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At least 19 recordsLinked to original sources
PubMed1983

[Roentgen diagnostic studies of peripheral joints, sacroiliac joints and the spine in psoriasis arthropathy].

The secure diagnosis "psoriasis arthropathica" must always be the result of a clinical examination, paraclinical and radiological findings. In 150 patients with arthropathic psoriasis X-ray examinations of peripheral joints, of the sacroiliac joints and of the spine were performed. As a result of subtle evaluations of the findings X-ray-morphological criteria on the skeleton of hand and foot, on the sacroiliac joints and on the spine may be derived. On the basis of the experiences gathered recommendations for the practice in form of radiographic objects of an X-ray-diagnostic basic programme in primary diagnostics and in repeated examinations are proposed. An optimum diagnostics of the arthropathic psoriasis can be achieved only ba close co-operation and by constant mutual informations between rheumatologists, dermatologists and radiologists.

Adult↗
PubMed2006

Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain.

Mapping studies of pain elicited by injections into the sacroiliac joints (SIJs) suggest that sacroiliac joint syndrome (SIJS) may manifest as low back pain, sciatica, or trochanteric pain. Neither patient-reported symptoms nor provocative SIJ maneuvers are sensitive or specific for SIJS when SIJ block is used as the diagnostic gold standard. This has led to increasing diagnostic use of SIJ block, a procedure in which an anesthetic is injected into the joint under arthrographic guidance. However, several arguments cast doubt on the validity of SIJ block as a diagnostic gold standard. Thus, the effects of two consecutive blocks are identical in only 60% of cases, and the anesthetic diffuses out of the joint in 61% of cases, often coming into contact with the sheaths of the adjacent nerve trunks or roots, including the lumbosacral trunk (which may contribute to pain in the groin or thigh) and the L5 and S1 nerve roots. These data partly explain the limited specificity of SIJ block for the diagnosis of SIJS and the discordance between the pain elicited by the arthrography injection and the response to the block. The limitations of provocative maneuvers and SIJ blocks may stem in part from a contribution of extraarticular ligaments to the genesis of pain believed to originate within the SIJs. These ligaments include the expansion of the iliolumbar ligaments, the dorsal and ventral sacroiliac ligaments, the sacrospinous ligaments, and the sacrotuberous ligaments (sacroiliac joint lato-sensu). They play a role in locking or in allowing motion of the SIJs. Glucocorticoids may diffuse better than anesthetics within these ligaments. Furthermore, joint fusion may result in ligament unloading.

Diagnosis, Differential↗
PubMed2004

Audit of conservative management of chronic low back pain in a secondary care setting--part I: facet joint and sacroiliac joint interventions.

The work of a chronic back pain service in secondary care in the West Midlands is reported. The service offers acupuncture, spinal injection procedures, osteopathy and a range of other interventions for patients whose back pain has not responded to conservative management. This section of the report focuses on injection procedures for lumbar facet joint and sacroiliac joint pain, which have been shown to be the cause of chronic low back pain in 16-40% and 13-19% of patients respectively. Diagnosis relies on the use of intra-articular or sensory nerve block injections with local anaesthetic. Possible treatments following diagnosis include intra-articular corticosteroid, radiofrequency denervation (for facet joint pain) or ligament prolotherapy injections (for sacroiliac joint pain). The results of several hospital audits are reported. At six month follow up, 50% of 38 patients undergoing radiofrequency denervation following diagnostic blocks for facet joint pain had improved by more than 50%, compared to 29% of 34 patients treated with intra-articular corticosteroid injection. Sixty three per cent of 19 patients undergoing prolotherapy following diagnostic block injection for sacroiliac joint pain had improved at six months, compared to 33% of 33 who had intra-articular corticosteroid. Both radiofrequency denervation and sacroiliac prolotherapy showed good long-term outcomes at one year.

Acupuncture Therapy↗
PubMed2001

Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome.

OBJECTIVE: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic sacroiliac joint injections in patients with sacroiliac joint syndrome. DESIGN: A retrospective study design with independent clinical review was utilized. Thirty-one patients were included; each patient met specific physical examination criteria and failed to improve clinically after at least 4 wk of physical therapy. Each patient demonstrated a positive response to a fluoroscopically guided diagnostic sacroiliac joint injection. Therapeutic sacroiliac joint injections were administered in conjunction with physical therapy. Outcome measures included Oswestry scores, Visual Analog Scale pain scores, work status, and medication usage. RESULTS: Patients' symptom duration before diagnostic injection averaged 20.6 mo. An average of 2.1 therapeutic injections was administered. Follow-up data collection was obtained at an average of 94.4 wk. A significant reduction (P = 0.0014) in Oswestry disability score was observed at the time of follow-up. Visual Analog Scale pain scores were reduced (P < 0.0001) at the time of discharge and at follow-up. Work status was also significantly improved at the time of discharge (P = 0.0313) and at follow-up (P = 0.0010). A trend (P = 0.0645) toward less drug usage was observed. CONCLUSIONS: These initial findings suggest that fluoroscopically guided therapeutic sacroiliac joint injections are a clinically effective intervention in the treatment of patients with sacroiliac joint syndrome. Controlled, prospective studies are necessary to further clarify the role of therapeutic injections in this patient population.

Adult↗
PubMed2006

Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome.

The purpose of this retrospective study was to evaluate the clinical and radiological outcome of bilateral sacroiliac joint (SIJ) fusion, using a new technique, in patients with a chronic SIJ syndrome. Seventeen patients with chronic low back pain, with a positive response to specific diagnostic tests for the SIJ, were considered candidates for bilateral sacroiliac fusion. The surgical indication was based on the results of local anaesthetic joint infiltration, temporary external fixation or bone scan. Ten patients had had previous surgery on the lumbar spine. Bilateral posterior SIJ fusion was performed with internal fixation and decortication of the sacroiliac joint, using a separate approach to each joint. Local bone grafting was performed. At the time of follow-up (on average 39 months after surgery), 3 patients reported moderate or absent pain, 8 marked pain and 6 severe pain. Seven patients showed a symptomatic non-union; union occurred in only 6 cases. Eighteen percent of the patients were satisfied, but in the other 82% the results were not acceptable. Reoperation was performed in 65% of the patients. Our results with bilateral posterior SIJ fusion were disappointing, which may be related with difficulties in patient selection, as well as with surgical technique. Better diagnostic procedures and possibly other surgical techniques might provide more predictable results, but this remains to be demonstrated.

Adult↗
PubMed1998

The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome.

OBJECTIVE: To determine the clinical validity of provocative sacroiliac joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint syndrome (SIJS). DESIGN: Prospective constructive cohort study using sacroiliac joint block (SIJB) as the diagnostic gold standard. SETTING: Tertiary care center. PATIENTS: Consecutive patients describing low back pain including the region of the sacral sulcus. Physical examination revealed a positive response to three provocative SIJ maneuvers, two of which had to be Patrick's test and pain with palpation over the ipsilateral sacral sulcus. INTERVENTIONS: All subjects underwent fluoroscopically guided SIJB. MAIN OUTCOME MEASURES: Response to SIJB was assessed with visual analog scale (VAS) ratings before and after the block. A reduction of the VAS rating by at least 80% was considered a positive response to SIJB. RESULTS: Fifty consecutive patients met our criteria and underwent SIJB. Thirty patients had positive response to SIJB, making up the positive SIJS group. Twenty patients had less than 80% pain reduction with SIJB and thus comprised the negative SIJS group. The positive predictive value of provocative SIJ maneuvers in determining the presence of SIJS is therefore 60%. CONCLUSIONS: Our results do not support the use of provocative SIJ maneuvers to confirm a diagnosis of SIJS. Rather, these physical examination techniques can, at best, enter SIJS into the differential diagnosis.

Adolescent↗
PubMed2000

Anatomy and pathophysiology of the sacroiliac joint.

The sacroiliac joint as a source of chronic pain has been a subject of debate for a long period of time. This controversy stems from the inherent anatomic location of the sacroiliac joint. Adjacent spinal structures may cause pain to be referred to the sacroiliac joint, thus making a precise diagnosis difficult. The most reliable method to establish the diagnosis of sacroiliac arthralgia is fluoroscopic-guided intra-articular injection of a local anesthetic preceded by a sacroiliac arthrogram. Although there are many therapeutic options for sacroiliac joint syndrome, the ideal treatment has not yet been discovered. There is evidence that intra-articular viscosupplementation of the sacroiliac joint with hylan can consistently and reliably induce a prolonged analgesic response in sacroiliac joint syndrome. Viscosupplementation restores joint homeostasis, allows increased joint motion, and induces analgesia. Hylan is highly viscoelastic hyaluronan (hyaluronic acid), and is capable of increasing the viscoelastic properties of synovial fluid.

Humans↗
PubMedDate not supplied

[Possibilities and relevance of three-dimensional reconstruction of the sacroiliac joint].

The sacroiliacal joint is difficult to evaluate clinically due to its complex form and its topographical position, deep in the body and surrounded by other skeletal structures. We evaluated the potential role of three-dimensional reconstruction and segmentation of CT data of this joint. A total of five patients were examined (age range 24-60 years). In three of these only surface reconstructions were obtained; in the other two, segmentation was obtained as well in order to directly visualize the joints surfaces of the sacroiliacal joint. Compared to conventional radiographs and standard CT, three-dimensional reconstruction and segmentation of the sacroiliac joint did not add significant information. The subtle skeletal findings occurring in inflammatory and degenerative disease were obscured by the process of segmentation. Therefore, radiographs and, in selected cases, CT remain the imaging methods of choice for the evaluation of sacroiliac pathology.

Adult↗
PubMed2005

Sacroiliac joint debridement: a novel technique for the treatment of sacroiliac joint pain.

OBJECTIVE: This study was a retrospective analysis of 38 patients who underwent sacroiliac joint debridement (SJD) as a treatment for confirmed sacroiliac joint (SI joint) pain. BACKGROUND DATA: This is a new, unpublicized, minimally invasive (we define minimally invasive as a surgery with an incision of less than 1 inch) surgical technique. There are no prior studies on this surgery, but the surgery is compared to SI joint fusion surgery, which offers a success rate of 50-70% in larger studies. METHODS: Thirty-eight patients with confirmed SI joint pain via a preoperative modified SI joint injection underwent SJD. These patients were followed up at 12-month intervals to determine their degree of pain relief from this surgery. RESULTS: Of the 38 patients, 61% of these patients had 50-100% reductions of their VAS and 53% had >75% improvement for >2 years. No complications were noted. Histology sections of the removed tissues revealed a non-inflammatory degenerative musculo-tendinous tissue similar to a chronic tendonitis. CONCLUSIONS: SJD is a reasonable treatment option for SI joint pain, which has a low complication rate and a success rate similar to SI joint fusion. Sacroiliac joint pain may be related to a degenerative musculo-tendinous condition of the surface of the joint on the iliac side.

Adult↗
PubMed1989

Pyogenic sacroiliac joint infection.

Sacroiliac joint infection is relatively uncommon. Since 1974, Staphylococcus aureus was the pathogen in 11 of 12 cases of pyogenic infection of the sacroiliac joint. Ten of the 12 cases were acute. All were treated with at least six weeks of antibiotics. Surgery was necessary in 11 of the 12 cases. Intraoperative specimens gave positive cultures in ten of 11 cases. All had a satisfactory result. This condition may be more common than previously thought. A careful history and physical examination are especially important. It should be treated early and aggressively to give optimum results. The indications for surgery are still uncertain.

Adolescent↗
PubMed1991

The effects of morphology and histopathologic findings on the mobility of the sacroiliac joint.

The sacroiliac joints of seven pelvic specimens were examined to determine functional, morphologic, and histopathologic aspects. The movements were measured in four intact pelvises (from two men and two women). The joint surfaces of all pelvises (from three men and four women) then were examined topographically by means of a photogrammetric method. After this, they were examined histologically to characterize any effects on function. The morphologic investigation revealed sex-specific differences. All joint surfaces from the female pelvises showed circular contours, the centers of which coincided with the iliac tuberosities. These morphologic characteristics were not discernible in the joint surfaces from the male pelvises; these had interlocking irregularities without a topographic pattern. As expected, this configuration involved distinct differences in mobility. Rotation of the sacrum was markedly less in the sacroiliac joints of men than in those of women.

Cadaver↗
PubMed1990

Imaging of the sacroiliac joints.

The sacroiliac joints present unique problems in diagnosis for both the clinician and the radiologist. Each of the imaging modalities presents advantages and problems. The specific clinical problems determine whether advanced imaging modalities such as scintigraphy, CT scan, or magnetic resonance imaging will complement the information on the plain radiographs.

Arthritis, Infectious↗
PubMed2006

Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection.

OBJECTIVE: Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. DESIGN AND PATIENTS: CT scans of pelvises were reformatted on 41 subjects, aged 51.7 (+/-15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 degrees to +30 degrees at 15 degrees increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. RESULTS: Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation. CONCLUSION: Angulation of the reconstruction plane considerably affects the appearance of the sacroiliac joints. By shortening joint depth, an inferiorly directed approach to SI joint injection may make fluoroscopic guidance easier, although associated bony interposition can prevent access to the synovial compartment. A superiorly directed approach is more likely to have adverse effects.

Anesthetics, Local↗
PubMedDate not supplied

Radiofrequency sacroiliac joint denervation for sacroiliac syndrome.

BACKGROUND AND OBJECTIVES: Radiofrequency (RF) denervation of the sacroiliac (SI) joint has been advocated for the treatment of sacroiliac syndrome, yet no clinical studies or case series support its use. METHODS: We report the results of a consecutive series of 50 SI joint RF denervations performed in 33 patients with sacroiliac syndrome. All patients underwent diagnostic SI joint injections with local anesthetic before denervation. Changes in visual analog pain scores (VAS), pain diagrams, physical examination (palpation tenderness over the joint, myofascial trigger points overlying the joint, SI joint pain provocation tests, and range of motion of the lumbar spine), and opioid use were assessed pre- and postdenervation. RESULTS: The criteria for successful RF denervation were at least a 50% decrease in VAS for a period of at least 6 months; 36.4% of patients (12 of 33) met these criteria. Failure of denervation correlated with the presence of disability determination and pain on lateral flexion to the affected side. The average duration of pain relief was 12.0 +/- 1.2 months in responders versus 0.9 +/- 0.2 months in nonresponders (P < or = 0.0001). A positive response was associated with an atraumatic inciting event. Successful denervation was associated with a change in the pain diagram and a reduction in the pattern of referred pain, a normalization of SI joint pain provocation tests, and a reduction in the use of opioids. CONCLUSIONS: This study suggests that RF denervation of the SI joint can significantly reduce pain in selected patients with sacroiliac syndrome for a protracted time period. Moreover, certain abnormal physical findings (i.e., SI joint pain provocation tests) revert to normal for the duration of the analgesia.

Adult↗
PubMed1992

The pathoanatomy and clinical significance of the sacroiliac joints.

The sacroiliac joint has a unique developmental anatomy which is responsible for an unusual and underdeveloped iliac cartilage surface. This surface tends to undergo premature degenerative change, which might be a factor in the pathogenesis of mechanical low back pain.

Adult↗