[Operative treatment of sacroiliac joint tuberculosis].
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Disease↗
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[Surgical treatment of tuberculosis of the sacroiliac joint].
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Disease↗
[Echinococcosis of the sacroiliac joint].
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Disease↗
Quantitative sacroiliac joint scintigraphy. A critical assessment.
With quantitative sacroiliac joint scintigraphy (QSS), sacroiliac joint-to-sacrum (SIS) ratios greater than or equal to 1.40 are abnormal for our method. High SIS ratios are associated with roentgenographically appreciated sacroiliitis and with early clinically evident sacroiliitis. Although highly sensitive, QSS abnormalities are not specific for inflammatory sacroiliac (SI) joint disease. High SIS ratios are also seen in rheumatoid arthritis, degenerative abnormalities of the lumbosacral spine, and metabolic bone disorder. Other disorders with roentgenographic SI joint abnormalities must be studied scintigraphically before QSS can be employed as a useful diagnostic test.
Humans↗
Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment.
The sacroiliac joint is an underappreciated cause of low back and buttock pain. It is thought to cause at least 15% of low back pain. It is more common in the presence of trauma, pregnancy, or in certain athletes. The pelvic anatomy is complex, with the joint space being variable and irregular. The joint transmits vertical forces from the spine to the lower extremities and has a role in lumbopelvic dynamic motion. History and physical examination findings can be helpful in screening for sacroiliac joint pain, but individual provocative maneuvers have unproven validity. Fluoroscopically guided injections into the joint have been found to be helpful for diagnostic and therapeutic purposes. Conservative treatment, which also can include joint mobilization, antiinflammatory medicines, and sacroiliac joint belts, generally is effective. Surgical arthrodesis should be considered a procedure of last resort.
Adrenal Cortex Hormones↗
[Comparison among the surgical approaches to tuberculosis of sacroiliac joint].
Forty-three cases (44 joints) with tuberculosis of sacroiliac joints were treated surgically through 3 approaches: (1) Anterior approach was indicated for the cases with abscess in iliac fossa or with fistula in buttock, in 21 cases (22 joints). (2) Posterior approach was used for the cases with or without abscess and/or fistula of buttock, in 20 cases. (3) Antero-posterior combined approach was adopted for the cases with large abscess and/or fistula both at iliac fossa and buttock, in 2 cases (2 joints). Follow-up, ranging between 6 months and 16 years, presented no recurrent case of tuberculosis. In the cases with bony fusion, the symptoms disappeared altogether postoperatively, while the local pain still remained in the cases without bone grafting. The authors' opinions are as following: In the treatment of tuberculosis of sacroiliac joint, surgical approach should be chosen according to the location and size of abscess and the direction of fistula. Bony fusion is significant for elimination of symptoms.
Abscess↗
Diagnostic value of quantitative sacroiliac joint scintigraphy in brucellosis
Increased bone activity in the sacroiliac joints has been shown to be a sensitive method for detecting sacroiliitis in brucellosis. Because symmetrically increased uptake usually is difficult to detect, this study was performed to improve the sensitivity by quantifying sacroiliac joint uptake. Quantification was accomplished by normalizing sacroiliac joint activity to activity in the lumbar spine and sacrum. From rectangular regions of interest over a standardized posterior pelvic view, the ratios of the sacroiliac:lumbar spine and sacroiliac:sacrum were calculated. Abnormal sacroiliac joint uptake was defined as uptake greater than the mean +2 SD of normal. This was applied to 79 patients with brucella sacroiliitis. The quantitative approach was compared with visual interpretation. Of the 16 patients in the age group of 5 to 19 years, 7 patients had visual evidence of sacroiliitis and 9 patients had positive evidence by sacroiliac-sacrum and 12 by sacroiliac-lumbar spine quantification. Of 21 patients who were 20 to 30 years old, 10 patients had positive visual evidence, whereas 17 and 20 patients had positive evidence of sacroiliitis by sacroiliac-sacrum and sacroiliac-lumbar spine, respectively. Of 42 patients who were 31 to 85 years old, 24, 32, and 36 patients had positive evidence of sacroiliitis by visual inspection, sacroiliac-sacrum, and sacroiliac-lumbar spine, respectively. Thus, the quantitative approach increased the sensitivity in diagnosing Brucella sacroiliitis in all age groups by 31.3%, 47.6%, and 28.6%, respectively, for sacroiliac-lumbar spine and by 12.5%, 33.3%, and 19%, respectively, for sacroiliac-sacrum.
Journal Article↗
Histologic analysis of neural elements in the human sacroiliac joint.
STUDY DESIGN: The posterior ligament of the human sacroiliac joint was examined for nerves and nerve endings using histologic and immunohistochemical techniques. OBJECTIVE: To identify nerve fibers and mechanoreceptors in the posterior ligament. SUMMARY OF BACKGROUND DATA: According to the findings of previous studies, the human sacroiliac joint receives myelinated and unmyelinated axons that presumably conduct pain and proprioceptive impulses derived from mechanoreceptors and free nerve endings in the human sacroiliac joint. METHODS: Tissue obtained from six patients was stained with gold chloride and that obtained from six additional patients was stained using antibodies specific for substance P and protein gene product 9.5. RESULTS: The staining of joint tissue using the gold chloride technique showed myelinated and unmyelinated nerve fibers, two morphotypes of paciniform encapsulated mechanoreceptors, and a single nonpaciniform mechanoreceptor. Analysis using immunohistochemical staining for protein gene product 9.5 did not unequivocally show axons, nerve fascicles, or mechanoreceptors. Similarly, analysis based on immunohistochemical staining for substance P, one of several neurotransmitters known to signal pain from the periphery, showed reactive elements that may have been nerves, but because of background staining, could not be positively identified as such. CONCLUSIONS: The presence of nerve fibers and mechanoreceptors in the sacroiliac ligament demonstrates that the central nervous system receives information, certainly proprioceptive, and possibly pain from the sacroiliac joint. Although it is not known how the central nervous system uses such information, it seems reasonable to speculate that the proprioceptive information is used to optimize upper body balance at this joint. In addition, because the staining techniques used generally to show nerves and nerve elements in periarticular connective tissue are nonspecific, the distinction between neural and nonneural should be made on the basis of both morphologic and staining characteristics.
Adult↗
Osteomyelitis and pyogenic infection of the sacroiliac joint. MRI findings and review.
Acute pyogenic sacroiliac joint infection and osteomyelitis of adjacent bones often present with severe, poorly localized lower back, pelvic or hip pain. Five cases of sacroiliac joint infection or sacroiliac bone osteomyelitis were evaluated by MRI. MRI may be a helpful diagnostic tool to evaluate early changes of infection in the sacroiliac area. It is very sensitive for detecting bone marrow abnormalities; however, it is non-specific and can not accurately differentiate osteomyelitis from sacroiliitis.
Arthritis, Infectious↗
Inflammatory sacroiliac joint pathology: evaluation of radiologic assessment techniques.
Recognition of sacroiliac disease has been integral to arthritis diagnostic approaches. However, intra- and inter-observer variation have been recognized as limiting factors in radiologic assessment of the sacroiliac joint. The assumption that such irregularly shaped joints can be radiologically assessed of the sacroiliac joint. The assumption that such irregularly shaped joints can be radiologically assessed has not actually been rigorously evaluated. Direct arthroscopic visualization of the joints was therefore used as a standard against which to assess the validity of routine radiologic views, stereo-radiology, tomography and computed tomography, in the analysis of a group of sacroiliac joints drawn from the Todd Collection (Cleveland Museum of Natural History). The most sensitive techniques for the recognition of erosions or fusion are 15 degree angulation and stereo, but the frequency of false positives makes the technique of questionable clinical utility. While sensitivity for joint space narrowing is high with several techniques (30 degree anterior-posterior or posterior-anterior projections and tomograms), specificity is still poor, with a high rate of false positives. Fulfillment of the New York Criteria for sacroiliac disease is especially insensitive and non-specific. Radiologic techniques therefore have major limitations for the assessment of sacroiliac disease and greater reliance on clinical acumen is required for patient categorization.
False Positive Reactions↗
The prognostic value of asymmetric laxity of the sacroiliac joints in pregnancy-related pelvic pain.
STUDY DESIGN: Prospective cohort study. OBJECTIVE: To determine the prognostic value of asymmetric laxity of the sacroiliac joints during pregnancy on pregnancy-related pelvic pain postpartum. SUMMARY OF BACKGROUND DATA: In a previous study, we observed a significant relation between asymmetric laxity of the sacroiliac joints and moderate to severe pregnancy-related pelvic pain during pregnancy. METHODS: A group of 123 women were prospectively questioned and examined, and sacroiliac joint laxity was measured by means of Doppler imaging of vibrations at 36 weeks' gestation and at 8 weeks' postpartum. A left to right difference in sacroiliac joint laxity >or=3 threshold units was considered to indicate asymmetric laxity of the sacroiliac joints. RESULTS: In subjects with moderate to severe pregnancy-related pelvic pain during pregnancy, sacroiliac joint asymmetric laxity was predictive of moderate to severe pregnancy-related pelvic pain persisting into the postpartum period in 77% of the subjects. The sensitivity, specificity, and positive predictive value of sacroiliac joint asymmetric laxity during pregnancy for pregnancy-related pelvic pain persisting postpartum were 65%, 83%, and 77%, respectively. Subjects with moderate to severe pregnancy-related pelvic pain and asymmetric laxity of the sacroiliac joints during pregnancy have a threefold higher risk of moderate to severe pregnancy-related pelvic pain postpartum than subjects with symmetric laxity. CONCLUSION: These data indicate that in women with moderate to severe complaints of pelvic pain during pregnancy, sacroiliac joint asymmetric laxity measured during pregnancy is predictive of the persistence of moderate to severe pregnancy-related pelvic pain into the postpartum period.
Adult↗
Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain.
STUDY DESIGN: A cross-sectional study was used to determine whether limited range of motion in the hip was present in 100 patients--one group with unspecified low back pain and another group with signs suggesting sacroiliac joint dysfunction. OBJECTIVES: To determine whether a characteristic pattern of range of motion in the hip is related to low back pain in patients and to determine whether such a pattern is associated with and without signs of sacroiliac joint dysfunction. SUMMARY OF BACKGROUND DATA: The sacroiliac joint is often considered a potential site of low back pain. Problems with the sacroiliac joint, as well as with the low back, have often been related to reduced or asymmetric range of motion in the hip. The correlation between sacroiliac joint dysfunction and hip range of motion, however, has not been thoroughly evaluated with reliable tests in a population of patients with low back pain. METHODS: Passive hip internal and external rotation goniometric measurements were taken by a blinded examiner, while a separate examiner evaluated the patient for signs of sacroiliac joint dysfunction. Patients with sacroiliac joint dysfunction were further classified as having a left or a right posteriorly tilted innominate. RESULTS: The patients with low back pain but without evidence of sacroiliac joint dysfunction had significantly greater external hip rotation than internal rotation bilaterally, whereas those with evidence of sacroiliac joint dysfunction had significantly more external hip rotation than internal rotation unilaterally, specifically on the side of the posterior innominate. CONCLUSIONS: Clinicians should consider evaluating for unilateral asymmetry in range of motion in the hip in patients with low back pain. The presence of such asymmetry in patients with low back pain may help identify those with sacroiliac joint dysfunction.
Adolescent↗
Failure load and displacement of the human sacroiliac joint under in vitro loading.
The stability of the sacroiliac joint was studied using an in vitro loading system. Forty-nine sacroiliac joints taken from fresh cadavers were examined. The ligamentous structures of the joint disrupted at 3368 +/- 923 N under transverse loading. Higher disruption forces were observed under ventrocranial (4933 +/- 1038 N) and dorsocranial (5150 +/- 947 N) loading. At joint failure the displacement in loading direction ranged from 5.5 +/- 2.3 mm in the transverse to 6.6 +/- 2.3 mm in the dorsocranial direction. In some experiments the interlocking effect between the articular surfaces of the sacrum and ilium were examined. The best interlocking capacity was observed under dorsocranial loading. This capacity is much higher than the friction in other human joints. The study shows that correct anatomical reconstruction without displacement increases the stability of the disrupted sacroiliac joint.
Adult↗
Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain.
STUDY DESIGN: This prospective study consisted of the evaluation of a double sacroiliac block in patients with low back pain. OBJECTIVES: To determine the prevalence of sacroiliac pain in a selected population of patients suffering from low back pain, and to assess certain pain provocation tests. SUMMARY OF BACKGROUND DATA: Previous studies have implicated the sacroliac joint as a potential etiology of back and leg pain, but none has tested double anesthetic blocks in a prospective fashion. METHODS: Fifty-four patients with unilateral low back pain, pain mapping compatible with a sacroiliac origin, tenderness over the sacroiliac joint, and no obvious source of pain in the lumbar spine were selected for a double anesthetic block. The procedure consisted of a through clinical examination with a visual analog scale, testing of sacroiliac pain provocation tests followed by a first screening block with a short-acting anesthetic. A second examination consisting of the same tests assessed the efficacy of the first block. If results were positive, a confirmatory block was performed. All blocks were performed under fluoroscopic guidance. RESULTS: Nineteen patients had a positive response to the first block. Among them, 10 (18.5%) were temporarily relieved by the confirmatory block. No pain provocation test reached statistical significance. CONCLUSION: The present study suggests the sacroiliac joint is an uncommon but real source of low back pain. The accuracy of some of the presumed "sacroiliac pain provocations tests" is questioned.
Adult↗
Viscosupplementation: a new concept in the treatment of sacroiliac joint syndrome: a preliminary report of four cases.
BACKGROUND AND OBJECTIVES: We describe a new therapeutic modality for sacroiliac joint syndrome that represents an alternative to other treatment modalities. We report on four cases of sacroiliac joint syndrome with severe pain. METHODS: Three patients had undergone operative treatment of the lumbar spine and one patient suffered from severe osteoarthritis of the spine. All patients were diagnosed with sacroiliac joint syndrome by means of patient history, physical examination, and intra-articular local anesthetic injection preceded by sacroiliac arthrogram. All patients received three injections of Hylan GF 20 in the sacroiliac joints 2 weeks apart. RESULTS: Twelve to 16 weeks after the injections, the pain was reported to be 40-67% better when measured on the visual analog scale. The duration of the beneficial effect of Hylan on arthralgia and joint function was undetermined. CONCLUSIONS: Viscosupplementation of the sacroiliac joint induced a significant degree of analgesia in all four patients. This treatment modality could represent an option in the management of sacroiliac joint pain and dysfunction.
Adult↗
Low back pain, the stiffness of the sacroiliac joint: a new method using ultrasound.
Abnormal biomechanical properties of the sacroiliac joints are believed to be related to low back and pelvic pain. Presently, physiotherapists judge the condition of the sacroiliac joints by function and provocation tests, and palpation. No objective measuring device is available. Research is ongoing to identify the biomechanical properties of the sacroiliac joints from the dynamic behaviour of the pelvic bones. A new concept based on ultrasound (US) for the measurement of bone vibration is under investigation. The objective of this study was to validate this concept on a physical model and to assess the applicability in vivo. A model consisting of a piezo shaker covered by a layer of US transmission gel (representing bone and soft tissue) has been used. A packet of US detection signals is directed onto the shaker and correlation-based processing is used to estimate the difference in time-of-flight of their echoes. These variations of time are used to compute the displacement of the shaker at each pulse reflection. To assess the validity of our US technique, we compared the obtained measurements with the readings of the built-in strain gauge sensor. The experimental procedure has been tested on a volunteer where low-frequency excitation was provided through the ilium and vibration detected on the sacrum and ilia. The results demonstrated that the correlation-based approach is capable of reproducing the piezo shaker displacements with high accuracy (+/- 7%). Vibration amplitudes from 0.25 microm to 3 microm could be measured. The US technique was able to detect bone vibration in vivo. In conclusion, the principle based on US waves can be used to develop a new measurement tool, instrumental in studying the relation between the biomechanical properties of the sacroiliac joints and low back pain.
Biomechanical Phenomena↗
Sacroiliac joint diagnostics in the Hamburg Construction Workers Study.
BACKGROUND: In the medical literature, test procedures for sacroiliac joint diagnostics are viewed as controversial. The provocation tests are based on provoked sacroiliac pain, whereas the palpation tests examine the motion of the sacroiliac joint or describe the condition indirectly if limitation of the sacroiliac function is present. It must be presumed that the use of different test results in the detection of varying functional phenomena of a sacroiliac dysfunction or, alternatively, that identical effects of a dysfunction are evaluated in differing ways. OBJECTIVE: This article presents results with regard to the consistency of tests for sacroiliac joint dysfunctions carried out on participants from the building trade. DESIGN AND PARTICIPANTS: The consistency of the tests (standing flexion test, spine test, iliac compression test, iliac springing test) used in a cross-section investigation of a cohort of 480 male construction workers is presented. To evaluate the degree of consistency of the test procedure the percentage agreement and the kappa value, including a confidence interval of 95%, are given. RESULTS: The consistency between the iliac compression test and the three sacroiliac palpation tests could not be shown to be statistically significant. The consistency between the three palpation tests was moderate to good and the percentage agreement was acceptable (87.4%, 88.6%, 80.9%). CONCLUSIONS: It may be assumed that the palpation tests characterize the same dysfunction of the sacroiliac joint. Standing flexion test, spine test, and iliac springing test seem to be valuable tools for sacroiliac joint diagnostics.
Adult↗
Neuroaugmentation in the management of sacroiliac joint pain. Report of two cases.
STUDY DESIGN: A report of two cases of severe sacroiliac pain that were resistant to conventional management techniques. Both patients had undergone lumbar fusion. This appeared to be a predisposing factor. OBJECTIVE: To define the source of pain in these patients by performing a series of diagnostic blocks under fluoroscopic guidance to determine if these patients were candidates for neuroaugmentation. SUMMARY OF BACKGROUND DATA: Mild to moderate sacroiliac joint pain can be managed conservatively with analgesics, anti-inflammatory drugs, and physical therapy. Severe sacroiliac joint pain can be incapacitating and more challenging to manage. Fluoroscopically guided intra-articular local anesthetic-steroid injections, followed by joint manipulation, can be effective, intracapsular injections of glycerin, glucose, and phenol also may be beneficial in some patients. The use of neuroaugmentation to manage pain of synovial origin has not been reported previously. Sacral nerve root stimulation in particular has been used to manage urinary bladder dysfunction and pain, but not sacroiliac joint pain. METHODS: Two patients with severe sacroiliac joint pain were treated by implanting a neuroprosthesis at the third sacral nerve roots. The patients had undergone lumbar fusion for back pain that developed as a result of work-related injuries. Stimulation was tried for 1 week with bilateral, percutaneously implanted, cardiac pacing wires at the third sacral nerve roots. RESULTS: Both patients experienced relief of approximately 60% of their pain during the trial period. Therefore, a neuroprosthesis (Medtronics, MN) was implanted permanently bilaterally at the third sacral nerve root in both patients. The use of analgesics was reportedly the same after implantation, but significantly more effective, and the patients' daily living activities were more tolerable. CONCLUSIONS: Two cases of refractory sacroiliac joint pain are reported that were managed with permanently implanted neuroprostheses at the third sacral nerve roots. The authors suggest that neuroaugmentation can be a reasonable option in selected patients with refractory sacroiliac pain.
Adult↗