUDY DESIGN: In human specimens the influence of the iliolumbar ligament on sacroiliac joint stability was tested during incremental moments applied to the sacroiliac joints. OBJECTIVES: To assess whether the iliolumbar ligament is able to restrict sacroiliac joint mobility in embalmed cadavers. BACKGROUND: Firstly, the sacroiliac joint can play an important role in non-specific low back pain; hence, its mobility and stability are of special interest. Secondly, the iliolumbar ligament is considered to be an important source of chronic low back pain. Data on a functional relation between the iliolumbar ligament and sacroiliac joint mobility are lacking. METHODS: In 12 human specimens an incremental moment was applied to the sacroiliac joint to induce rotation in the sagittal plane. After the assessment of the relationship between rotation angle and moment in the intact situation, specific parts of the iliolumbar ligaments were transected. After each partial transection the measurements were repeated. RESULTS: Sacroiliac joint mobility in the sagittal plane was significantly increased after a total cut of both iliolumbar ligaments. This increase was in particular due to the transection of a specific part of the iliolumbar ligament, the ventral band. CONCLUSIONS: The main conclusions are: (a) the iliolumbar ligaments restrict sacroiliac joint sagittal mobility; (b) the ventral band of the iliolumbar ligament contributes most to this restriction. RELEVANCE: In embalmed human cadavers, the mobility of the sacroiliac joint increases after sequential cutting of specific parts of the iliolumbar ligaments. It can be expected that severance of this ligament during surgery will lead to increase of mobility and hence loss of stability of the sacroiliac joint. As a consequence adjacent structures will be affected. This may well be a cause of pain in patients with failed back surgery.

Aged↗
PubMed2006

Sacroiliac joint bridging: simple and reliable criteria for sexing the skeleton.

Vital to the study of past populations and an important phase in executing a forensic anthropological examination is the determination of skeleton sex. The aim of this study is to present an easy and reliable criterion for sexing the skeleton. The ilium and sacrum of 2845 skeletons were examined for new bone formation and for bridging/fusion in/across the sacroiliac joint. Sacroiliac joint bridging (SIB) was present in 12.27% of the males and 1.83% of the females. In 97% of the males bridging was extra-articular, whereas in all females bridging was intra-articular. In addition, computed tomograghy images of 81 in vivo individuals were examined for the same phenomenon. SIB was present in 34.2% of the males and 4.6% of the females. Bony spurs present on the ilium for a preliminary partial or full extra-articular bridging of the sacroiliac joint indicate a male skeleton. SIB presents an easy technique for sexing skeletons (especially in elderly individuals where the phenomenon of SIB becomes very common), as no prior knowledge, training, or equipment is required to apply the criterion.

Adolescent↗
PubMed1998

Manipulation does not alter the position of the sacroiliac joint. A roentgen stereophotogrammetric analysis.

STUDY DESIGN: A roentgen stereophotogrammetric analysis study of patients with sacroiliac joint dysfunction. OBJECTIVES: To investigate whether manipulation can influence the position between the ilium and the sacrum, and whether positional tests for the sacroiliac joint are valid. SUMMARY OF BACKGROUND DATA: Sacroiliac joint dysfunction is a subject of controversy. The validity of different sacroiliac joint tests is unknown. Long-standing therapeutic tradition is to manipulate supposed dysfunctions of the sacroiliac joint. Many manual therapists claim that their good clinical results are a consequence of a reduction of subluxation. METHODS: Ten patients with symptoms and sacroiliac joint tests results indicating unilateral sacroiliac joint dysfunction were recruited. Twelve sacroiliac joint tests were chosen. The results of most of these tests were required to be positive before manipulation and normalized after manipulation. Roentgen stereophotogrammetric analysis was performed with the patient in the standing position, before and after treatment. RESULTS: In none of the 10 patients did manipulation alter the position of the sacrum in relation to the ilium, defined by roentgen stereophotogrammetric analysis. Positional test results changed from positive before manipulation to normal after. CONCLUSIONS: Manipulation of the sacroiliac joint normalized different types of clinical test results but was not accompanied by altered position of the sacroiliac joint, according to roentgen stereophotogrammetric analysis. Therefore, the positional test results were not valid. However, the current results neither disprove nor prove possible beneficial clinical effects achieved by manipulation of the sacroiliac joint. Because the supposed positive effects are not a result of a reduction of subluxation, further studies of the effects of manipulation should focus on the soft tissue response.

Adult↗