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At least 379 records · Page 21Linked to original sources
PubMed1999

CT-guided sacroiliac joint injections.

Confusion surrounding low back pain syndrome may partially be resolved in a select small group of patients by instituting a provocative intraarticular injection of a combination of a local anesthetic and a steroid. This approach enables one to determine whether the sacroiliac joint (SIJ) is the site of origin of the low back pain syndrome. We carried out a study of 71 computed tomography (CT)-guided injections in 58 patients with noninflammatory etiology. The injection was confirmatory to the SIJ abnormalities in 64 (90.1%) joints. The effect wore off in 2-14 days in 90% of the patients. We conclude that CT guidance is the best method of precise needle placement, and thus CT-guided anesthetic injection is the most specific confirmatory test for diagnosing the SIJ arthritis. In addition, in noninflammatory conditions, the role of intraarticular injection is primarily for diagnostic purposes and it has little or no therapeutic benefit.

Adult↗
PubMed2002

[Sacroiliac joint blockage caused by bedding after spinal anaesthesia can simulate a neurological complication].

Back pain after spinal anaesthesia is often attributed to the spinal anaesthesia and the accompanying puncture. We demonstrate two cases where this problem was not caused by spinal anaesthesia but was due to sacroiliac joint blockage caused by bedding. As far as we know, this complication has not been described yet. When taken into account, it can be treated easily and with success.

Anesthesia, Spinal↗
PubMed1998

Sacroiliac joint dysfunction in patients with imaging-proven lumbar disc herniation.

A dysfunction of a joint is defined as a reversible functional restriction of motion presenting with hypomobility according to manual medicine terminology. The aim of our study was to evaluate the frequency and significance of sacroiliac joint (SIJ) dysfunction in patients with low back pain and sciatica and imaging-proven disc herniation. We examined the SIJs of 150 patients with low back pain and sciatica; all of these patients had herniated lumbar disks, but none of them had sensory or motor losses. Forty-six patients, hereinafter referred to as group A, were diagnosed with dysfunction of the SIJ. The remaining 104 patients, hereinafter referred to as group B, had no SIJ dysfunction. Dysfunctions were resolved with mobilizing and manipulative techniques of manual medicine. Regardless of SIJ findings, all patients received intensive physiotherapy throughout a 3-week hospitalisation. At the 3 weeks follow-up, 34 patients of group A (73.9%) reported an improvement of lumbar and ischiadic pain, 5 patients were pain free. Improvement was recorded in 57 of the group B patients (54.8%); however, nobody in group B was free of symptoms. We conclude that in the presence of lumbar and ischiadic symptoms our presented data suggest consideration of SIJ dysfunction, requiring manual medicine examination and, in the presence of SIJ dysfunction, appropriate therapy, regardless of intervertebral disc pathomorphology. This could avoid wrong indications for nucleotomy.

Adult↗
PubMed1987

[Nuclear magnetic resonance tomography of the sacroiliac joint. A new examination technic in the differential diagnosis of rheumatic diseases of the lumbosacral transition].

25 patients with the clinical diagnoses of possible sacroiliitis were investigated by Magnetic Resonance Tomography (MR). Using axial or coronal tomography in a T1-weighted sequence (7 slices, 1 echo, NEX: 2, slice thickness 8 mm, TR: 600 ms, TE: 33 ms) and in a T2-weighted sequence (7 slices, 4 echos, NEX: 2, slice thickness 8 mm, TR: 1800 ms, TE: 33, 66, 99, 132 ms) we found normal sacroiliac joints in 10 patients, in 12 patients we diagnosed a sacroiliitis, in 3 patients a sacroiliac sclerosis. Descriptive evaluation and T2-calculation we showed, that MR is specific in differentiation of inflammation from sclerosis. The mean T2-relaxation time is 126 ms in healthy subjects, 320 ms in sacroiliitis and 87 ms in sclerotic areas. The results are significant in the Student-T-test (5% level). In addition the method allows the distinction of sclerosis from inflammation with a resolution of 2 mm. In evaluating sacroiliac rheumatic diseases MR may be helpful as a new imaging technique to complete the information of conventional radiography, computer assisted tomography and scintigraphy.

Adult↗
PubMed2006

Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series.

This study was a case series design. The objectives of the study were to investigate the ability of a motor learning intervention to change aberrant pelvic floor and diaphragm kinematics and respiratory patterns observed in subjects with sacroiliac joint pain (SIJP) during the active straight leg raise (ASLR) test. The ASLR test is a valid and reliable tool to assist in the assessment of load transference through the pelvis. Irregular respiratory patterns, decreased diaphragmatic excursion and descent of the pelvic floor have been reported in subjects with SIJP during this test. To date the ability to alter these patterns has not been determined. Respiratory patterns, kinematics of the diaphragm and pelvic floor during the ASLR test and the ability to consciously elevate the pelvic floor in conjunction with changes in pain and disability levels were assessed in nine subjects with a clinical diagnosis of SIJP. Each subject then undertook an individualized motor learning intervention. The initial variables were then reassessed. Results showed that abnormal kinematics of the diaphragm and pelvic floor during the ASLR improved following intervention. Respiratory patterns were also influenced in a positive manner. An inability to consciously elevate the pelvic floor pre-treatment was reversed. These changes were associated with improvement in pain and disability scores. This study provides preliminary evidence that aberrant motor control strategies in subjects with SIJP during the ASLR can be enhanced with a motor learning intervention. Positive changes in motor control were associated with improvements in pain and disability. Randomized controlled research is required to validate these results.

Adult↗
PubMed2003

MR imaging of the normal sacroiliac joint with correlation to histology.

OBJECTIVE: The microscopic study of the various components of joints provide a proper basis for understanding the nature of pathologic lesions to which they are subject and their imaging appearances. This study was designed to correlate MR imaging with a systematic histological study of the normal sacroiliac joint (SIJ), which to our knowledge is not available in the literature. DESIGN AND PATIENTS: Five male cadavers, aged 20 to 45 years, and seven male and seven female volunteers, aged 23 to 44 years, were investigated with oblique transaxial and coronal MR imaging of the SIJs. A variety of sequences including pre- and post-contrast T1 fat-saturated studies in the volunteers were used. Cryosectioning was performed in six SIJs of the five cadavers and compared with the MR images for the microscopic joint anatomy and assessed for the presence of abnormalities resembling those associated with sacroiliitis. RESULTS: Throughout the SIJ, the hyaline cartilage of the sacral bone and the proximal third of the hyaline iliac cartilage was strongly attached to the surrounding stabilizing ligaments, forming wide margins of fibrocartilage. In the distal one-third of the joint only, the margins of the iliac joint facet resemble that of a synovial joint, which include an inner capsule with synovial cells. The MR anatomy of the ventral and dorsal aspects of the SIJ was only adequately visualized at oblique transaxial MR imaging. No contrast enhancement occurred in the synovial tissue or in the cartilaginous joint space. The dorsal transition between the proximal 2/3 and distal 1/3 of the cartilaginous joint was at microscopy rich in anatomical and histological variants, including osseous clefts, cartilage and subchondral defects, and vascular connective tissue in the bone marrow. These were all recognized at oblique transaxial MR imaging and in coronal MR sectioning may resemble abnormalities. Otherwise, no erosions, bone marrow abnormalities, bone sclerosis or abnormal contrast enhancement occurred in the normal joints. CONCLUSIONS: The SIJ should be classified anatomically as a symphysis with some characteristics of a synovial joint being confined to the distal cartilaginous portion at the iliac side. Coronal MR imaging does not allow assessment of normal anatomy, variants or abnormalities of the ventral and dorsal margins of the cartilaginous SIJ.

Adult↗
PubMed1997

Tuberculous arthritis of sacroiliac joint with abscess formation: a case report.

Extrapulmonary tuberculosis at times appears to be an unusual presentation of the disease. Its incidence has not decreased, though a slow decline in pulmonary tuberculosis has been observed over the past decades around the world. The diagnosis of extrapulmonary tuberculosis is still rather difficult today. Tuberculosis of the bones and joints, which constitutes a smaller part of extrapulmonary tuberculosis, is relatively rare in documented cases and can yield variable clinical manifestations. This study describes a young male patient who developed a rare condition of tuberculous arthritis of the right sacroiliac joint, with an abscess formation over the anterior aspect of the right iliac fossa and iliopsoas muscle. The diagnosis was made by roentgenographic examinations and proved by microscopic confirmation of the presence tuberculous bacilli in drainage from the involved foci. Antituberculosis therapy was begun thereafter. Symptoms improved and the patient was regularly followed up at the Outpatient Department. It is suggested that in patients with prolonged fever and possible Mycobacterium tuberculosis infections, repeated roentgenographic and microbiological examinations are mandatory.

Abscess↗
PubMed1999

Symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy associated with McRoberts' maneuver. A case report.

BACKGROUND: McRoberts' maneuver is often used prophylactically with the onset of active maternal expulsive efforts or immediately before delivery of the fetus. CASE: A 31-year-old woman, gravida 1, para 0, at 39 + 2 weeks' gestational age, was continuously maintained in an exaggerated lithotomy position while actively pushing during the second stage of labor. Immediately following spontaneous vaginal delivery of a 3,598-g infant, the patient noted left gluteal pain and left anterior thigh dysesthesia. Orthopedic evaluation revealed a 5-cm symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy. The patient underwent closed reduction of the left hemipelvis, followed by open reduction and internal fixation of the symphysis pubis two weeks later after failing conservative treatment. CONCLUSION: Although McRoberts' maneuver is generally safe, care should be exercised with use of excessive force or prolonged placement of the patient's legs in a hyperflexed position.

Adult↗
PubMed1995

The measurements of sacroiliac joint stiffness with colour Doppler imaging: a study on healthy subjects.

RATIONALE AND OBJECTIVES: Primary peripartum pelvic and low back pain is a common complaint of females. The etiologic relation between pain and pelvic stability has been shown in previous studies, but at present there is no objective clinical testing method to evaluate pelvic stability. METHODS: In this study, a dynamic measurement method using sonoelasticity to assess the sacroiliac joint (SI) stiffness was tested in vivo in 14 healthy female volunteers. With the subjects in supine position vibrations were unilaterally applied to the anterior iliac spine. The vibrations were registered by a Colour Doppler Imaging (CDI) transducer over the ipsilateral SI joint. Since the threshold level of the apparatus has a direct relation with the power of the vibrations, the intensity of the vibrations (sonoelasticity) on the sacrum and ilium was measured indirectly in threshold units. The differences between the threshold values were accepted as the power loss of vibrations through the SI joint. One-way analysis of variance-test and T-test for paired samples were applied on the measurement results (P < 0.05). RESULTS: Statistically, the results showed a satisfactory intraindividual reproducibility and inter-individual variability. There was no significant difference between the data derived from the left SI joint and right SI joint. CONCLUSIONS: Based on the promising results on healthy female volunteers, this method will be specifically used in future studies on patients with peripartum pelvic pain.

Adult↗
PubMed2005

Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment.

Sacroiliac (SI) joint pain is a challenging condition affecting 15% to 25% of patients with axial low back pain, for which there is no standard long-term treatment. Recent studies have demonstrated that historical and physical examination findings and radiological imaging are insufficient to diagnose SI joint pain. The most commonly used method to diagnose the SI joint as a pain generator is with small-volume local anesthetic blocks, although the validity of this practice remains unproven. In the present review I provide a comprehensive review of the anatomy, function, and mechanisms of injury of the SI joint, along with a systematic assessment of its diagnosis and treatment.

Arthralgia↗
PubMed1999

Four clinical tests of sacroiliac joint dysfunction: the association of test results with innominate torsion among patients with and without low back pain.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the association between innominate torsion (asymmetric anteroposterior positioning of the pelvic innominates) and Gillet, standing forward flexion, sitting forward flexion, and supine-to-sit tests. SUBJECTS: A sample of 21- to 50-year-old patients with low back pain (n=150) and a comparison group of patients with upper-extremity impairments (n=138) were recruited from outpatient physical therapy facilities. METHODS: The association of single and combined test results with innominate torsion (calculated from pelvic landmark data) and with presence or absence of low back pain were estimated via odds ratios, sensitivities, specificities, and predictive values. RESULTS: Individual test sensitivities were low (8%-44%), as were negative predictive values (28%-38%), for identifying the presence of innominate torsion. Combining tests and controlling for sex, age group, leg-length difference, or iliac crest level did not improve performance characteristics. The associations of test results with low back pain were weak, with the exception of the Gillet test (odds ratio=4.57). CONCLUSION AND DISCUSSION: The data do not support the value of these tests in identifying innominate torsion, although the use of these tests for identifying other phenomena (eg, sacroiliac joint hypomobility) cannot be ruled out. Further exploration of the association of Gillet test results with low back pain is warranted.

Adult↗
PubMed2000

Reduction and fixation of sacroiliac joint dislocation by the combined use of S1 pedicle screws and the galveston technique.

STUDY DESIGN: This retrospective study was designed to analyze the results of the treatment with S1 pedicle screws and the Galveston technique of seven patients with sacroiliac dislocation. OBJECTIVES: To evaluate the effectiveness of the combined use of S1 pedicle screws and the Galveston technique for the treatment of sacroiliac dislocation. SUMMARY OF BACKGROUND DATA: Although several procedures for internal fixation of sacroiliac dislocation have been reported, there have been no reports discussing surgical treatment of sacroiliac dislocation by the combined use of S1 pedicle screws and the Galveston technique. METHODS: Seven patients with sacroiliac dislocation were treated with pedicle screws of S1 and iliac rod according to the Galveston technique. In the seven patients, the dislocation was associated with vertical displacement of the sacroiliac joint and rotational deformity of the pelvic ring. They were classified into Type-C pelvic disruption according to the Tile's classification. Three patients with disruption of the symphysis pubis underwent additional fixation of the symphysis using a dynamic compression plate. The remaining four patients were treated by the posterior procedure alone. RESULTS: The vertical displacement was completely reduced in five patients, and the rotational deformity was completely corrected in four patients. The reduction was maintained at the time of the final follow-up evaluation. There were no perioperative complications with the exception of late infection in one patient. CONCLUSIONS: The combined use of S1 pedicle screws and the Galveston technique provided immediate stability and sufficient reduction for sacroiliac dislocation in seven patients in this study. This hybrid internal fixation procedure is useful for reduction and fixation of sacroiliac dislocation associated with the vertical and rotational instability of the pelvic ring.

Adult↗
PubMed1998

Reproducibility of manual pressure force on provocation of the sacroiliac joint.

BACKGROUND AND PURPOSE: Previous studies of pain-provocation sacroiliac (SI) joint tests have revealed conflicting results. The aim of the present study was to evaluate the intra- and inter-test reliability of pressure force applied during distraction test, compression test and pressure on the apex sacralis. METHODS: Seventeen physiotherapists (PTs), median age 43 years and median clinical experience 11 years, all experienced in musculoskeletal evaluation and therapy, participated in the study. Each PT performed each test on the same healthy volunteer for 20 s, on three separate occasions, at intervals of one week using a specially constructed examination table which registered pressure force. RESULTS: The PTs were capable of maintaining a relatively constant pressure force for 20 s. The intra-test reliability was acceptable even though there were individual differences on different occasions between those PTs who used the SI joint tests often and those who seldom or never used them. The inter-test reliability was insufficient. CONCLUSIONS: The findings indicate the advantage of registering pressure force as a complement for standardized methods for pain-provoking tests and when learning provocation tests, since individual variability was considerable.

Adult↗
PubMed1978

Symphyseal and sacroiliac joint pain associated with pubic symphysis instability.

Fifty patients presenting with lumbosacral and inguinal pain were examined by routine clinical radiographic and electromyographic evaluations. All were without antecedent history of major pelvic trauma or spinal surgery but demonstrated evidence of pubic symphysis instability. Slip between the pubic rami in excess of 2 mm could be demonstrated in each with alternate leg weight bearing. Asymmetry of hip mobility on the symptomatic side with a reduction in abduction and external rotation was present in 20 patients. An approach to treatment of pain associated with pubic symphyseal and associated sacroiliac joint instability is described, combining both intraarticular steroids, lumbosacral supports and physical therapy modalities.

Adolescent↗
PubMed2002

[Fat at sacroiliac joints: MR imaging findings (comparison and analysis of 18 volunteers and 52 patients with ankylosing spondylitis)].

OBJECTIVE: In aid of MR imaging diagnosis of ankylosing spondylitis (AS), MRI findings of sacroiliac (SI) joints in volunteers were compared with those in patients with AS, with special reference to the fat findings. METHODS: 18 normal volunteers and 52 AS patients underwent the MRI examinations with the same protocols, i.e., SE T1WI, FSE T2WI, GE T2*WI sequences were taken using a 0.3T imager. All the images were observed and analyzed by two radiologists. RESULTS: Symmetric or patchy distribution fat component either in sacrum and/or ilium was detected in 52.8% of SI joints of volunteers. Thin zone distribution of fat was seen in 35.6% of SI joints of AS patients, which was adjacent to the erosion and sclerosis. In another 25.0% of SI joints of AS patients, the distribution of fat component was found similar to that of the normal volunteers. Cartilage changes were detected in 85.6% of the SI joints of AS patients. In addition, bone erosion, sclerosis and subchondral bone marrow edema were also detected. CONCLUSION: Subchondral fat infiltration associated with erosion and sclerosis should be considered as sacroiliitis. The knowledge of the characteristics of fat component could be helpful for evaluating sacroiliac joints.

Adipose Tissue↗