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PubMedDate not supplied

The scintigraphic anatomy of the equine sacroiliac joint.

The aim of this study was to describe the scintigraphic appearance and location of the sacroiliac joint (SI-joint) in dorsal and dorso 30 degree lateral views of the equine pelvis in a scintigram. The pelvis from 10 different horses was prepared by attaching plastic tubes along relevant margins of the bone and around the SI-joint. A radioactive solution was injected into the tubes, and scintigraphic images were acquired with a gamma camera. Five specific landmarks were identified on the left and right sides of the pelvis. There was no significant difference in the distance measurements between the left and right sides in the dorsal view. The SI-joint was roughly ovoid in shape, with its long axis angled to the midline. The most craniolateral point of the SI-joint (Y) was located at the middle (SD = 0.04) of a line drawn from the caudal margin of the tuber sacrale (TS) to the craniolateral margin of the tuber coxa (TC), which was called TS-TC. In 85% of the specimens, the long axis of the SI-joint (SILA) was located caudal to or intersecting TS-TC, and the mean angle between SILA and TS-TC was 16.4 degrees (SD = 5.6 degrees). The distance from the caudomedial point of the SI-joint (Z) to Y was 0.38 times (SD = 0.04) the length of TS-TC. The distance from the tuber sacrale to the medial border of the SI-joint (TS-X) was 0.15 times (SD = 0.02) the length of TS-TC. In the oblique view, the SI-joint appeared wider and was positioned more laterally compared to the dorsal view. The distance TS-Y increased to 0.61 times (SD = 0.046) TS-TC, but SILA/TS-TC was essentially unchanged. The mean angle between TS-TC and SILA increased to 20.9 degrees (SD = 5.6 degrees). TS-X increased to 0.31 times (SD = 0.037) TS-TC. The location of the SI-joint was very similar in all horses, which makes it possible to estimate the location of the SI-joint in a scintigram in which the tuber sacrale and the craniolateral margin of the tuber coxa are identified.

Animals↗
PubMed1979

[Computer tomography of the sacroiliac joints (author's transl)].

Computer tomography, like conventional radiography, can demonstrate inflammatory, degenerative or reparative, traumatic and neoplastic lesions of the sacroiliac joints. In some cases computer tomography adds important information, for instance as regards soft tissue changes near the S.I. joints in the presence of neoplastic or posttraumatic lesions (tumour extension, hematoma). Computer tomography is also able to demonstrate minor disalignment of the sacro-iliac joints (so-called sacro-listhesis).

Bone Diseases↗
PubMed2000

Enteropathic arthritis in the sacroiliac joint. Imaging and differential diagnosis.

OBJECTIVES: A new high resolution computed tomography (HRCT) scoring system of sacroiliac joint (SIJ) involvement in enteropathic arthritis is introduced. PATIENTS AND METHODS: SIJ's of 100 patients were studied. A total of 25 patients presented with pain syndrome, 25 with suspicious seronegative spondylarthritis, 25 with inflammatory bowel diseases and 25 without joint or bowel diseases, as a control group. HRCT was carried out in all 100 patients. For comparison, a plain film radiography (PFR), conventional CT (slices of 10 mm) and bone scan were used. RESULTS: Quantitative differences: In the pain syndrome group, there were no erosions identified neither intraarticular calcifications. Disc degeneration was seen in 12/25 cases. In 4/25 patients, vacuum phenomena appeared in the SIJ. In 3/25 patients, ventral capsular calcification occurred in the ventral sacroiliac ligament (anterior capsule complex). In the seronegative spondylarthritis group, 16/25 patients had positive findings, while PFR documented erosions only in 3/25 cases. In the bowel diseases group, erosions were detected in 17/25 cases with HRCT, while the plain film was positive only in three cases and in seven cases the findings were questionable. Intraarticular calcification with erosion was documented in three cases and in seven cases without erosion. The bone scan was positive in 7/25 of this cases, but in 5/7 there was mismatching with HRCT. Important new finding was the HRCT detected erosion which was not detected on BS but was obvious on Anti-Granulocyte-Antibody scintigraphy. In the control group, only degenerative changes were seen in 4/25 cases and no erosions. CONCLUSION: HRCT is: (1) the reliable imaging of definitive (often 'cold stage') sacroileitis; (2) gives optimal detection of erosion; and (3) appears to be the only method in the documentation of calcifications in the posterior ligamental portion of the SIJ.

Arthritis↗
PubMed1997

Acute gout of the right sacroiliac joint.

An eighty-year-old woman suffered from acute idiopathic gout of the right sacroiliac joint and tophaceous deposits in two fingers of her right hand. Hyperuricemia and findings consistent with gout detected by histological examination of a biopsy specimen taken from the digital nodules supported the diagnosis. The radiological workup revealed osteolytic changes at the bases of the phalanges in Roentgenograms of the feet. Various aspects of the very rare incidence of sacroiliac gout are discussed.

Acute Disease↗
PubMed1987

Inter- and intra-examiner reliability of palpation for sacroiliac joint dysfunction.

The purpose of this study was to operationally define and evaluate inter- and intra-examiner reliability of the standing sacroiliac mobility (Gillet) test on 53 college students. Both inter- and intra-examiner reliability data showed high mean percentages of agreement (85.3% and 89.2%, respectively.) Cohen's unweighted kappa statistic for concordance was applied yielding "fair" concordance for aggregate intra-examiner data and "slight" concordance for aggregate inter-examiner data. The intra-examiner reliability data suggests that the Gillet test is clinically useful for a single examiner in assessing the sacroiliac joint for mobility dysfunction, especially at upper sacroiliac contact points. Linear regression analyses suggest that the test is sensitive, in that reliability improves with increasing perceived abnormality. Further revisions to the operational definition may improve both inter- and intra-examiner reliability of the Gillet test.

Adult↗
PubMed1999

Should radiologists image and report sacroiliac joints in patients referred for examination of the lumbar spine?

It is routine to image the sacroiliac joints (SIJs) in patients referred for radiographic examination of the lumbar spine but there were only two consistent with ankylosing spondylitis in a review of 392 radiographic reports of lumbar spine examinations. A more sensible policy would be to only image and report on the SIJs if the clinical history were indicative of ankylosing spondylosis.

Adult↗
PubMedDate not supplied

An alternate method of radiofrequency neurotomy of the sacroiliac joint: a pilot study of the effect on pain, function, and satisfaction.

BACKGROUND AND OBJECTIVES: The sacroiliac joint (SIJ) can be a source of chronic refractory mechanical spine pain. Few previous studies have described radiofrequency (RF) sensory denervation of the SIJ; results have been inconsistent and technically demanding. This uncontrolled, prospective, cohort study evaluates the effects of an innovative method of RF ablation of the posterior sensory nerves of the SIJ on pain, analgesic use, disability, and satisfaction of patients suffering with chronic mechanical SIJ pain. METHODS: Nine subjects with SIJ pain, confirmed by a local anesthetic joint block, were studied. Subjects were treated with a series of RF strip lesions performed adjacent to the lateral dorsal foraminal aperture plus conventional monopolar lesioning at the L5 dorsal ramus. Each subject completed a questionnaire twice before and at 1, 3, 6, 9, and 12 months after the procedure. The questionnaire evaluated pain intensity and frequency, analgesic intake, disability, satisfaction (with current pain level and the RF procedure), and procedure complications. Data were analyzed by using linear mixed model analysis. RESULTS: After the procedure, significant reductions of back and leg pain frequency and severity, analgesic intake, and dissatisfaction with their current level of pain occurred. Complications were minimal. Overall, 8 of 9 subjects were satisfied with the procedure. CONCLUSIONS: RF sensory ablation of the SIJ using bipolar strip lesions is a technically uncomplicated and low-risk procedure. The resulting effects on pain, disability, and satisfaction are promising. Further evaluation of this technique, including randomized controlled trials, is recommended.

Adult↗
PubMed2001

Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints.

OBJECTIVE: The aim of this study was to investigate the association between pregnancy-related pelvic pain (PRPP) and sacroiliac joint (SIJ) laxity. METHODS: A cross-sectional analysis was performed in a group of 163 women, 73 with moderate or severe (PRPP+) and 90 with no or mild (PRPP-) PRPP at 36 weeks of pregnancy. SIJ laxity was measured by means of Doppler imaging of vibrations in threshold units (TU). Pain, clinical signs and disability were assessed with visual analog scale (VAS), posterior pelvic pain provocation (PPPP) test, active straight leg raise (ASLR) test, and Quebec back pain disability scale (QBPDS), respectively. RESULTS: Mean SIJ laxity in the PRPP+ group was not significantly different from the PRPP- group (3.0 versus 3.4 TU). The mean left-right difference, however, was significantly higher in the PRPP+ group (2.2 TU) than in the PRPP- group (0.9 TU). In the PRPP- group, only 4% had asymmetric laxity of the SIJs in contrast to 37% of the PRPP+ group. Between the PRPP+ subjects with asymmetric and symmetric laxity of the SIJs significant differences were found with respect to mean VAS for pain (7.9 versus 7.0), positive PPPP test (59% versus 35%), positive ASLR test (85 versus 41%) and mean QBPDS score (61 versus 50). CONCLUSIONS: Increased SIJ laxity is not associated with PRPP. In fact, pregnant women with moderate or severe pelvic pain have the same laxity in the SIJs as pregnant women with no or mild pain. However, a clear relation between asymmetric laxity of the SIJs and PRPP is found.

Adult↗
PubMed1978

Movements in the sacroiliac joints demonstrated with roentgen stereophotogrammetry.

Using a roentgen stereophotogrammetric method, the three-dimensional movements in the sacroiliac joints were quantified in 4 patients. To provoke motion of the sacrum, changes between body positions and a test with manual pressure were used. In tests with symmetric forces on the sacrum, it in most cases rotated mainly about a transverse axis and at most approximately 2 degrees. The axis of rotation passed through the iliac bones mainly in the lower part of the iliac tuberosity. The rotations between the iliac bones and the sacrum about any of the three main axes were determined with a precision in the mean of 0.2 degrees. The distance between the two superior posterior iliac spines varied at most 0.4 mm between seven different body positions.

Adult↗
PubMed1999

Measurement of sacroiliac joint dysfunction: a multicenter intertester reliability study.

BACKGROUND AND PURPOSE: Previous research suggests that visual estimates of sacroiliac joint (SIJ) alignment are unreliable. The purpose of this study was to determine whether handheld calipers and an inclinometer could be used to obtain reliable measurements of SIJ alignment in subjects suspected of having SIJ dysfunction. SUBJECTS: Seventy-three subjects, evaluated at 1 of 5 outpatient clinics, participated in the study. METHODS: A total of 23 therapists, randomly paired for each subject, served as examiners. The angle of inclination of each innominate was measured while the subject was standing. The position of the innominates relative to each other was then derived. An intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and a kappa coefficient were calculated to examine the reliability of the derived measurements. RESULTS: The ICC was .27, the SEM was 5.4 degrees, and the kappa value was .18. CONCLUSION AND DISCUSSION: Measurements of SIJ alignment were unreliable. Therapists should consider procedures other than those that assess SIJ alignment when evaluating the SIJ.

Adolescent↗
PubMedDate not supplied

Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondylarthropathy.

OBJECTIVE: To evaluate the efficacy of periarticular corticosteroid injection of the sacroiliac joint (SIJ) in patients with seronegative spondylarthropathy in a double blind, controlled study. METHODS: 20 patients with seronegative spondylarthropathy and clinical sacroiliitis entered the study. In 10 patients one affected SIJ was treated with periarticular injection of 1.5 ml (40 mg/ml) methylprednisoloneacetate and 1.5 ml (20 mg/ml) lignocaine (MP group), whereas 10 patients received 1.5 ml isotonic sodium chloride and 1.5 ml (20 mg/ml) lignocaine (non-MP group). Clinical assessment at the onset of the study and after two months follow-up included the patients' estimation of pain in the SIJ by the visual analogue scale (VAS) and by a pain index which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the two months follow-up examination the VAS (p = 0.02) and the pain index (p = 0.01) had improved significantly in the MP group compared with the non-MP group. CONCLUSION: The results of our study indicate that the periarticular injection of methylprednisolone may be effective in the treatment of clinical sacroiliitis in patients with seronegative spondylarthropathy.

Adult↗
PubMed1991

[Innervation of the sacroiliac joint. Macroscopical and histological studies].

Macroscopical and histological studies were carried out to clarify nerve innervation of the sacroiliac joint which is believed to have a role in the development of low back pain. Eighteen Japanese adult cadavers were used for gross anatomical examination and six for histological examination of the nerve supply to the joint. The results were as follows: 1) It is suggested by the gross examination that the upper ventral portion of the joint is mainly innervated by the ventral ramus of the 5th lumber nerve. 2) The lower ventral portion of the joint was mainly supplied by the ramus of the 2nd sacral nerve or branches from the sacral plexus. 3) Lateral branches of the dorsal ramus of the 5th lumber nerve were considered to be the main nerves which innervated the upper dorsal portion of the joint. 4) The lower dorsal portion was innervated by nerves arising from a plexus composed of lateral branches of the dorsal rami of the sacral nerves. 5) The nerves which innervate the joint range in diameter from 0.292 mm to 0.997 mm, and no difference was found among those in the four subdivisions of the joint. 6) Histological examination revealed that nerve fibers and the terminals were present in the joint capsule and adjoining ligaments. The nerve fibers varied from 0.2 micron to 2.5 microns in diameter and ended with five morphologically different terminals.

Adult↗
PubMed1976

Bilateral sacroiliac joint dislocation with intrapelvic intrusion of the intact lumbosacral spine and sacrum.

Two cases of bilateral sacroiliac joint dislocation with intrapelvic intrusion of the intact lumbosacral spine and sacrum are reported. This condition is a distinct traumatic entity. The essential features of this condition are the disruption of the pelvic ring with bilateral sacroiliac dislocation. The spine as a whole descends into the depths of the pelvis. Disruption of the anterior structures but not always the pubic symphysis is apparently a prerequisite for the development of the condition. Extensive soft-tissue damage is part of the injury. The etiology is a direct crushing violence to a standing or walking patient. It is assumed that this injury is less rare than it seems, and that the main reason for not being mentioned is the rarity of the survival of the patients. As a result of success in the intensive care of the severly injured, more survivals and more reports are anticipated.

Adult↗
PubMed1996

The sacroiliac joint: anatomical study in the coronal plane and MR correlation.

The current clinical imaging technique applied to the sacroiliac joint (SIJ) is coronal Computed Tomography (CT). The aims of this study were: 1) to section the cartilage, the ligaments of the SIJ, and their relations to adjacent organs, in a coronal plane; 2) to correlate anatomical and magnetic resonance (MR) sections; 3) to extend these data in vivo. A topographic dissection of a 52 year-old female specimen was performed to identify the various components, and spatial relationships of the SIJ. Another fresh frozen 50 year-old female cadaver was chosen on CT criteria of normality, and examined with a high resolution (HR) T1-weighted spin echo sequence, in a plane parallel to the ventral limit of the first two sacral vertebrae. This cadaver was then sliced with a sliding gauge device (slice thickness: 5 mm, and device thickness: 1 mm). The SIJ of a 28 year-old nulliparous volunteer, were examined in HR MR imaging, and with a faster sequence, for comparison with the post mortem data. The slice study was correlated with conventional dissection. The continuity and thickness of the auricular cartilage, the complex fascicles of proximal ventral and dorsal sacroiliac ligaments, and distant sacrotuberous and sacrospinous ligaments, were studied. In each plane, coronal HR MR imaging studies were correlated with anatomical sections. The clinical relevance of this comparison was to extend these data in vivo. The auricular cartilage and the ligaments of the SIJ are clearly analyzed by MR imaging, which could contribute to the study of sacroiliitis.

Adult↗
PubMed1993

Staphylococcus aureus meningitis associated with pyogenic infection of the sacroiliac joint.

Although we have reported the first case of Staphylococcus aureus meningitis due to pyogenic arthritis of the sacroiliac joint, this finding is actually not surprising, given the strong association between this form of meningitis and underlying bone, joint, and soft tissue infections. The physician faced with a case of meningitis due to S aureus in a patient without a history of trauma or neurosurgical manipulation must do a prompt and thorough search for underlying infectious conditions. In the case of sacroiliitis in particular, a high index of suspicion needs to be maintained, given the difficulties and delays in diagnosis associated with this infection. Radionuclide scanning with 99mTc or 67Ga is usually helpful in the early confirmation of this condition, the presence of which may be suspected on the basis of thorough physical examination.

Anti-Bacterial Agents↗