[ON DISEASES OF THE SACROILIAC JOINT].
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Humans↗
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In vitro assessment of movements of the sacroiliac joint in the horse.
REASONS FOR PERFORMING STUDY: Sacroiliac joint (SIJ) disease is associated with poor hindlimb action, lameness and poor performance in horses. However, little is known about the biomechanics of this low-motion joint. OBJECTIVES: To determine in vitro the capacities of movement of the SIJ in the sagittal plane, and to test the effect of a sacrosciatic and sacrotuberal desmotomy on its stabilisation. METHODS: Six anatomical specimens underwent cycles of flexion-extension of the lumbosacral joint (LSJ) before and after desmotomy. Kinematic triads were linked rigidly to the sacrum, spinous process of vertebra L5 and iliac wing. Angles were measured using a joint coordinate system based on anatomical frames. RESULTS: The LSJ underwent regular movements of flexion and extension (overall mean +/- s.d. range 23.4 +/- 1.6 degrees). The only recorded movement of the SIJ was a nutation during LSJ flexion (overall mean +/- s.d. 0.8 +/- 0.5 degrees). Desmotomy induced an increase of that nutation (overall mean +/- s.d. 1.7 +/- 0.2 degrees). CONCLUSIONS AND POTENTIAL RELEVANCE: Movements of the SIJ were small and coupled only with the flexion of the LSJ. The ligaments surrounding the SIJ have a strong effect on the stabilisation of this joint. Due to the limited amount of movement, its biomechanical study in vivo seems to be difficult. Further in vitro studies would be useful to determine the role of each ligament, to better understand the clinical consequences of the tears frequently observed during necropsy.
Animals↗
Anatomic considerations of an anterior approach to the sacroiliac joint.
This anatomic study was performed on 25 disarticulated pelves and 10 embalmed cadavers to evaluate an anterior approach to the sacroiliac joint. The angle of inclination of the superior limb of the sacroiliac joint was 15 degrees superolateral to inferomedial in the sagittal plane, and the inferior limb was parallel to the sagittal plane. The cranial lateral part of the ala overlapped the joint space and the adjacent part of the ilium. Elevation of a rectangular bone block on the cranial part of the ala removed the joint space from the superior limb and provided direct access to the joint space of the inferior limb.
Anthropometry↗
Subluxation of the sacroiliac joints in a black female with ankylosing spondylitis.
A 55-year-old black female with ankylosing spondylitis (AS) is described. The patient had a severe flexion attitude secondary to a rotational subluxation at the sacroiliac joints with subsequent bony ankylosis. The sacroiliac abnormality has not been reported in AS patients. Sacroiliac joint laxity during multiple pregnancies might have contributed to the subluxation. The importance of this anatomic site in evaluating the surgical correction of the postural deformities of AS is stressed.
Female↗
Variations in thickness of articular cartilage in the human sacroiliac joint.
Differences in articular cartilage thickness in the sacroiliac joint were investigated in different regions of the sacral and the iliac articular surfaces in the embalmed cadavers of five males and six females. The mean thickness of the sacral articular cartilage was greater than that of the iliac articular cartilage (P < 0.001) and the sacral articular cartilage of the female was thicker than that of the male (P < 0.02). Differences between thicknesses of the iliac articular cartilage in the male and female and in different regions of the sacral and iliac articular cartilages were found to be not significant.
Age Factors↗
Radiology of disorders of the sacroiliac joints.
Differentiation of the many disorders that affect the sacroiliac joints can often be accomplished by attention to radiographic detail. By evaluating the distribution of disease, the presence of erosions and other changes as noted herein, and the course of disease over a period of time, a specific diagnosis can often be made, or at the very least, suggested (Table).
Adult↗
Sacroiliac joint dysfunction in athletes.
The sacroiliac (SI) joint is a common source of low back pain in the general population. Because it is the link between the lower extremities and the spine, it sustains even higher loads during athletic activity, predisposing athletes to a greater probability of joint dysfunction and pain. The diagnosis and treatment of SI joint dysfunction remains controversial, due to complex anatomy and biomechanics, and a lack of universally accepted nomenclature and terminology, consistently reliable clinical tests and imaging studies, and consistently effective treatments. This article clarifies these issues by presenting a model of SI joint anatomy and function, a systematic approach to the diagnosis of dysfunction, and a comprehensive treatment plan.
Adult↗
The sacroiliac joints: anatomic, plain roentgenographic, and computed tomographic analysis.
Due to its unique bicompartmental anatomy and spatial configuration, the sacroiliac joint can be more accurately defined by computed tomography (CT) than conventional radiography. Using a tilted gantry and paraaxial scanning technique, the synovial portion of the joint is oriented vertically on the CT image, while the ligamentous portion is oriented oblique-horizontally. The tilted CT gantry technique allows full ventral-dorsal imaging of the synovial portion of the sacroiliac joint. We have found the accuracy of CT to be superior to conventional radiography in the detection of early erosive sacroiliitis and joint space narrowing. In all patients with discrepancy between the two radiologic techniques, the changes were either only demonstrated or better demonstrated by CT than conventional radiography.
Adolescent↗
[Diagnostic value of sacroiliac-joint scintigraphy in acute iridocyclitis].
The association between acute iridocyclitis (a.i.) and sacroiliitis/ankylosing spondylitis is well known. Since bone scintigraphy is a sensitive method of detecting sacroiliitis before radiologic evidence of this condition appears, we examined the role of scintiscanning in the investigation of sacroiliitis in patients with a.i. The sacroiliac-joint/sacrum ratio was determined in 30 control subjects and in 21 patients with a.i., who showed no radiologic signs of sacroiliitis. No discrimination between patients with a.i. and control subjects was obtained by scintigraphy, neither did we find any difference in the mean sacroiliac-joint/sacrum ratios between HLA-B-27-positive and HLA-B-27-negative individuals with a.i. This study does not support the claim that patients with a.i. often suffer from clinically and radiologically silent sacroiliitis which would be detected only by scintigraphy. According to our results, regular scintigraphic examinations of the sacroiliac joint in all patients with a.i. are not indicated.
Adult↗
MR imaging of radiation osteitis in the sacroiliac joints.
The purpose of this study was to analyze magnetic resonance (MR) images of radiation osteitis of sacroiliac joints, retrospectively. Seven patients with radiation osteitis, which was diagnosed by pelvic plain radiographs and CT images, underwent MRI. T(1)-weighted spin echo images and T(2)-weighted fast spin echo images were obtained in all patients. Four patients were examined after gadolinium injection. Major signal changes of radiation osteitis were distributed on the iliac side. T(1)-weighted images showed diffuse low intensity both in sacral and iliac sides. T(2)-weighted images showed very low intensity adjacent to sacroiliac joints, but mixed intensity was illustrated apart from joints, and high intensity in the peripheral areas. Radiation osteitis showed slight to mild, but irregular enhancement in four patients after gadolinium administration. MRI can illustrate abnormal bone change distribution and is useful for diagnosing this entity by characteristic intensity patterns on T(1)-weighted images with and without gadolinium and T(2)-weighted image. However, the diagnosis of accompanied insufficiency fractures in the area of radiation osteitis is occasionally difficult with conventional MRI.
Aged↗
Sacroiliac joint involvement in classical or definite rheumatoid arthritis.
In 188 patients with rheumatoid arthritis 564 radiologic examinations of the sacroiliac joints were performed. Severe blurring of the joint space or ankylosis were uncommon. The involvement was related to an age > 40 years at the onset, high values of the ESR and involvement of most joint groups in the limbs and cervical spine. Sex, presence or high titres of the rheumatoid factor and antinuclear antibodies were unrelated to lesions of the sacroiliac joints. A relation to the severity of rheumatoid arthritis rather than to the immunologic condition is suggested.
Adult↗
A randomized clinical trial of manual versus mechanical force manipulation in the treatment of sacroiliac joint syndrome.
OBJECTIVE: To investigate the effect of instrument-delivered compared with traditional manual-delivered thrust chiropractic adjustments in the treatment of sacroiliac joint syndrome. METHODS: Prospective, randomized, comparative clinical trial. Sixty patients with sacroiliac syndrome were randomized into two groups of 30 subjects. Each subject received 4 chiropractic adjustments over a 2-week period and was evaluated at 1-week follow-up. One group received side-posture, high-velocity, low-amplitude chiropractic adjustments; the other group received mechanical-force, manually-assisted chiropractic adjustments using an Activator Adjusting Instrument (Activator Methods International, Ltd, Phoenix, Ariz). RESULTS: No significant differences between groups were noted at the initial consultation for any of the outcome variables. Statistically significant improvements were observed in both groups from the first to third, third to fifth, and first to fifth consultations for improvements (P < .001) in mean numerical pain rating scale 101 (group 1, 49.1-23.4; group 2, 48.9-22.5), revised Oswestry Low Back Pain Disability Questionnaire (group 1, 37.4-18.5; group 2, 36.6-15.1), orthopedic rating score (group 1, 7.6-0.6; group 2, 7.5-0.8), and algometry measures (group 1, 4.8-6.5; group 2, 5.0-6.8) for first to last visit for both groups. CONCLUSIONS: The results indicate that a short regimen of either mechanical-force, manually-assisted or high-velocity, low-amplitude chiropractic adjustments were associated with a beneficial effect of a reduction in pain and disability in patients diagnosed with sacroiliac joint syndrome. Neither mechanical-force, manually-assisted nor high-velocity, low-amplitude adjustments were found to be more effective than the other in the treatment of this patient population.
Adolescent↗
Diagnostic and therapeutic features of facet and sacroiliac joint injection. Anatomy, pathophysiology, and technique.
A diagnosis of exclusion facet syndrome is considered one of the many genuine causes of low back pain. Using careful patient selection, percutaneous facet joint block is a useful diagnostic and therapeutic procedure in the management of lumbar facet syndrome. Sacroiliac joint syndrome appears to be a more tangible entity diagnostically and more amenable to injection. This article addresses the anatomy, pathophysiology, and salient radiographic features of the apophyseal joint, and describes the procedures and techniques for facet as well as sacroiliac joint injection.
Anesthesia, Local↗
The crescent fracture: a posterior fracture dislocation of the sacroiliac joint.
Between October 1987 and August 1992, 22 patients with crescent fractures, a posterior fracture-dislocation of the sacroiliac joint, were admitted, treated, and available for review at Tampa General Hospital and The Hospital for Special Surgery. The purpose of the study was twofold: (a) to evaluate the incidence, severity, and pattern of associated injuries, and (b) to determine the efficacy of a treatment protocol using a posterior extrapelvic approach and extraarticular internal fixation. The study population was composed of 13 females and nine males; the average age was 25 years (range 10-52). Despite the fracture pattern resulting in a rotationally unstable hemipelvis, all patients were hemodynamically stable at the time of presentation. Fourteen patients (64%) had other associated injuries, including five (23%) with closed head injury. In all cases a posterior extrapelvic approach was used with an anatomic reduction of the fractured iliac wing and the sacroiliac joint dislocation. Stable extraarticular internal fixation was obtained using intertable lag screws and outer-table neutralization plates. All the fractures were clinically and radiographically healed within 8-10 weeks postoperatively, and there were no acute wound, neurologic, or vascular complications. One patient developed osteomyelitis of the iliac crest 6 months postoperatively.
Adolescent↗
[Biomechanical properties of the sacroiliac joint].
The purpose of this study was to investigate the biomechanical properties of the bony and cartilagenous elements of the sacroiliac joint. The materials were obtained from human fresh cadavers en bloc, and they were analysed on cartilage thickness, dynamic viscoelasticity, static compressive strength, and bony trabecular structure. The results were as follows: Cartilage thickness of the joint was well correlated with viscoelasticity, and the results of viscoelasticity and static compressive strength were highly equivalent to the results of analysis of the trabecular bone. The values of viscoelasticity, static compressive strength and bone area were higher in the iliac side of the joint than in the sacral side, and markedly high values were obtained in the middle part of the iliac side. In conclusion, the middle part of the sacroiliac joint may play an important role in the support and transmission of the load.
Adolescent↗
The mobility of the sacroiliac joint in healthy subjects.
A three-dimensional stereophotogrammetric method is described for measuring the mobility of the sacroiliac joint, which was based on preliminary two-dimensional in vitro experiments. The investigations were carried out with intraosseous markers in 24 healthy volunteer male (15) and female (9) subjects having an age range of 20 to 50 years. Considerable intra- and inter-individual variability was found for both the measurements of rotation and translation. The position and direction of the movement axes showed wide variations, but a basic pattern could always be recognized. The average values for rotation and translation were low, being 1.8 degrees / 0.7 mm for the males and 1.9 degrees / 0.9 mm for the females. No statistically significant differences could be demonstrated with respect to either sex or age. On the basis of the measurement results, it is postulated that there is pathological sacroiliac joint movement when rotation is more than 6 degrees and translation more than 2 mm. This increased mobility seems to be of greater clinical significance than reduced mobility.
Adult↗
Magnetic resonance imaging of sacroiliac joint inflammation.
A consecutive series of 27 patients with symptoms compatible with sacroiliitis underwent magnetic resonance imaging (MRI) of the sacroiliac joints. The diagnostic sensitivity of MRI was similar to that of computed tomography or conventional radiography. However, MRI seems to have the potential of providing unique information about the disease process in sacroiliitis by demonstrating abnormalities in subchondral bone and periarticular bone marrow. The results of this study suggest that early inflammatory changes in sacroiliitis occur in the subchondral structures of the sacroiliac joints.
Adolescent↗
Neoplastic involvement of the sacroiliac joint: MR and CT features.
The radiological findings in five patients with pelvic soft tissue neoplasms directly involving the sacroiliac joint, are described. All patients had Computed Tomography (CT) examinations, two of the patients also having Magnetic Resonance Imaging (MRI). The role of imaging in this uncommon entity is discussed as well as the importance of making this diagnosis, thereby excluding unilateral sacroiliitis. The therapeutic implications of this diagnosis relate to local neural involvement, especially the sciatic nerve, and the fact that involvement of the sacroiliac joint by tumors significantly compromises chances of a successful surgical outcome. The role of MR in this condition is not yet certain, but it may prove to be the method of choice in view of its excellent depiction of skeletal neoplasms.
Adult↗