[Roentgenologic changes of ileosacral joints in Bechterew's disease].
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Ankylosis↗
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CT guided percutaneous fixation of sacroiliac fractures in trauma patients.
BACKGROUND: Open reduction and internal fixation of unstable pelvic fractures has been advocated to minimize complications and avoid further injury. We have recently performed CT guided percutaneous fixation of sacroiliac joints as an alternative to open repair. METHODS: From May 1, 1998 to April 30, 1999, our Level II trauma center admitted 76 patients with pelvic fractures, all due to blunt trauma. Twenty patients with unstable sacroiliac fracture-distractions underwent 22 percutaneous fixation procedures under general anesthesia in the radiology department by the third hospital day. Procedure times averaged 82 minutes. Localization with CT guidance was performed by the radiologist using 3-D images followed by percutaneous screw placement by the orthopaedic surgeon. RESULTS: There was minimal procedural blood loss and no post-procedural wound complications. There was one operative delay due to respiratory difficulties and one postoperative death unrelated to the pelvic fracture. All patients were mobilized on the first post-procedural day. CONCLUSION: CT guided fixation of unstable pelvic fractures minimizes blood loss during a short procedure with few subsequent complications and allows early mobilization of the patients.
Accidents, Traffic↗
Does the adjustment cavitate the targeted joint? An investigation into the location of cavitation sounds.
BACKGROUND: The cavitation sounds heard during chiropractic adjustments of the spine are common phenomena; yet, their location relative to the technique used is relatively untested. OBJECTIVE: The purpose of this study was to locate the cavitation sounds during the L5 spinous hook adjustment and a lower sacroiliac adjustment. The sounds were analyzed for significant difference in location relative to the 2 techniques. METHODS: Thirty asymptomatic volunteers were randomly divided into 2 equal groups. Each group represented either the spinous hook adjustment or lower sacroiliac adjustment. Subjects had 8 microphones taped to their skin, over the relevant facet and sacroiliac joints. Radiographic confirmation was used to ensure optimal placement of the microphones. Sound signals produced during the adjustments were digitized, recorded, and analyzed statistically. RESULTS: The results indicated that no statistically significant correlation existed between the anatomical location of cavitation sounds and the adjustment technique selected. CONCLUSION: Location of cavitation sounds does not appear to have a relationship with type of manipulative technique selected. Further studies using other techniques need to be performed.
Adult↗
Effective treatment of low back pain in pregnancy.
OBJECTIVE: To assess the possible cause of low back pain in pregnancy and develop a management program. METHOD: All women attending a rural general practice for antenatal care were asked about back pain. They were tested for pain of lumbar and sacroiliac origin and if positive were treated with mobilising technique and home exercise. RESULTS: Of the 20 patients identified as having low back pain, the iliolumbar ligament was identified in three while the sacroiliac joint was suggestive in the remainder. After three visits 15 had no pain and the rest had more than a 50% improvement in their pain. CONCLUSION: Low back pain in pregnancy is likely to be due to sacroiliac dysfunction which can be significantly improved with mobilisation.
Female↗
The clinical spectrum of osteoarticular tuberculosis in non-human immunodeficiency virus patients in a defined area of northwestern Spain (1988-1997).
OBJECTIVE: To examine the frequency and clinical manifestations of osteoarticular tuberculosis in non-human immunodeficiency virus (HIV) patients during the past 10 years in a northwestern area of Spain. METHODS: The charts of all patients older than 14 years of age, not HIV-infected, and diagnosed as having osteoarticular tuberculosis at the Xeral-Calde Hospital from 1988 through 1997 were reviewed. All patients were residents of the region of Lugo. The diagnosis of osteoarticular tuberculosis was made on the basis of a positive culture for Mycobacterium tuberculosis from synovial fluid, joint tissue or paravertebral abscess or by histological findings of caseating granulomas in biopsied tissue. RESULTS: Thirty-two HIV-negative patients (20 men and 12 women) were diagnosed with osteoarticular tuberculosis. The average annual incidence rate of osteoarticular tuberculosis in the combined (male and female) non-HIV population > or = 15 years of age was 15.68/million (95% CI: 10.25; 21.11); males 20.02/million (95% CI: 11.25; 28.79); females 11.52/million (95% CI: 5.00; 18.03). The age at the time of diagnosis was 60.8 +/- 17.5 years. Peripheral monoarthritis was observed in 16 of the 32 cases. The knee was the most frequent site of peripheral tuberculous arthritis (31%), but involvement of the non-weight-bearing joints (50%) was also common. Spondylitis involving the lower thoracic and upper lumbar vertebrae (31%) and unilateral sacroiliitis (19%) were less commonly observed. In general, patients with osteoarticular tuberculosis had a long duration of symptoms of the disease prior to the diagnosis (median: 5.5 months). The tuberculin skin test was negative in 3 cases. Chest radiograph was abnormal in only 6 of 32 patients (19%). The ESR (mean +/- SD) at the time of diagnosis was 55.7 +/- 29.0 mm/hr. Computed tomography was very useful in detecting early involvement of the sacroiliac joints and in defining the extent of the abscesses and the severity of the involvement in patients with spondylitis. All patients received chemotherapy for tuberculosis. None of them suffered relapses of tuberculosis. CONCLUSION: Tuberculosis is a major source of osteoarticular complications in northwestern Spain. The prevailing low level of clinical suspicion may explain the long delay to the diagnosis in most patients. A greater awareness of the possibility of this severe complication, especially in the elderly people or in high-risk populations, would be advisable.
Adolescent↗
Anterior square-plate fixation of sacroiliac disruption. 2-8 years follow-up of 23 consecutive cases.
21 consecutive patients with 23 rotationally and vertically unstable sacroiliac joint disruptions were operated on through an anterior approach. Open reduction and internal fixation with a 2-hole square plate was performed. At follow-up after 5 (2-8) years, 18 patients were rated excellent or good and 3 patients poor. In all the cases the reduction of the SI-joints was maintained.
Adolescent↗
The relationship between HLA-B27 positive peripheral arthritis and sacroiliitis.
HLA typing for B27 antigen is a helpful diagnostic aid in the classification of peripheral arthritis patients (especially young patients) who are rheumatoid factor negative. We studied 109 patients with seronegative peripheral arthritis belonging to various clinical categories; 23% proved to be B27 positive in comparison to 7% of normal controls. In spite of a paucity of spinal manifestations there was a high prevalence of sacroiliitis (83%) in the B27 positive peripheral arthritis patients as opposed to only 21% in those without B27 antigen. HLA-B27 typing and radiographs of the sacroiliac joints are important differential tests.
Adolescent↗
The active straight leg raising test and mobility of the pelvic joints.
Objective signs to assess impairment in patients who are disabled by peripartum pelvic girdle pain hardly exist. The purpose of this study was to develop a clinical test to quantify and qualify disability in these patients. The study examined the relationship between impaired active straight leg raising (ASLR) and mobility of pelvic joints in patients with peripartum pelvic girdle pain, focusing on (1) the reduction of impairment of ASLR when the patient was wearing a pelvic belt, and (2) motions between the pubic bones measured by X-ray examination when the patient was standing on one leg, alternating left and right. Twenty-one non-pregnant patients with peripartum pelvic girdle pain in whom pain and impairment of ASLR were mainly located on one side were selected. ASLR was performed in the supine position, first without a pelvic belt and then with a belt. The influence of the belt on the ability to actively raise the leg was assessed by the patient. Mobility of the pelvic joints was radiographically visualized by means of the Chamberlain method. Assessment was blinded. Ability to perform ASLR was improved by a pelvic belt in 20 of the 21 patients (binomial two-tailed P = 0.0000). When the patient was standing on one leg, alternating the symptomatic side and the reference side, a significant difference between the two sides was observed with respect to the size of the radiographically visualized steps between the pubic bones (binomial two-tailed P = 0.01). The step at the symptomatic side was on average larger when the leg at that side was hanging down than when the patient was standing on the leg at that side. Impairment of ASLR correlates strongly with mobility of the pelvic joints in patients with peripartum pelvic girdle pain. The ASLR test could be a suitable instrument to quantify and qualify disability in diseases related to mobility of the pelvic joints. Further studies are needed to assess the relationship with clinical parameters, sensitivity, specificity and responsiveness in various categories of patients. In contrast with the opinion of Chamberlain, that a radiographically visualized step between the pubic bones is caused by cranial shift of the pubic bone at the side of the standing leg, it is concluded that the step is caused by caudal shift of the pubic bone at the side of the leg hanging down. The caudal shift is caused by an anterior rotation of the hip bone about a horizontal axis near the sacroiliac joint.
Adult↗
Neurofibrosarcoma following radiotherapy for ankylosing spondylitis.
Twenty-six years after radiotherapy to the spine for ankylosing spondylitis a patient developed a neurofibrosarcoma initially around the left sacroiliac joint. It is likely that this was a long-term complication of the radiotherapy.
Adult↗
Symptom-giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and developmental dysplasia of the hip. The Norwegian Association for Women with Pelvic Girdle Relaxation (Landforeningen for Kvinner Med Bekkenløsningsplager).
OBJECTIVES: To describe the clinical characteristics and outcomes of a large group of women with symptom-giving pelvic girdle relaxation of pregnancy and postnatal pelvic joint syndrome. To determine if there is an increased incidence of developmental dysplasia of the hip in the children of women with such pelvic problems. METHODS: A postal survey of 1,609 Norwegian women registered as having pregnancy-initiated pelvic joint pain. The response rate was 79% and from the answers 1,115 women were defined as having had symptom-giving pelvic joint syndrome of pregnancy and/or postnatal pelvic joint syndrome. RESULTS: Pelvic pains began in the first pregnancy in 74% of the respondents usually beginning in the first trimester. Pelvic pain worsened with subsequent pregnancies and persisted for a mean of 6.25 years, often causing major incapacity and lifestyle changes. Rest and physical supports brought temporary relief only. Sacroiliac joints and the symphysis pubis were the commonest sites of pain but peripheral joints were also often affected. There was a strong family history of both pelvic joint syndrome and developmental dysplasia of the hip. The incidence of hip dysplasia in the children of women surveyed was 45/1,000 which is 5 times the Norwegian incidence. CONCLUSION: Pelvic joint syndrome nearly always follows pelvic girdle relaxation of pregnancy and may have prolonged debilitating effects which do not respond long term to current therapies. The incidence of developmental dysplasia of the hip in the children of these women was high. A genetic susceptibility to joint dysfunction in both mother and fetus, possibly due to an aberration of relaxin physiology, is surmized. Identification of possible relaxin receptor changes in affected joints is a hypothesis worthy of testing with a view to the design of selective relaxin receptor modulators in pregnancy.
Adult↗
Confusion of roentgenographic differential diagnosis between ankylosing hyperostosis (Forestier's disease) and ankylosing spondylitis.
A patient with ankylosing hyperostosis (Forestier's disease) initially diagnosed elsewhere as a case of ankylosing spondylitis with bamboo spine, is presented. The characteristic roentgenographic findings of Forestier's disease in the axial skeleton of this patient are described, including computerized tomography of the lower lumbar spine and sacroiliac joints. Major clinical and radiological distinguishing features of Forestier's disease and ankylosing spondylitis are discussed.
Aged↗
Low back pain, sacroiliitis, and the relationship with HLA-B27 in Crohn's disease.
OBJECTIVE: To determine the prevalence of sacroiliitis in patients who have back pain in Crohn's disease (CD) using computed tomography (CT); and to reassess the association of sacroiliitis in CD with HLA-B27. METHODS: A total of 134 consecutive patients with CD completed a questionnaire about musculoskeletal symptoms. Those reporting low back pain were assessed, including plain radiographs and CT of the sacroiliac joints. HLA-B27 status was determined in patients with and without back pain. RESULTS: There were 70 (52%) patients with low back pain, of whom 31 (45%) had CT evidence of sacroiliitis. These were characterized by more frequent morning spinal stiffness and positive sacroiliac compression tests even when sacroiliitis was not suspected. Nine had previously recognized radiological and clinical ankylosing spondylitis (AS), and of these 78% were HLA-B27 positive. Of those with newly identified sacroiliitis, 14% were HLA-B27 positive. This frequency was not statistically dissimilar to the 9% HLA-B27 positivity of those without back pain. CONCLUSION: Sacroiliitis defined by CT is a common cause of low back pain in CD. A relationship of sacroiliitis and HLA-B27 could be confirmed only for those with classical AS. Our results accord with the possibility that sacroiliitis in CD is an isolated phenomenon, which is unrelated to HLA-B27 and which may evolve into classical spinal ankylosis in genetically susceptible subjects.
Adult↗
Sacral pseudotumor complicating iliac bone harvest: radiographic, CT and MRI appearances.
We present the imaging appearances of a lytic pseudotumor in the right sacral ala presenting with referred pain to the right thigh. Subsequent imaging revealed the presence of a cystic lesion arising at the site of previous bone graft harvest; CT-guided aspiration yielded synovial fluid presumed to arise from the contiguous sacroiliac joint.
Biopsy, Needle↗
Scintigraphy of sacroiliac pyarthrosis in children.
Eight children with low back, hip, or lower limb pain who were subsequently shown to have pyogenic infections of their sacroiliac joints were examined by a combination of plain roentgenography and radionuclide bone scintigraphy. In all cases, the scintigraphic examination was diagnostic, while the roentgenograms were initially abnormal in only two cases. In the other six cases, one to six weeks passed before changes compatible with sacroiliac pyarthrosis were seen on roentgenographic examination. Radionuclide scintigraphy is recommended as part of the initial workup of children with appropriate symptoms.
Adolescent↗
[The prevalence of radiographic sacroiliitis in patients affected by inflammatory bowel disease with inflammatory low back pain].
Inflammatory bowel diseases (IBD), as Crohn's disease (CD) or ulcerative colitis (UC), are frequently complicated by joint complaints with prevalence that varies between 10 and 28%. The IBD related arthropathy may be expressed as peripheral arthritis or axial one frequently indistinguishable from the classical ankylosing spondylitis (AS). According to ESSG criteria for spondyloarthropathy, the presence of synovitis or the inflammatory back pain (IBP) in IBD patients is diagnostic for spondyloarthropathy, but for diagnosis of ankylosing spondylitis also radiological criteria must be fulfilled. There are few studies regarding the radiological prevalence of sacroiliitis in patients with IBD. We examined, by plain film radiograms of pelvis, 100 sacroiliac joints (SJ) of 50 IBD patients with IBP. The New York (1984) SJ radiological score with gradation from 0 to 4 was applied. Total sacroiliac score (SJS) was summarized between left and right side (from 0 to 8). Fourteen patients fulfilled New York modified criteria for AS and 8 patients had unilateral 2nd grade sacroiliitis. Only 4 of 14 AS patients (28%) were HLA B27 positive. Thirty patients had localized IBP, 10 extended to buttock and 4 extended to sacrum. Sixteen patients had sciatica-like extension of back pain. A difference in SJS between left and right side was observed only in CD patients (1.3 +/- 0.8 and 0.8 +/- 0.9 respectively; p < 0.05), but not in UC (1.5 +/- 1.2 vs 1.5 +/- 1.3; p = ns) nor in total IBD patients (1.4 +/- 1.0 vs 1.2 +/- 1.2; p = ns). Total SJS was higher in UC respect CD, but not significantly (2.9 +/- 2.3 vs 2.1 +/- 1.5; p = ns). Our data confirm the importance of these symptoms in patients with IBD, who need to be carefully investigated also for these aspects.
Adult↗
Progressive sacro-iliac obliteration in Forestier disease.
In 11 patients with Forestier disease 4 were shown to have obliteration of the sacroiliac joints. We suggest that if patients with this disease are observed for a long period ossification of the sacro-iliac joints will be seen, as in ankylosing spondylitis, with loss of sacro-iliac pain when present.
Humans↗
Unusual exercise-related stress fractures. Two case reports.
We describe two unusual exercise-related stress fractures, one in the sacroiliac joint of a long distance runner, the other in the body of the scapulae of an above-knee amputee. Each were detected on a 2-hour delay bone scan. To our knowledge, neither have been described scintigraphically. The bilateral scapular fracture is an unreported entity, and the fractured SI joint is a very uncommon site for an overuse injury.
Adolescent↗
Impairment-based examination and disability management of an elderly woman with sacroiliac region pain.
BACKGROUND AND PURPOSE: The purpose of this case report is to describe the use of a cluster of sacroiliac tests in conjunction with an impairment-based model of examination, diagnosis, and management of sacroiliac region pain. CASE DESCRIPTION: The patient was a 74-year-old woman with an 18-month history of low back, left buttock, and groin pain following a misstep. The initial symptoms were intermittent. The symptoms became constant and limited her walking tolerance to 5 minutes, which affected her ability to care for her grandchildren. She was examined using a cluster of sacroiliac tests that examined: (1) innominate active mobility, (2) innominate positional symmetry, and (3) sacroiliac ligament tenderness. OUTCOMES: Following 4 treatments for identified impairments, the patient had unlimited walking tolerance and she resumed an active caregiving role for her grandchildren. DISCUSSION: This case illustrates the use of an impairment-based model for examination and management of an elderly patient with what appeared to be sacroiliac joint dysfunction.
Aged↗