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PubMed1998

[Pneumocysts juxta-articular to the ilial bone and the sacral bone].

PURPOSE: The purpose of the study was to detect and safely diagnose pneumatocysts by means of computed tomography. METHODS: From September 1995 to May 1996 computed tomography of the pelvis was performed in six patients for various indications. A slice thickness of 8 mm was employed for all studies. One patient had undergone surgery for hyperparathyroidism nine years previously. Attenuation values within the coincidentally diagnosed pneumatocysts were obtained. RESULTS: We found a total of 14 pneumatocysts juxtaarticular to the sacroiliac joint. Three patients demonstrated a bilateral intraarticular vacuum phenomenon, yet a joint communication was not found. The lesions did not coincide with inflammation, tumour or trauma. CONCLUSION: Pneumatocysts are benign bone lesions associated with arthrotic changes of the sacroiliac joint. Computed tomography is the modality of choice for the diagnosis of pneumatocysts.

Aged↗

PubMed1998

[Postpartum septic arthritis. Two case reports].

Nongonococcal septic arthritis can occur during the postpartum period. We report two cases, one involving the wrist and the sacroiliac joints and the other the pubic symphysis. The difficulty of initial diagnosis in the postpartum period is emphasized. This pathology is uncommon and may begin insidiously. The sacroiliac joint is particularly at risk for postnatal sepsis, but its deep localization hinders investigations. Besides the classical obstetrical infectious assessment (blood cultures, urine culture, vaginal sample, white blood cell count and CRP) and radiological investigations, joint puncture is needed to isolate the causal infectious agent. Joint immobilization in combination with major 3-month antibiotic therapy is usually successful, generally with no sequellae.

Adult↗

PubMed1976

[HL-A W27 antigen and atypical rheumatic pelvispondylitis].

The authors report 26 cases of atypical inflammatory rheumatism in which the discovery of HL-A W27 antigen indicated the possibility of atypical ankylosing spondylarthritis. These patients included 17 men and 9 women with an average age of 35.6 years. The clinical symptoms included :--pelvic or vetebral signs alone in 8 cases,--pelvic or vertebral signs combined with peripheral inflammatory rheumatism, the latter being always cleaarly evident, in 9 cases,--extravertebral signs alone without any involvement of the vertebral column or of the sacroiliac joints in 9 cases (8 cases of peripheral inflammatory rheumatism, 1 case of talalgia). The vertebral radiograms were normal in 84 percent of cases. The sacroiliac joints were clear radiologically in 65 percent of cases. In the other cases the lesions, generally unilateral, were extremely discrete. In all the cases, the Waaler-Rose reaction was negative. The therapeutic test with non-hormonal anti inflammatory products were generally positive. The evolution of the condition confirmed the diagnosis of rheumatic pelvispondylitis in 2 cases. The patients have been under observation for insufficient time to be sure whether all the cases presented represent authentic cases of ankylosing spondylarthritis that were at first atypical. The authors emphasize the high percentage of female cases (38 percent) the high frequency of extra-vertebral manifestations. They also emphasize the value of looking for HL-A W27 antigen in patients with atypical inflammatory rheumatism.

Adolescent↗

PubMed1993

Forces exerted during spinal manipulative therapy.

Spinal manipulative therapy has been widely recognized in the medical fields as a conservative treatment modality for spinal dysfunction and pain. Spinal manipulative therapy consists of an application of a thrusting force on a specific part of the spine in a well-defined direction. The magnitude of this force has been associated with positive treatment effects, such as realigning vertebral bodies, mobilizing spinal joints, relaxing back musculature through reflex pathways, and producing a respiratory burst. However, direct force measurements during spinal manipulative therapy in a clinically relevant situation have not been performed to date. The purpose of this study was to measure the forces exerted onto patients during spinal manipulative therapy on various locations of the spinal column. Force measurements were obtained using a thin, flexible pressure mat. The results indicate that peak and preload forces are considerably smaller for spinal manipulative therapy performed on the cervical spine compared to corresponding values obtained on the thoracic spine and sacroiliac joint. Furthermore, for treatments on the thoracic spine and sacroiliac joint, a significant relation was found to exist between preload and peak forces.

Biomechanical Phenomena↗

PubMed1975

Investigation of sacroiliac disease: Comparative evaluation of radiological and radionuclide techniques.

An attempt has been made to improve diagnostic precision in a group of diseases associated with inflammation of the sacroiliac joints, by using a 99mTechnetium stannous pyrophosphate bone scan. Inflammation of these joints is associated with osteoblastic activity and is reflected by an increase in the uptake of radionuclide, which can be precisely quantitated. The uptake was markedly above the range of normal in patients with active ankylosing spondylitis (AS), and also in a number of patients with possible AS, psoriasis, and Reiter's syndrome. However, patients with Grade 4 radiological changes of the sacroiliac joints frequently had normal scans. This technique may be useful in the early diagnosis of sacroiliitis, and the nosological implications of the changes in patients with Reiter's syndrome and psoriasis are of interest.

Arthritis, Reactive↗

PubMed1982

Tomography for evaluation of sacroiliitis.

The radiographs and charts of 18 patients were reviewed to determine if sacroiliac joint tomography clarified the equivocal or clinically inconsistent findings of other imaging procedures. In six of eight patients with proven sacroiliitis, tomography detected joint erosions or sclerosis that were not detected on routine pelvis radiographs. In the other 10 patients, tomography excluded sacroiliitis which had been initially suggested by plain radiographs (four patients), quantitative sacroiliac scintigraphy (three patients), or clinical findings (three patients). The estimated average skin radiation exposure was 1.27 R (0.33 mC/kg) per tomographic section. The authors conclude that tomography improves delineation of sacroiliac joint abnormalities, but its use should be restricted to problem cases because of the high radiation exposure.

Adolescent↗

PubMed1987

Quantifying the effects of spinal manipulations on gait, using patients with low back pain: a pilot study.

A pilot study was performed to investigate the effects of chiropractic treatment on the gait of one patient with a chronic sacroiliac joint syndrome. Qualitative and quantitative measures were used to describe pain, sacroiliac joint mobility, functional ability and gait patterns of this patient before and after receiving chiropractic treatment, and throughout the rehabilitation period. For this patient, chiropractic treatment reduced the low back pain and was associated with significant changes in selected gait parameters. A study involving 10-20 subjects is under way to possibly generalize the findings of this investigation.

Adult↗

PubMed1992

[Pelvic insufficiency during pregnancy. Is pelvic girdle relaxation an unambiguous concept?].

Pelvic insufficiency during pregnancy, pelvic girdle relaxation, is defined as a condition with pain at the pubic symphysis and/or the sacroiliac joint developing in connection with pregnancy or delivery. No unambiguous criteria for the diagnosis of pelvic girdle relaxation exist but the following findings occur: Direct tenderness at the pubic symphysis and/or sacroiliac joint, waddling gait, pain on change of position, positive Trendelenburg's sign, iliac compression test, iliac gapping test and sacral pressure test. The frequency is 7.6-18.5 per 1000 deliveries. The incidence is increased in multiparae and women with occupations which strain the back. Recurrence occurs in 41-77%. The condition appears for the first time usually in the 5th-8th months of pregnancy. The majority of patients recover shortly after delivery but in some a condition of prolonged pain persists. The cause of pelvic girdle relaxation is unknown. Hormonal and biomechanical factors are considered to be of significance. No increased mobility in the pelvic joints nor general hypermobility have been demonstrated. Treatment is symptomatic and consists of information, instruction in relief and psychosocial support. Exercises and a trochanter belt may be useful. No controlled investigations of the value of treatment are available.

Back Pain↗

PubMed2001

Pelvis and hip joint injuries as a reconstructive factors in car-to-pedestrian accidents.

The pelvic girdles of 371 pedestrian victims of road traffic accidents were evaluated during postmortem examinations. Additionally, 144 hip joints were opened. The pelvic injuries were found in 28% of the pedestrians hit exclusively in their upright position and 52% of the victims run over by a vehicle. The side of the body hit by a car was determined on the basis of the location of blood suffusions within the subcutaneous tissues and muscles of lower limbs as well as the character of injuries found in the knee and upper ankle joints. The findings were verified with the data from court records. It was shown that the injuries of the sacroiliac joints or vertical fractures of the posterior parts of iliac bones were useful parameters for determining the side (left or right) of the body hit by a vehicle. Moreover, it was found that a direct impact on the hip region was evidenced by the ipsilaterally localized fractures of the iliac ala, central hip fractures and intraosseous blood suffusions within the greater trochanter of the femur. The external dislocations of the hip joints (always) and bilateral injuries to the sacroiliac joints (usually) were observed in the victims run over by vehicles.

Accidents, Traffic↗

PubMed1997

[Sacroiliitis: the key symptom of spondylathropathies. 1. The clinical aspects].

Seronegative and HLA B27-associated spondyloarthropathy (SpA) is a heterogeneous disease, so far without a clear origin. The term comprises five clinically defined subcategories: ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), inflammatory bowel disease-associated arthritis and undifferentiated spondyloarthropathy (uSpA). Sacroiliitis, an inflammatory involvement of one or both sacroiliac joints, is the key symptom of all spondyloarthropathies. Sacroiliitis is often associated with inflammatory back pain, manifest as deep nocturnal back pain that is improved by exercise. The pathogenesis of SpA and the reason for the tropism for the sacroiliac joints is still obscure. A genetic background of an initially bacterial triggered infection seems to be most likely.

Diagnosis, Differential↗

PubMed2006

An unusual case of osteoid osteoma clinically mimicking sacroiliitis.

Osteoid osteoma is one of the unusual causes of musculosceletal pain. A case of a 21-year-old man who had low back and hip pain radiating to the posterior thigh for 3 years is presented. Pain was worse at night but reduced with the use of nonsteroidal anti-inflammatory drugs. Straight leg raising test was negative. Patrick-Fabere and sacroiliac compression tests were positive on the right. Neurological examination was normal. Lumbar spinal and pelvic radiographs were normal except for sclerosis at the inferior half of the iliac bone adjacent to the right sacroiliac joint. Sedimentation rate, C-reactive protein, and whole blood counts were normal. Bone scan showed nonspecific increased uptake. Computed tomography revealed the presence of diffuse sclerosis at inferior half of the right iliac bone extending to medial border of sacroiliac joint with subcortical osteolytic region and centrally hyperdense sclerotic nidus inside.

Adult↗

PubMed1988

Effect of imaging time on the values of the sacroiliac index.

Quantitative scintigraphy of the sacroiliac joints was performed in a group of normal subjects and a group of subjects with unilateral and bilateral sacroiliitis. The aim of the study was to determine whether the time intervals of imaging had any effect on the values of the sacroiliac index. Imaging was performed every 30 min up to 300 min and the indices were calculated at the time intervals mentioned. We found that the values of the sacroiliac index increased in the group of normal subjects until 150 min after the application of the radiopharmaceutical, and that in the group of subjects who had sacroiliitis they increased until 210 min. The results show that the time interval optimal to quantitative sacroiliac joint imaging is at least 3 1/2 h after administration of the radiopharmaceutical.

Adolescent↗

PubMed1995

Axial skeletal changes in paralysed patients may mimic ankylosing spondylitis.

Patients with paralysis may develop radiographic changes in the axial skeleton and sacroiliac joints that resemble those seen in ankylosing spondylitis. These similarities can result in confusion when evaluating paralysed patients with back pain. We report on a patient with paralysis secondary to amyotrophic lateral sclerosis who developed back pain, apparent sacroiliac joint fusion, and a 'bamboo spine', leading to the misdiagnosis of ankylosing spondylitis. Serial radiographs of the bony changes in our patient are presented, along with a brief review of the literature on axial skeletal abnormalities in paralysis and a discussion of the subtle changes that distinguish immobilization spondyloarthropathy from ankylosing spondylitis.

Diagnosis, Differential↗

PubMed1982

Detection of sacroiliac injury by bone scanning in fractures of the pelvis and its clinical significance.

Fifteen patients with stable pelvic fractures were investigated by technetium bone scanning of the pelvis and subsequently reviewed to study their recovery from this injury. Eleven of these patients had a significantly raised uptake of isotope over the ipsilateral sacroiliac joint suggesting a bone injury in this region, probably as a result of micro-avulsion fractures. All patients, with one exception, made a full recovery from their fractures within 4 months. We conclude from this that the region of the sacroiliac joint is frequently injured in isolated fractures of the pubic rami, but in the short term this has a good prognosis.

Adolescent↗

PubMed1999

The potential role of brain asymmetry in the development of adolescent idiopathic scoliosis: a hypothesis.

BACKGROUND: The size asymmetry of cerebral hemispheres may predispose to head tilt and asymmetric blocking of the zygapophysial joints, potentially leading to the development of compensatory curvatures in the lower segments of the spine. OBJECTIVE: To analyze the effects of spinal manipulation, maintained by an exercise program, on the progression of idiopathic adolescent scoliosis in 2 children aged 6 and 10. CLINICAL FEATURE: The scoliosis found was 16 and 60 degrees. INTERVENTION AND OUTCOME: For diagnosis and monitoring of therapy, we recorded qualitative parameters of shoulder asymmetry, axillary line asymmetry, and scapular angle position. Manual treatment consisted of the examinations of all sliding motion in zygapophysial joints and both sacroiliac joints and removing the limitations of the sliding motions according to the method of Karel Lewit. The treatment procedure consisted of 3 or 4 manipulations within 17 months and an exercise program. The manipulation effects were maintained by the exercise program. The exercises were done in 2 or 3 sessions weekly for a year. In both patients we observed that scoliosis decompensation was successfully stopped and the effects of the correction persisted for 10 years. CONCLUSION: Brain and head asymmetry may be only a transient state, predisposing to asymmetric blocking at the atlanto-occipital level. Removal of blocking may prevent curve progression in children who had adolescent idiopathic scoliosis. The manipulative therapy may also have a promising effect on retarding curve progression when used in skeletally immature patient.

Brain↗

PubMed1998

Rheumatoid arthritis: sequences.

OBJECTIVE: Rheumatoid arthritis (RA) is an autoimmune disorder of unknown etiology characterized by symmetric, erosive synovitis and sometimes multisystem involvement. It affects 1% of the adult population and exhibits a chronic fluctuating course which may result in progressive joint destruction, deformity, disability and premature death. We review the literature data relative to the peculiar pathologic features of the disease shown by diagnostic imaging techniques. METHODS: All our patients were classified according to the diagnostic criteria of the American Rheumatism Association (1987). Plain radiography remains the diagnostic technique of choice, but ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are also used. RESULTS: Clinically articular involvement presents as pain, swelling, stiffness and motion impairment. The patients with positive rheumatoid factor are > 70% likely to develop joint damage or erosions within 2 years of disease onset. Any joint can be involved, but the proximal interphalangeal and metacarpophalangeal joints of the hand and the wrist are preferential sites, as well as the metatarsophalangeal joint of the foot, the knee and the joints of the shoulder, the ankle and the hip. Symmetry is the hallmark of joint involvement. The synovium of bursae and tendon sheaths is also affected. Soft tissue (subcutaneous nodules), muscles (weakness and atrophy) and vessels (vasculitis) may also be involved. Systemic involvement may result in Felty's syndrome, metabolic bone disorders (i.e. osteoporosis), Sjögren syndrome and pleuropulmonary abnormalities (pleural effusion, fibrosing alveolitis, constrictive bronchiolitis). The earliest abnormalities consist in synovial proliferation, soft tissue swelling, and osteoporosis. At a slightly later stage, the inflamed synovial tissue ('pannus') extends across the cartilage surface, leading to chondral erosions and small bone erosions at the joint margin (bare areas). Marginal and central erosions follow in advanced stages and finally fibrous ankylosis, joint deformities (subluxations and dislocations), fractures and fragmentations are typical findings of more advanced RA. CONCLUSION: RA is a frequent joint disorder with a characteristic radiographic picture. Joint involvement patterns are sufficiently common to permit accurate diagnosis, especially when fusiform soft tissue swelling, regional osteoporosis, marginal and central erosions and diffuse loss of interosseous space are present. Conventional radiography remains the standard imaging technique for joint studies in the patients with suspected RA. US is recommended to diagnose soft tissue involvement (joint effusion). CT is very useful for showing abnormal processes in complex joints (sacroiliac and temporomandibular joints and craniocervical junction) which are difficult to depict completely with conventional radiography. Magnetic resonance applications include the assessment of disease activity: in particular, this technique may be the only tool differentiating synovial fluid and inflammatory pannus.

Adult↗

PubMedDate not supplied

Lumbar spine pain originating from vertebral osteophytes.

BACKGROUND AND OBJECTIVES: Axial spine pain originates from a number of structures. Putative pain generators include facet joints, intervertebral disks, sacroiliac joints, and myofascial structures. Osteophytes originating from lumbar vertebral bodies in the area of the intervertebral disks may be a source of nociceptive low back pain which may respond to local injection. METHODS: Five patients with axial low back pain unresponsive to traditional treatment modalities were treated with fluoroscopic guided injection of local anesthetic and corticosteroid near large intervertebral osteophytes. RESULTS: All 5 patients experienced relief. CONCLUSION: Vertebral osteophytes may be a source of axial spine pain. Injection of painful osteophytes with a local anesthetic and corticosteroid solution may produce pain relief.

Adrenal Cortex Hormones↗

PubMed2004

Pelvic emergency clamps: anatomic landmarks for a safe primary application.

The application of the pelvic clamp as a tool for emergency stabilization of unstable pelvic ring fractures has proved to be a life-saving procedure. Using correct technique, the pelvic clamp can be applied within a few minutes after the patient's admission. To avoid severe complications (eg, pin perforation into the pelvis) during the application, anatomic landmarks for the correct pin placement have to be defined. The surface landmarks that are presently recommended for the correct pin placement are not always reliably found due to deformation of the body surface caused by swelling and hematoma. Our experience with 43 emergency applications of the pelvic C-clamp showed that reliable anatomic landmarks on the bony surface of the innominate bone could be identified to ensure correct pin placement. The ideal insertion point of the pins is an anatomic region on the lateral cortex of the ileum, where an easily palpable "groove" is formed by angulations of the lateral cortex of the iliac wing. Being increasingly used as an entry point for percutaneous transiliosacral screw fixations of sacroiliac joint injuries and sacral fractures, this region, which is close to the sacroiliac joint, represents an ideal point for maximum compression of the posterior pelvic ring. With the described technique, this "groove" can be identified easily even in emergency situations by blunt palpation with an instrument, avoiding the time-consuming use of a fluoroscope in most cases.

Emergency Medical Services↗