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PubMedDate not supplied

Early diagnosis of septic arthritis of the sacroiliac joint by use of computed tomography.

Two cases of suspected septic arthritis of the sacroiliac joint with normal radiographs and nuclide scans were investigated by computed tomography. Bone and soft tissue abnormalities consistent with septic arthritis were found. Diagnosis was confirmed by needle aspiration of the sacroiliac joint. Computed tomography may be useful in the early diagnosis of the sacroiliac joint when plain radiographs and nuclide scans are normal.

Adolescent↗

PubMed1991

Bilateral fracture-dislocation of the sacroiliac joint: a case report.

Bilateral fracture-dislocation of the sacroiliac joint with intrapelvic displacement of the sacrum is a rare and extremely severe injury. We treated a patient with bilateral fracture-dislocation of the sacroiliac joint using a nonoperative method and obtained an excellent functional result.

Adult↗

PubMed2004

Inciting events initiating injection-proven sacroiliac joint syndrome.

OBJECTIVE: To determine the inciting events leading to the development of sacroiliac joint syndrome (SIJS). METHODS: This was a retrospective descriptive cohort series from an academic interdisciplinary spine center. Consecutive patients presenting with low back or buttock pain with or without leg symptoms who met specific inclusion and exclusion criteria for the diagnosis of SIJS were included in the study. Inciting events leading to the development of SIJS in these patients were categorized into traumatic, cumulative, and idiopathic events. RESULTS: Of 194 patients who were included in the study, 54 patients had symptom resolution with one or more therapeutic intraarticular sacroiliac joint injections, following a positive diagnostic injection. Those patients were given the diagnosis of SIJS. Of these, 24 (44%) had had a traumatic event (13 motor vehicle accidents, six falls onto the buttock, three immediately postpartum, one severe football tackle, and one pelvis fracture). Eleven (21%) patients were considered to have a cumulative injury (four lifting, two running, three altered gait due to lower extremity disorder, one crew training injury, and one forceful hip extension injury). Nineteen (35%) patients had spontaneous or idiopathic onset of sacroiliac joint pain. CONCLUSION: SIJS can occur following a traumatic event or cumulative shear events, or can occur spontaneously.

Adult↗

PubMed2000

Anatomy of the anterior sacroiliac joint with reference to lumbosacral nerves.

There are no detailed descriptions of the neural structures that may be seen during surgical interventions of the pelvis. Anatomic dissections were performed to see which nerves are endangered in approaches to the anterior sacroiliac joint for plate fixations. Sixty cadavers were dissected bilaterally. Fifty-one were male and nine were female. L4 and L5 nerve roots were followed along the sacroiliac joint from the intervertebral foramen to the entrance into the lesser pelvis. Measurements were made between the nerves and sacroiliac joint from the proximal end of the joint to the pelvic brim. The L4 nerve root and the lumbosacral trunk (and not the L5 nerve root) were the nerves most susceptible to injury because of their course and proximity to the sacroiliac joint. As a result, during the anterior approach and fixation of the sacroiliac joint with plates, extreme care should be taken to identify the L4 nerve root or lumbosacral trunk or both at the anteroinferior third of the joint because the distance between the nerve and the joint is less than 1 cm.

Adult↗

PubMed2000

Clinical tests of the sacroiliac joint.

In the literature many tests are described which are designed to provoke pain or detect joint mobility in the sacroiliac joint (SIJ). However, in part 1 of this review, the authors stated that there is little evidence of reliability of these tests. In this article, the authors describe the methodological review of 11 studies, which have dealt with the validity of SIJ tests. The methodological quality of the studies was tested by using a list of criteria that consisted of three categories: 1) study population, 2) test procedure and 3) test results. A weighting for each criterion was developed. The methodological score for the studies was, in general, disappointing and looked promising for only two out of 11 studies (58 and 64 points). Four authors drew conclusions of positive validity from the tests they studied but other authors did not confirm these results. The conclusion of this methodological review is that there is no evidence to support the inclusion of mobility and pain provocation tests for the SIJ in clinical practice. Three major problems have been identified in validating SIJ dysfunction tests. Firstly, poor reliability of SIJ dysfunction tests exists, which may be improved by multiple test scores as postulated in part 1 of this review. Secondly, the methodological quality of validity studies needs to be developed to a much higher level with special consideration paid to sensitivity, specificity, confidence intervals and likelihood ratio values. And finally, there is a need for the proper use of a gold standard in assessing the validity of SIJ tests.

Humans↗

PubMed2005

Functional aspects of cross-legged sitting with special attention to piriformis muscles and sacroiliac joints.

BACKGROUND: Transversely oriented pelvic muscles such as the internal abdominal oblique, transversus abdominis, piriformis and pelvic floor muscles may contribute to sacroiliac joint stability by pressing the sacrum between the hipbones. Surface electromyographic measurements showed that leg crossing lowers the activity of the internal oblique abdominal muscle significantly. This suggests that leg crossing is a substitute for abdominal muscle activity. No previous studies addressed piriformis muscle and related pelvic structures in cross-legged sitting. METHODS: Angles of pelvis and femur were measured in healthy subjects in standing, normal sitting and cross-legged sitting, and were used to simulate these postures on embalmed pelvises and measure piriformis muscle elongation. Deformations of pelvic ring and iliolumbar ligament caused by piriformis muscle force were measured on embalmed pelvises. FINDINGS: Cross-legged sitting resulted in a relative elongation of the piriformis muscle of 11.7% compared to normal sitting and even 21.4% compared to standing. Application of piriformis muscle force resulted in inward deformation of the pelvic ring and compression of the sacroiliac joints and the dorsal side of the pubic symphysis. INTERPRETATION: Cross-legged sitting is common. We believe that it contributes to sacroiliac joint stability. This study demonstrates the influence of the piriformis muscle on sacroiliac joint compression. The elongation of the piriformis muscle bilaterally by crossing the legs may be functional in the build-up of active or passive tension between sacrum and femur.

Abdominal Muscles↗

PubMed1994

Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation.

STUDY DESIGN: A pain referral map generated from Part I of this study was tested in 54 consecutive patients. Pain diagrams, completed by each patient, were compared to the map generated from sacroiliac injections in 10 volunteers (Part I). Two clinicians, blinded to the examination of each individual, selected the diagrams most consistent with the pain map. OBJECTIVES: To determine the applicability of a pain referral map as a screening tool for sacroiliac joint dysfunction. SUMMARY OF BACKGROUND DATA: Two independent examiners, blinded to the patients' examinations, selected 16 individuals whose pain diagrams most represented the map generated in Part I. There was a 100% concordance of patients selected. All 16 patients selected had a provocation-positive SI joint injection. Ten of these individuals also received lumbar discography and lumbar facet injections. Only the SI injection on the symptomatic side was provocation positive. METHODS: Patients selected for evaluation based on pain mapping received sacroiliac joint injection. Provocation-positive injections were used to confirm the diagnosis of sacroiliac joint dysfunction. Ten subjects subsequently underwent lumbar discography and lumbar facet joint injections to further confirm the diagnosis. RESULTS: Few studies involving low back pain have used pain referral maps. In the present study, patients were successfully screened for sacroiliac joint dysfunction using a pain referral map generated from provocation of asymptomatic volunteers. CONCLUSION: Patients can be successfully screened for sacroiliac joint dysfunction based on comparison with a pain referral map. Further study on the false negative rates of sacroiliac pain maps is needed.

Adult↗

PubMed1998

Age-related changes in the articular cartilage of human sacroiliac joint.

Iliac and sacral articular cartilage of 25 human sacroiliac joints (1-93 years) are examined by light microscopy and immunohistochemistry in order to gain further insight into the nature and progress of degenerative changes appearing during aging. These changes can already be seen in younger adults as compared to cartilage degeneration known in other diarthrodial joints. Structural differences between sacral and iliac cartilage can already be observed in the infant: the sacral auricular facet is covered with a hyaline articular cartilage, reaching 4 mm in thickness in the adult and staining intensely blue with alcian blue at pH1. Iliac cartilage of the newborn is composed of a dense fibrillar network of thick collagen bundles, crossing each other at approximately right angles. A faint staining with alcian blue suggests a low content of acidic glycosaminoglycans. In the adult, iliac cartilage becomes hyaline and its maximal thickness reaches 1-2 mm. Both articular facets exhibit morphological changes during aging that are more pronounced in the iliac cartilage and resemble osteoarthritic degeneration; the staining pattern of the extracellular matrix becomes inhomogenous, chondrocytes are arranged in clusters and the articular surface develops superficial irregularities and fissures. Sometimes fibrous tissue fills up these defects. Nevertheless, large areas of iliac cartilage remain hyaline in nature. Sacral articular cartilage often remains largely unaltered until old age. The sacral subchondral bone plate is usually thin and shows spongiosa trabeculae inserted at right angles, suggesting a perpendicular load on the articular facet. Iliac subchondral spongiosa shows no definite alignment and joins the thickened subchondral bone plate in an oblique direction. The iliac cartilage therefore seems to be stressed predominantly by shearing forces, arising from the changing monopodal support of the pelvis during locomotion. The subchondral bone plate on both the iliac and sacral auricular facet is penetrated by blood vessels that come into close contact with the overlying articular cartilage. These vessels may contribute to the high incidence of rheumatoid and inflammatory diseases in the human sacroiliac joint. Immunolabelling with an antibody against type II collagen reveals a diminished immunoreactivity in the upper half of adult sacral cartilage and only a faint and irregular labelling in the iliac cartilage. Type I collagen can be detected in a superficial layer on the sacral articular surface and around chondrocyte clusters in iliac cartilage, as in dedifferentiating chondrocytes during the development of osteoarthritis.

Adolescent↗

PubMed2003

Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus.

STUDY DESIGN: A retrospective audit and examination of anatomic findings. OBJECTIVE: To examine the effectiveness of sensory stimulation-guided radiofrequency neurotomy for the treatment of recalcitrant sacroiliac joint pain. SUMMARY OF BACKGROUND DATA: Sacroiliac joint-mediated pain is a distinct clinical entity. The prevalence of intra-articular pain arising from the sacroiliac joint in patients with low back pain has been estimated at 15% to 30%. Unfortunately, the clinical success of current treatment methods for chronic sacroiliac pain is discouraging. Based on the anatomy of the sacral posterior primary rami and their lateral branch nerves, an anatomically based sensory stimulation-guided radiofrequency technique was developed to overcome the inherent challenge posed by the variable topography of the sacral lateral branch nerves. MATERIALS AND METHODS ANATOMIC STUDY: Meticulous dissection exposing the dorsal sacral plexus and lateral branch nerves entering the sacroiliac joint complex was performed on three cadaveric specimens. Small-gauge wires were placed adjacent to the lateral branch nerves entering the joint and over the dorsal sacrum to the dorsal sacral foramina. Fluoroscopic images were obtained correlating the location and number of these branches arising from the posterior primary rami of S1-S3 to identifiable bony landmarks. CLINICAL STUDY: A retrospective chart review was performed selecting patients who underwent sensory stimulation-guided sacral lateral branch radiofrequency neurotomy after dual analgesic sacroiliac joint deep interosseous ligament analgesic testing between February 17, 1998 and March 15, 1999. RESULTS: A total of 14 patients met inclusion criteria for this retrospective study. Success was defined as greater than 60% consistent subjective relief and greater than a 50% consistent decrease in visual integer pain score, maintained for at least 6 months after the procedure. Sixty-four percent of patients experienced a successful outcome, with 36% experiencing complete relief. Fourteen percent of patients did not achieve any improvement. No patients experienced a complication or worsening of their pain from the procedure. CONCLUSIONS: A sensory stimulation-guided approach toward the identification and subsequent radiofrequency thermocoagulation of symptomatic sacral lateral branch nerves appears to offer significant therapeutic advantages over existing therapies for the treatment of chronic sacroiliac joint complex pain.

Adult↗

PubMed1995

Normal variation in the magnetic resonance imaging appearances of the sacroiliac joints: pitfalls in the diagnosis of sacroiliitis.

The purpose of this paper is to define the normal and variable appearances of the sacroiliac joints and adjacent subchondral marrow on unenhanced and enhanced Magnetic Resonance Imaging (MRI). Twenty subjects were imaged with spin-echo T1-weighted (T1), fast spin-echo T2-weighted (T2), T1-weighted with fat suppression (T1FS) and fast short tau inversion recovery (Fast STIR) sequences. Five of these subjects were imaged following intravenous Gd-DTPA administration, and the enhancement factor of the synovial compartment of the sacroiliac joint and subchondral marrow was calculated. The appearance of the cartilage of the synovial compartment on T1 and T2 images is of an intermediate signal bounded by signal void of bone cortex. On T1FS and Fast STIR images the cartilage has an intermediate to high signal. The marrow on T1, T2 and T1FS images has a homogeneous intermediate signal. T1FS images demonstrate the synovial compartment with greater clarity than T1 images. Cortical erosions and subchondral sclerosis were not demonstrated in our subjects, and partial volume artifact between the synovial and ligamentous compartments should not be interpreted as erosions. On Fast STIR images there is normally a region of high signal from the immediate subchondral marrow, which should not be interpreted as early sacroiliitis. Seven subjects demonstrated a patchy distribution of fat within the bone marrow, an appearance which alone does not indicate sacroiliitis. One subject had an accessory articular facet of the sacroiliac joint. The percentage maximal enhancement factor of the synovial compartment of the sacroiliac joint and adjacent subchondral marrow is 52% and 94% on T1FS images respectively. These figures redefine the normal maximal enhancement factors in this region of the body.

Adipose Tissue↗

PubMed1990

Incidence of sacroiliac joint dysfunction and low back pain in fit college students.

The incidence of low back pain and sacroiliac joint dysfunction and their relationship was studied in a sample of physically fit college students. An incidence of 26.5% was found for low back pain, while an incidence of 19.3% was found for sacroiliac joint dysfunction. This study found no significant relationship between sacroiliac joint dysfunction and low back pain.

Adolescent↗

PubMed1988

Changes in innominate tilt after manipulation of the sacroiliac joint in patients with low back pain. An experimental study.

The purposes of this study were to 1) propose a method to detect sacroiliac joint dysfunction (SIJD), 2) test the interrater reliability of the method on a group of patients with low back pain (LBP), and 3) document changes in innominate tilt after manipulation of the sacroiliac joint. Criteria for SIJD were established by the authors. Twenty-six patients with unilateral LBP were examined independently for presence of SIJD by two examiners. Interrater agreement for presence or absence of SIJD was found to be excellent (Cohen's Kappa = .88). Twenty of the patients who met the criteria for SIJD were randomly assigned to an Experimental Group (n = 10) or a Control Group (n = 10). The left and right innominate bones of these 20 patients were measured for tilt before and after the intervention period. The sacroiliac joint of the patients in the Experimental Group was manipulated during the intervention period, whereas the patients in the Control Group received no treatment. Data were analyzed using a mixed three-factor analysis of variance. The data analysis revealed that the manipulation procedure resulted not only in an altered innominate tilt of the same side but also in an equal and opposite tilt of the opposite side (F = 67.07; df = 1.18; p less than .05). The results indicate that SIJD can be identified reliably in patients with LBP and that a manipulative procedure purported to be specific to the sacroiliac joint changes innominate tilt bilaterally and in opposite directions.

Adolescent↗

PubMed1992

The treatment of the sacroiliac joint component to low back pain: a case report.

This case report describes the treatment of a patient who had symptoms and signs suggestive of a sacroiliac joint component of low back pain. The patient developed right-sided low back pain without provocation. He appeared to have sacroiliac joint dysfunction, excessive right hip lateral rotation, and limited right hip medial rotation. The patient's habit of crossing his right leg over his left leg while sitting was believed to have contributed to the excessive lateral hip rotation. After treating the sacroiliac joint and restoring symmetrical hip rotation, the patient no longer complained of low back pain. This case report suggests that asymmetrical hip rotation may contribute to what is often called a sacroiliac joint component of low back pain.

Adult↗

PubMedDate not supplied

The long-term effects of spinal fusion on the sacroiliac joints and ilium.

Ninety-six patients who had lumbar disk excision and primary posterior fusion were studied 10 or more years after their operations. Thirty-seven per cent complained of persistent graft donor site pain. A comparison of fused patients with and without donor site pain and 36 patients who underwent simple disk excision, revealed no differences in the flexion-extension mobility of the sacroiliac joints, or degenerative changes in the sacroiliac joints. Ectopic bone formation at graft donor sites, and cluneal nerve neuromata did not influence the result. Patients with graft donor site pain had significantly greater complaints of persistent low back pain, postoperative leg pain, and lost more time from work. If the graft was taken from the same side as that of preoperative leg pain, persistent complaints were more common. It is concluded that the sacroiliac joints are not adversely affected by lumbar spine fusion, and that persistent donor site pain is more likely part of a total pain complex referred from the lumbar spine. The sacroiliac joints appear to be relatively noncontributory to problems following lumbar disk surgery.

Bone Transplantation↗

PubMedDate not supplied

Pulsed radiofrequency denervation for the treatment of sacroiliac joint syndrome.

OBJECTIVE: Current therapies for sacroiliac joint (SIJ) dysfunction offer discouraging results in alleviating low back pain. The innervation and target nerves for radiofrequency denervation (RFD) of the SIJ remain unclear. We present a prospective case series on the treatment of intractable SIJ dysfunction with pulsed radiofrequency denervation (PRFD) of lateral branches from L4-S3. INTERVENTIONS: A total of 126 patients with presumptive SIJ dysfunction based on history and physical examination underwent arthrographically confirmed steroid/local anesthetic SIJ injection. Fifty-two patients (41.3%) had >75% pain relief after two consecutive injections, physical therapy, repeated SIJ injections, and/or analgesics. Twenty-two patients failed to respond. These patients underwent PRFD of the medial branch of L4, posterior primary rami of L5, and lateral branches S1 and S2. OUTCOME MEASURES: Visual analog score (VAS) and quality of life (QOL) assessments were performed prior to and after treatment. RESULTS: Sixteen patients (72.7%) experienced "Good" (>50% reduction in VAS), or "Excellent" (>80% reduction in VAS) pain relief following PRFD. Duration of pain relief range was 6-9 weeks in four patients, 10-16 weeks in five patients, and 17-32 weeks in seven patients. In addition, QOL scores improved significantly in all measured categories. Six patients (26.1%) did not respond to PRFD and had less than 50% reduction in VAS and were considered failures. CONCLUSIONS: PRFD of the lateral branch of the medial branch of L4, posterior primary rami of L5, and lateral branches S1 and S2 is an effective treatment for some patients with SIJ pain unresponsive to other forms of therapy.

Adult↗

PubMed1978

Craniocaudal axial view of the sacroiliac joint.

A technique that provides a craniocaudal axial view of the sacroiliac joint is described. This technique gives information about the ventral aspect of the sacroiliac joint, particularly at the level of the pelvic brim. It can demonstrate extraarticular ventral ankylosis of the joint, which is not visible or only suspected on anteroposterior films. In osteitis condensans ilii, it shows the thickness of the involved iliac bone. It is very useful for the accurate localization of paraarticular changes.

Ankylosis↗

PubMed1983

Biochemical and morphologic studies of cartilage from the adult human sacroiliac joint.

The cartilage of the adult sacroiliac joint contains type II collagen and a high concentration of glycosaminoglycan. Furthermore, large aggregating proteoglycans and link proteins were extracted from the sacral cartilage. In these respects the sacroiliac cartilage is similar to that in the peripheral joints. However, while the organization of the collagen in the sacral cartilage is typical of an articular cartilage, the organization of the ilial cartilage is very different, and throughout its depth it possesses narrow collagen fibrils arranged parallel to the articular surface.

Adult↗

PubMed2000

Magnetic resonance imaging in rheumatic disorders of the spine and sacroiliac joints.

OBJECTIVE: To review the value of magnetic resonance imaging (MRI) in diagnosis and evaluation of rheumatic diseases of the spine and sacroiliac joints. METHODS: A review of the literature on MRI of the spine and sacroiliac joints in rheumatoid arthritis (RA), ankylosing spondylitis (AS), infectious spondylodiscitis, infection of the sacroiliac joint (SIJ), gout, calcium pyrophosphate deposition disease, nontraumatic vertebral compression fractures, insufficiency fracture of the sacrum, avascular necrosis of the vertebral body, sarcoidosis, and Paget's disease was performed. The reports were obtained from a Medline search. RESULTS: In RA, AS, and crystal deposition disease, synovial tissue, atlantoaxial and subaxial subluxations, crystal deposition, and neurologic compromise can be adequately diagnosed with MRI of the cervical spine. Studies on MRI of SIJs in AS indicate that MRI enables early diagnosis of sacroiliitis. In most cases of infectious spondylodiscitis, avascular necrosis of the vertebral body, nontraumatic vertebral compression fractures, and insufficiency fractures of the sacrum characteristic findings on MRI suggest the correct diagnosis. Moreover, soft tissue abnormalities and neurologic compromise can be visualized. In infection of the SIJ, MRI shows findings suggesting an inflammatory process. In Paget's disease, MRI does not provide additional information as compared with plain radiography (PR) or computed tomography (CT). CONCLUSION: In evaluation of spinal and SIJ abnormalities in many rheumatic diseases, MRI, in addition to PR, can replace conventional tomography, CT, and myelography. Moreover, MRI can visualize soft tissue abnormalities and neurologic compromise without use of intrathecal contrast.

Humans↗