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At least 667 records · Page 37Linked to original sources
PubMed2002

Anesthetic pain management in Siriraj Hospital: a retrospective review.

Neural blockade has been used as the single method to anesthetize a part of the body or used in combination with general anesthesia to lessen perioperative pain. Currently, nerve blocks are used for diagnostic, prognostic, therapeutic and prophylactic proposes for management of chronic, acute and cancer pain in a Pain Clinic. Reviewing the records of the 3,349 patients at Siriraj Pain Clinic, we found 2,662 and 687 cases had chronic and acute pain problems respectively, and only 646 patients were treated with anesthetic interventions during 1990 to 1998. They consisted of 317 male and 329 female. The techniques included stellate ganglion block, paravertebral nerve block, celiac plexus block, hypogastric plexus block, mesenteric plexus block, sacral nerve block, epidural steroid, lumbar sympathectomy, first and second thoracic sympatholysis, facet joints injection, sacroiliac joint injection, intravenous regional block with guanethidine or ketanserin, continuous opioid infusion, intravenous lidocaine infusion, and a phentolamine test. The common problems of pain included brachial plexus injury, chronic spinal pain, herpetic neuralgia, ischemic pain, central post-stroke pain, and causalgia. This retrospective review showed that 38 per cent of them reported 50 per cent pain relief with temporary effect. 34 per cent experienced good and satisfactory pain relief while 9 per cent reported excellent pain relief. 17 per cent did not gain benefit from any technique of pain relief and about 2 per cent could not be evaluated due to they did not return for follow-up. One serious complication after thoracic sympatholysis was brachial plexus injury. The neural blockade is proven to be one of the useful adjunct in the management of chronic pain but the selection of the technique is subjected to its critical appraisal.

Female↗
PubMed1992

[Diagnosis, classification and indications for surgical treatment of pelvic ring fractures].

In cases of high-energy trauma, it is well known that there is a high incidence of pelvic fractures. The mechanism of injury, inspection and physical examination of the victim at the accident site direct attention to a pelvic fracture. In most cases, the first radiological examination (A.P. X-ray of the pelvis, oblique view of the obturator and oblique view of the ilium) shows the extent of the bony lesion. The diagnosis and therapy of lesions of the urinary tract, of intra-abdominal organs and blood vessels are vitally important. For the definitive operation of unstable pelvic ring fractures, additional diagnostic means, i.e., CT scans to distinguish posterior instability, can be necessary. Osteosynthesis can only be successful in the pelvis if one has a biochmechanical understanding of the physiological flux of force from the neck of the femur via the acetabular fossa to the sacroiliac joint. The sacroiliac ligaments have a particularly important support function. For assessing stability and classifying the traumatic patterns, it is helpful to use Pennal's classification, which takes the direction of the action of force into account. Three basic forms can be distinguished: anteroposterior compression, lateral compression and vertical avulsion. Depending on the extent of the traumatic pattern, one can distinguish three subtypes: type 1 is treated conservatively while types 2 and 3 require surgical treatment. The biochmechanics, traumatic patterns, diagnostics and treatment techniques applied are described clearly and with good illustrations.

Biomechanical Phenomena↗
PubMed1992

[Pelvic girdle fractures--must they be stabilized?].

Osteosynthesis can only be successful in the pelvis if one has a biomechanical understanding of the physiological flux of force from the neck of the femur via the acetabular fossa to the sacroiliac joint. The sacroiliac ligaments have a particularly important support function here. For assessing stability and classifying the traumatic patterns it is helpful to use Pennal's classification, which takes the direction of the action of force into account. Three basic forms can be distinguished: anteroposterior compression, lateral compression and vertical avulsion. Depending on the extent of the traumatic pattern one can distinguish three subtypes. Type 1 is treated conservatively while types 2 and 3 require surgical treatment. The traumatic patterns and treatment techniques applied are described clearly and with good illustrations.

Biomechanical Phenomena↗
PubMed2000

Precision diagnostic disc injections.

Spinal pain is an important public health problem affecting the population indiscriminately. The structures responsible for pain in the spine include the vertebrae, intervertebral discs, spinal cord, nerve roots, facet joints, ligaments, muscles, atlanto-occipital joints, atlanto-axial joints, and sacroiliac joints. Even though disc herniation, facet joints, strained muscles, and torn ligaments have been attributed to be the cause of most spinal pain, either in the neck and upper extremities, upper and mid back, or low back and lower extremities, disorders of the disc other than disc herniation have been implicated more frequently than any other disorders. Once stifled by misinformation, discography now has applications in a number of clinical settings. While cervical and lumbar discography is well studied and well known, thoracic discography is in its nascent stages of clinical application. The value of discography lies in its ability to produce pain and thereby identify a "pain generator." This allows treatment to be based on the specific cause of pain. The three primary components of diagnostic disc injection are: provocation/analgesia, discometry, and nucleography. Despite the recent exponential growth of noninvasive spinal technology, diagnostic disc injection remains the sole direct method for definitively determining whether a disc is a physiological pain generator. It is clear that discography is a safe and powerful complement to the overall clinical context.

Journal Article↗
PubMed2004

Pyrexia due to pyogenic sacroiliitis with iliopsoas abscess after spinal cord injury.

STUDY DESIGN: Single case report. OBJECTIVES: To present an unusual cause of fever in a patient with spinal cord injury (SCI). SETTING: University Hospital, Belgium. METHODS: A 52-year-old man with a complete T9 paraplegia was admitted to hospital with a 7 day history of fever above 39 degrees C without pain and without gastrointestinal, urinary, or respiratory complaints. The patient had had a flap coverage for a sacral pressure ulcer 6 months prior to admission. RESULTS: Bone scintigraphy demonstrated markedly increased activity in the left sacroiliac joint. Computed tomography (CT) revealed an infection of the left sacroiliac joint with a large abscess involving the iliopsoas muscle. The responsible organism, Pseudomonas aeruginosa, was isolated from abscess liquid obtained by CT-guided aspiration. We postulated that P. aeruginosa had colonized the eschar and, due to the proximity, infected the sacroiliac joint and the adjacent iliopsoas muscle. Prompt intravenous antibiotic therapy ensured clinical improvement and radiological regression. CONCLUSION: Pyogenic sacroiliitis is a relatively rare condition that may be difficult to diagnose in patients with normal sensation, and even more so in SCI patients. As far as we know, psoas abscess associated with pyogenic sacroiliitis has never been described in SCI patients. This infectious pathology must be kept in mind in SCI patients with fever of unknown origin and with a history of sacral eschar.

Amikacin↗
PubMed1993

[Diagnostic methods of detection of early degenerative changes in the lumbo-coccygeal triangle in relation to the use of prostheses].

In the evaluation of early degenerative changes of lumbocoxal triangle, that is of sacroiliac joints with the patients with above knee amputations, two diagnostic methods were used: X-ray method and scintigraphic method. X-ray method: pictures of sacroiliac joints according to Bársony as morphologic method show first degenerative changes in the period of six to twelve months after amputation. Scintigraphy of sacroiliac joints and the determination of s.i. index as functional method has established the degree of degenerative changes, that is their progression or stagnation. It has been seen that the degree of degenerative changes of sacroiliac joints in not the same with the patients who regularly use prostheses and those who do it occasionally. With the patients who use the prosthesis all the time, the degenerative changes stagnate.

Adult↗
PubMed1998

The morphology and biomechanics of latissimus dorsi.

OBJECTIVE: To determine the morphology of the latissimus dorsi in order to assess its actions on the shoulder, the lumbar spine and the sacroiliac joint. DESIGN: A dissection study accompanied by an analysis of the force vectors of the muscle and its parts. BACKGROUND: Although recognised as a muscle of the shoulder, latissimus dorsi has been accorded a role as an extensor of the lumbar spine, and is said to brace the sacroiliac joint. Consideration of the anatomy of the latissimus dorsi suggests that the magnitude of these actions has been overstated. METHODS: The fascicular anatomy of the latissimus dorsi was determined by dissection in five adult cadavers. The size, attachments, and orientation of each fascicle were determined. By applying a force coefficient the maximum force of each fascicle was estimated from its physiological cross-sectional area. By summing the forces and moments of each fascicle the maximum force exerted by latissimus dorsi was calculated for its actions on the shoulder, the lumbar spine, and the sacroiliac joint. RESULTS: The latissimus dorsi was found to consist of a series of fascicles with segmental attachments to the lower six thoracic spinous processes, the L1 and L2 spinous processes, the lateral raphe of the thoracolumbar fascia, the iliac crest and the lower three ribs. These fascicles were uniform in size across a given muscle but varied from specimen to specimen. The maximum total force exerted by the latissimus dorsi on the shoulder was estimated to range between 162 and 529 N, but in view of the attachments of the muscle, only a portion of that force can be exerted on the lumbar spine. The maximum extensor moment exerted on the lumbar spine was calculated to be 6.3 N m. The maximum force exerted across the sacroiliac joint was calculated to be 30 N. CONCLUSIONS: The latissimus dorsi is designed to move the upper limb or to raise the entire trunk in brachiation. Its possible contribution to extension of the lumbar spine is trivial as is its capacity to brace the sacroiliac joint. RELEVANCE: Despite assertions and concerns to the contrary, the latissimus dorsi is of little mechanical importance in the lumbosacral region.

Journal Article↗
PubMed2004

Ultrasonographic examination of the equine sacroiliac region.

REASONS FOR PERFORMING STUDY: Little information exists about the normal ultrasonographic appearance of the equine sacroiliac region, but knowledge of the ultrasonographic anatomy is necessary to understand the possible pathological changes in sacroiliac diseases. OBJECTIVES: The normal ultrasonographic appearance of soft tissues and bony structures of the sacroiliac region in horses was studied in order to establish clinically relevant reference parameters. METHODS: Thirteen cadaver specimens were examined using a transcutaneous approach above the tubera sacrale to image the dorsal sacroiliac ligament and the tendon of the longissimus dorsi muscle. A rectal approach was used to outline the sacroiliac joint and its adjacent structures. Thirteen sound horses with no history of back pain were examined following the same protocol as for the post mortem examinations. RESULTS: The tendon of the longissimus dorsi muscle can clearly be distinguished from the dorsal sacroiliac ligament, especially in longitudinal images. Transrectal examination of the sacroiliac joint consists of evaluation of the bony surfaces of the sacrum and ilium in comparison with the contralateral side. CONCLUSIONS: Ultrasonographic examination of the sacroiliac region provided clear images of the caudomedial border of the sacroiliac joint and its adjacent structures and is a useful aid in the diagnosis of sacroiliac joint diseases and adjacent lesions. The study has shown ultrasonography to be a useful method for examining and differentiating the longissimus dorsi muscle and the dorsal sacroiliac ligament at the level of the tubera sacrale. POTENTIAL RELEVANCE: Diagnostic ultrasound is available to most practitioners. These reference ultrasound parameters may help to improve the diagnosis of sacroiliac diseases.

Animals↗
PubMed2006

[Internal fixation for pelvic posterior ring lesions].

OBJECTIVE: To explore the choice for the internal fixation in treatment of pelvic posterior lesions. METHODS: From May 2000 to June 2005, the treatment was given to 40 patients (28 males, 12 females, aged 21-58 years) with pelvic posterior ring fracture and dislocation. Of the patients, 23 had a traffic accident, 11 had a crush injury and 6 had a fall. As for the state of an injury to the pelvic posterior ring, 22 patients had dislocation of the sacroiliac joint, 12 had a sacrum fracture dislocation, and 6 had an ala iliac fracture and dislocation of the sacroiliac joint. According to the Denis (1988) classification, fracture of the (sacral region I was found in 6 cases, fracture of the sacral) region II in 3 cases, and fracture of the sacral region III in 3 cases. As for the complication of the pelvic front ring fracture: separation of the symphysis pubis was found in 14 cases, fracture of the superior ramus and inferior ramus of the pubis on one side in 10 cases. The two-side superior ramus of public and inferior ramus of pubis in 8 cases, homopleural acetabular fracture on one side in 4 cases, acetabular fracture on one side and contralateral superior ramus and inferior ramus fracture of the pubis in 3 cases, and acetabular fracture on the opposite side in 1 case. As for the operation, 28 patients underwent the still-plate internal fixation of the sacroiliac joint from anterior at 24 h to 15 days after the injury, 2 underwent the screw internal fixation of the sacroiliac joint from posterior, and remaining 10 underwent the internal fixation by the Galveston Technique associated with the ISOLA system. The therapeutic results were analyzed. RESULTS: The follow-up of the 40 patients for 6 months to 3 years revealed that before operation 3 had a sacral plexus nerve injury, and after operation 1 patient developed perineum numbness and urinary incontinence, 1 developed claudication,3 developed posterior urethral fragmentation, and 2 developed urinary bladder rupture; however, they had a complete recovery after the reparative surgery. CONCLUSION: In treatment of the pelvic posterior ring lesions, an appropriate internal fixation can be chosen according to the type of the pelvic fracture, applicability of internal fixation, condition of the patient,equipment available, and the doctor's experience.

Adult↗
PubMed1993

A comparison of two different methods to treat hip pain in runners.

Little or no research has been performed on the physical therapy treatment of hip pain. The purpose of this study was to compare two different treatments for hip pain. Twenty runners who had primary hip pain and sacroiliac joint dysfunction, without evidence of arthritic changes, were randomly assigned to two groups. One group received a mobilization technique to the involved hip, while the other was treated with a manipulative technique known to affect sacroiliac joint dysfunction. The subjects were evaluated by using a pain questionnaire and the Faber test to determine the response of the hip joint to treatment. Data were analyzed with the Mann-Whitney U statistic for perceived pain response and with the Chi-square statistic with Yates correction for the Faber test. Results showed a significant difference in perceived pain response, as well as reproduction of pain with the Faber test, between the two groups. The results suggest that a manipulative technique designed to reduce sacroiliac joint dysfunction is an effective method to reduce hip pain. Physical therapists should evaluate the sacroiliac joint in patients with hip pain.

Adolescent↗
PubMed1988

Spondyloarthropathy in progressive ankylosis (ank/ank) mice: morphological features.

Progressive ankylosis mice rapidly develop an ankylosing spondyloarthropathy that rapidly affects all of the articulations of the vertebral column. The disorder symmetrically affects the nonsynovial synchondroses and symphyses of the intervertebral spaces, the diarthrodial synovial apophyseal and costovertebral joints, and the sacroiliac joint. These joints present a clear progression from syndesmophyte formation through joint bridging to total fusion. The similarities and differences of the disorder identified in this mouse and human spondyloarthropathies are discussed.

Animals↗
PubMed1993

[Results of surgical therapy of bacterial sacroiliitis with primary arthrodesis].

Surgical treatment of pyogenic infections of the sacroiliac joint is indicated in cases of ineffective conservative treatment, abscess formation, septicemia, and neurological deficits. Between 1983 and 1990 in nine patients surgical treatment was performed for pyogenic sacroiliitis under this criteria. The surgical procedure included joint debridement, primary arthrodesis of the sacroiliac joint using a autologous bone graft, antibiotic therapy and postoperative immobilisation. Follow-up examination of 8 patients in average 47 months postoperatively revealed excellent functional and roentgenological results in 6 patients. Two patients suffered only from mild low-back pain, none of the eight patients demonstrated signs of a recurrent infection, one patient died due to complications of a long-lasting preoperative septicemia. Regarding these postoperative follow-up results surgical therapy including primary sacroiliac arthrodesis should be early considered, because this treatment has a low complication rate and the surgical technique is easy to perform and results are excellent or good in most of the patients.

Abscess↗
PubMed2005

The mechanical effect of a pelvic belt in patients with pregnancy-related pelvic pain.

BACKGROUND: Many patients with pregnancy-related pelvic girdle pain experience relief of pain when using a pelvic belt, which makes its use a common part of the therapy, but there is no in vivo proof of the mechanical effect of the application of a pelvic belt. METHODS: The influence of a pelvic belt on sacroiliac joint laxity values was tested in 25 subjects with pregnancy-related pelvic girdle pain by means of Doppler imaging of vibrations in prone position with and without the application of a pelvic belt. The belt was adjusted just below the anterior superior iliac spines (high position) and at the level of the pubic symphysis (low position). FINDINGS: Sacroiliac joint laxity values decreased significantly during both applications of a pelvic belt (P<0.001). The application of a pelvic belt in high position decreased sacroiliac joint laxity to a significantly greater degree than the application of a belt in low position (P=0.006). The decrease of laxity significantly correlated with the decrease of the score on the active straight leg raise test (r=0.57 for the low position, P=0.003 and r=0.54 for the high position, P=0.005). INTERPRETATION: Application of a pelvic belt significantly decreases mobility of the sacroiliac joints. The decrease of mobility is larger with the belt positioned just caudal to the anterior superior iliac spines than at the level of the pubic symphysis. The findings are in line with the biomechanical predictions and might be the basis for clinical studies about the use of pelvic belts in pregnancy-related pelvic girdle pain.

Adult↗
PubMedDate not supplied

A typical low-back pain caused by an atypical etiology.

OBJECTIVE: Pain arising in the lumbar spine can have many etiologies, nearly 80% of which cannot be established with certainty. We present a very rare cause of back pain. CASE REPORT: A 54-year-old woman presented with a 2-month history of low-back pain and right-sided sciatica. Conventional analgesics, physiotherapy, and epidural steroid application had failed to provide relief. She had tenderness of the right sacroiliac joint. Diagnostic fluoroscopic-guided sacroiliac-joint injection with lidocaine did not produce symptomatic relief. Pelvic ultrasonography and magnetic resonance imaging showed septated multilocular hydatic cysts along the sciatic nerve. Surgical exploration noted multicystic lesions along the sciatic nerve woven to the nerve. Her low-back pain disappeared completely after the operation. She received oral albendazole for 6 months to prevent any recurrence of the disease and remains asymptomatic. CONCLUSION: Hydatid cyst can be included in the differential diagnosis of lumbar back pain, especially in the endemic areas.

Albendazole↗
PubMed2003

A prospective study of early diagnostic investigations in the diagnosis of ankylosing spondylitis.

This study was designed to assess the relative values current of locally available investigations in the early diagnosis of inflammatory sacroiliitis. Consecutive patients attending routine rheumatology clinics in Aberdeen clinically considered by consultant rheumatologists to have inflammatory back disease but with insufficient criteria to firmly establish a diagnosis of ankylosing spondylitis were included. Patients were assessed using a standard questionnaire, clinical examination of spinal movements, plain radiology of the sacroiliac joints, computerised tomographic scanning of the sacroiliac joints and HLA-B27 typing. Patients were systematically followed up using repeated clinical and radiological examination for five years. Plain film evidence of grade 2 radiological sacroiliitis (bilateral or unilateral) was found to be the most reliable predictor for the development of ankylosing spondylitis satisfying the New York criteria at 5 year follow up. CT scanning and HLA-B27 typing were of no added value in this series and the clinical questionnaire lacked specificity. It is concluded that the combination of clinical history, examination and plain film radiology are currently reliable criteria for diagnosing the subsequent development of ankylosing spondylitis satisfying established criteria.

Adult↗
PubMed2004

Management of chronic low back pain.

Treatment for chronic low back pain (pain persisting for over 3 months) falls into three broad categories: monotherapies, mulitidisciplinary therapy, and reductionism. Most monotherapies either do not work or have limited efficacy (eg, analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants, antidepressants, physiotherapy, manipulative therapy and surgery). Multidisciplinary therapy based on intensive exercises improves physical function and has modest effects on pain. The reductionist approach (pursuit of a pathoanatomical diagnosis with the view to target-specific treatment) should be implemented when a specific diagnosis is needed. While conventional investigations do not reveal the cause of pain, joint blocks and discography can identify zygapophysial joint pain (in 15%-40%), sacroiliac joint pain (in about 20%) and internal disc disruption (in over 40%). Zygapophysial joint pain can be relieved by radiofrequency neurotomy; techniques are emerging for treating sacroiliac joint pain and internal disc disruption.

Analgesia↗
PubMedDate not supplied

[Evaluation of a quantitative diagnostic sacroiliac bone scan index in cases of chronic low back pain in young male adults].

Quantitative bone scan of the sacroiliac joints has long been an established diagnostic method in cases of chronic low back pain (LBP), though its value has been questioned due to the significant overlap of the numerical values between patients with inflammatory sacroiliitis and healthy controls. In an effort to solve this dissent, 133 young male adults aged 18-36 years were studied. We thus aimed to have a relatively homogenous population sample that would include the age that many sacroiliac diseases appear. Thirty-two of our patients had chronic, inflammatory disease of non-infectious origin, as tested by clinicolaboratory procedures (Group A), 29 had mechanical (non-inflammatory type) LBP (Group B), and 72 had been scintiscanned for reasons irrelevant to spine disease (Group C). The members of each group were also classified in three subgroups (a, b and c) according to age. The protocol of planar static multispot bone scan was applied to all three Groups. Three regions of interest (ROI), two on the sacroiliac joints plus one over the L4 vertebra were drawn and finally a non-dimensional numerical parameter called "lambda" was extracted by the equation lambda=total counts/total pixels of the "hottest" of the two sacroiliac joints area divided by the counts/pixels corresponding to the L4 values (lambda=SI/L4). The statistical analysis showed negative correlation of lambda with age in all three groups (P~0.04 for Group A, P~0.012 for Group B and P~0.05 for Group C). When all Groups were examined regardless of age, lambda appeared significantly different (P<0.0005) between Groups A and C, as well as between Groups A and B (P~0.002) but there was no difference between Groups B and C (P~0.12). When the members of each group were analyzed according to age, the paired difference of lambda stirred with remarkable vagueness along the whole spectrum of statistical significance. Conclusively, lambda seems to decrease with ageing at ages ranging from 18 to 36 years (P</=0.05), regardless of the presence of LBP. Additionally, the clinical utility of this parameter seems to be confined to distinguishing patients with LBP due to inflammation from normal people (P<0.0005). This parameter (lambda) may not be used to distinguish patients with LBP of the mechanical type. Using two ROI from the sacroiliac joints instead of one and comparing this to the ROI of the O4 vertebra and also by using a homogenous population one may come to more valid statistics supporting the use of this quantitative factor (lambda), which we describe. To our knowledge, there is no other study of the SI to O4 uptake ratio in young male adults with chronic low back pain mentioned in the literature. A larger population sample would be necessary to accurately standardize the normal value range of lambda. Finally, due to the broad range of normal values of the abovementioned parameter, it is suggested that every nuclear medicine department uses its own normal values of lambda, according to the above methodology.

Adolescent↗
PubMed1993

Epiphysial ossification centres in iliosacral joints: anatomy and computed tomography.

Bilateral apparently bony structures of different forms and sizes located in the inferior and superior ventral parts of the sacroiliac joints were observed on axial CT images of the pelvic region of juvenile patients. No other pathological changes were noted in the sacroiliac joints of these individuals. In one patient the bony structures could also be seen on a conventional plain radiograph. We also examined 3 juvenile autopsy specimens of this joint using radiology, CT, macroscopical evaluation and histology. In two of them, structures could be detected on the CT scans which were similar to those observed in the young patients. Macroscopic investigations revealed the structures to be secondary ossification centres located in the articular cartilage of the lateral part of the os sacrum at the levels of the first and third sacral segments. According to older anatomical literature, these epiphysial ossification centres contribute to the auricular surface of the lateral part of the os sacrum and the free lateral surface of the inferior sacral parts. They can be observed between the ages of 12 and 25 years and begin to synostose with the lateral part around the age of 18 years. In macerated juvenile specimens of the bony pelvis, free ossicles were not detectable in the region of the sacroiliac joints. Histological peculiarities of the ossification process observed are discussed. These physiologically occurring ossification centres are to be differentiated from pathological alterations appearing as bony or bone-like structures on CT scans.

Adolescent↗