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At least 19 recordsLinked to original sources
PubMed1983

[Roentgen diagnostic studies of peripheral joints, sacroiliac joints and the spine in psoriasis arthropathy].

The secure diagnosis "psoriasis arthropathica" must always be the result of a clinical examination, paraclinical and radiological findings. In 150 patients with arthropathic psoriasis X-ray examinations of peripheral joints, of the sacroiliac joints and of the spine were performed. As a result of subtle evaluations of the findings X-ray-morphological criteria on the skeleton of hand and foot, on the sacroiliac joints and on the spine may be derived. On the basis of the experiences gathered recommendations for the practice in form of radiographic objects of an X-ray-diagnostic basic programme in primary diagnostics and in repeated examinations are proposed. An optimum diagnostics of the arthropathic psoriasis can be achieved only ba close co-operation and by constant mutual informations between rheumatologists, dermatologists and radiologists.

Adult↗
PubMed2001

Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome.

OBJECTIVE: To investigate the outcomes resulting from the use of fluoroscopically guided therapeutic sacroiliac joint injections in patients with sacroiliac joint syndrome. DESIGN: A retrospective study design with independent clinical review was utilized. Thirty-one patients were included; each patient met specific physical examination criteria and failed to improve clinically after at least 4 wk of physical therapy. Each patient demonstrated a positive response to a fluoroscopically guided diagnostic sacroiliac joint injection. Therapeutic sacroiliac joint injections were administered in conjunction with physical therapy. Outcome measures included Oswestry scores, Visual Analog Scale pain scores, work status, and medication usage. RESULTS: Patients' symptom duration before diagnostic injection averaged 20.6 mo. An average of 2.1 therapeutic injections was administered. Follow-up data collection was obtained at an average of 94.4 wk. A significant reduction (P = 0.0014) in Oswestry disability score was observed at the time of follow-up. Visual Analog Scale pain scores were reduced (P < 0.0001) at the time of discharge and at follow-up. Work status was also significantly improved at the time of discharge (P = 0.0313) and at follow-up (P = 0.0010). A trend (P = 0.0645) toward less drug usage was observed. CONCLUSIONS: These initial findings suggest that fluoroscopically guided therapeutic sacroiliac joint injections are a clinically effective intervention in the treatment of patients with sacroiliac joint syndrome. Controlled, prospective studies are necessary to further clarify the role of therapeutic injections in this patient population.

Adult↗
PubMed1998

The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome.

OBJECTIVE: To determine the clinical validity of provocative sacroiliac joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint syndrome (SIJS). DESIGN: Prospective constructive cohort study using sacroiliac joint block (SIJB) as the diagnostic gold standard. SETTING: Tertiary care center. PATIENTS: Consecutive patients describing low back pain including the region of the sacral sulcus. Physical examination revealed a positive response to three provocative SIJ maneuvers, two of which had to be Patrick's test and pain with palpation over the ipsilateral sacral sulcus. INTERVENTIONS: All subjects underwent fluoroscopically guided SIJB. MAIN OUTCOME MEASURES: Response to SIJB was assessed with visual analog scale (VAS) ratings before and after the block. A reduction of the VAS rating by at least 80% was considered a positive response to SIJB. RESULTS: Fifty consecutive patients met our criteria and underwent SIJB. Thirty patients had positive response to SIJB, making up the positive SIJS group. Twenty patients had less than 80% pain reduction with SIJB and thus comprised the negative SIJS group. The positive predictive value of provocative SIJ maneuvers in determining the presence of SIJS is therefore 60%. CONCLUSIONS: Our results do not support the use of provocative SIJ maneuvers to confirm a diagnosis of SIJS. Rather, these physical examination techniques can, at best, enter SIJS into the differential diagnosis.

Adolescent↗
PubMed2000

Anatomy and pathophysiology of the sacroiliac joint.

The sacroiliac joint as a source of chronic pain has been a subject of debate for a long period of time. This controversy stems from the inherent anatomic location of the sacroiliac joint. Adjacent spinal structures may cause pain to be referred to the sacroiliac joint, thus making a precise diagnosis difficult. The most reliable method to establish the diagnosis of sacroiliac arthralgia is fluoroscopic-guided intra-articular injection of a local anesthetic preceded by a sacroiliac arthrogram. Although there are many therapeutic options for sacroiliac joint syndrome, the ideal treatment has not yet been discovered. There is evidence that intra-articular viscosupplementation of the sacroiliac joint with hylan can consistently and reliably induce a prolonged analgesic response in sacroiliac joint syndrome. Viscosupplementation restores joint homeostasis, allows increased joint motion, and induces analgesia. Hylan is highly viscoelastic hyaluronan (hyaluronic acid), and is capable of increasing the viscoelastic properties of synovial fluid.

Humans↗
PubMedDate not supplied

[Possibilities and relevance of three-dimensional reconstruction of the sacroiliac joint].

The sacroiliacal joint is difficult to evaluate clinically due to its complex form and its topographical position, deep in the body and surrounded by other skeletal structures. We evaluated the potential role of three-dimensional reconstruction and segmentation of CT data of this joint. A total of five patients were examined (age range 24-60 years). In three of these only surface reconstructions were obtained; in the other two, segmentation was obtained as well in order to directly visualize the joints surfaces of the sacroiliacal joint. Compared to conventional radiographs and standard CT, three-dimensional reconstruction and segmentation of the sacroiliac joint did not add significant information. The subtle skeletal findings occurring in inflammatory and degenerative disease were obscured by the process of segmentation. Therefore, radiographs and, in selected cases, CT remain the imaging methods of choice for the evaluation of sacroiliac pathology.

Adult↗
PubMed1989

Pyogenic sacroiliac joint infection.

Sacroiliac joint infection is relatively uncommon. Since 1974, Staphylococcus aureus was the pathogen in 11 of 12 cases of pyogenic infection of the sacroiliac joint. Ten of the 12 cases were acute. All were treated with at least six weeks of antibiotics. Surgery was necessary in 11 of the 12 cases. Intraoperative specimens gave positive cultures in ten of 11 cases. All had a satisfactory result. This condition may be more common than previously thought. A careful history and physical examination are especially important. It should be treated early and aggressively to give optimum results. The indications for surgery are still uncertain.

Adolescent↗
PubMed1991

The effects of morphology and histopathologic findings on the mobility of the sacroiliac joint.

The sacroiliac joints of seven pelvic specimens were examined to determine functional, morphologic, and histopathologic aspects. The movements were measured in four intact pelvises (from two men and two women). The joint surfaces of all pelvises (from three men and four women) then were examined topographically by means of a photogrammetric method. After this, they were examined histologically to characterize any effects on function. The morphologic investigation revealed sex-specific differences. All joint surfaces from the female pelvises showed circular contours, the centers of which coincided with the iliac tuberosities. These morphologic characteristics were not discernible in the joint surfaces from the male pelvises; these had interlocking irregularities without a topographic pattern. As expected, this configuration involved distinct differences in mobility. Rotation of the sacrum was markedly less in the sacroiliac joints of men than in those of women.

Cadaver↗
PubMed1990

Imaging of the sacroiliac joints.

The sacroiliac joints present unique problems in diagnosis for both the clinician and the radiologist. Each of the imaging modalities presents advantages and problems. The specific clinical problems determine whether advanced imaging modalities such as scintigraphy, CT scan, or magnetic resonance imaging will complement the information on the plain radiographs.

Arthritis, Infectious↗
PubMedDate not supplied

Radiofrequency sacroiliac joint denervation for sacroiliac syndrome.

BACKGROUND AND OBJECTIVES: Radiofrequency (RF) denervation of the sacroiliac (SI) joint has been advocated for the treatment of sacroiliac syndrome, yet no clinical studies or case series support its use. METHODS: We report the results of a consecutive series of 50 SI joint RF denervations performed in 33 patients with sacroiliac syndrome. All patients underwent diagnostic SI joint injections with local anesthetic before denervation. Changes in visual analog pain scores (VAS), pain diagrams, physical examination (palpation tenderness over the joint, myofascial trigger points overlying the joint, SI joint pain provocation tests, and range of motion of the lumbar spine), and opioid use were assessed pre- and postdenervation. RESULTS: The criteria for successful RF denervation were at least a 50% decrease in VAS for a period of at least 6 months; 36.4% of patients (12 of 33) met these criteria. Failure of denervation correlated with the presence of disability determination and pain on lateral flexion to the affected side. The average duration of pain relief was 12.0 +/- 1.2 months in responders versus 0.9 +/- 0.2 months in nonresponders (P < or = 0.0001). A positive response was associated with an atraumatic inciting event. Successful denervation was associated with a change in the pain diagram and a reduction in the pattern of referred pain, a normalization of SI joint pain provocation tests, and a reduction in the use of opioids. CONCLUSIONS: This study suggests that RF denervation of the SI joint can significantly reduce pain in selected patients with sacroiliac syndrome for a protracted time period. Moreover, certain abnormal physical findings (i.e., SI joint pain provocation tests) revert to normal for the duration of the analgesia.

Adult↗
PubMed1992

The pathoanatomy and clinical significance of the sacroiliac joints.

The sacroiliac joint has a unique developmental anatomy which is responsible for an unusual and underdeveloped iliac cartilage surface. This surface tends to undergo premature degenerative change, which might be a factor in the pathogenesis of mechanical low back pain.

Adult↗
PubMed2002

[A morphologic evaluation of the sacroiliac joint and plate fixation on a pelvic model using a S1 pedicular screw, transiliosacral screws, and a compression rod for sacroiliac joint injuries].

OBJECTIVES: Morphological measurements were performed, of the articular surfaces and adjacent bone structures of the sacroiliac joint on dry bone specimens to determine the projection of the sacroiliac joint on the outer table of the posterior ilium. In addition, the effect of plate fixation using transiliosacral screws and a pedicular screw on S1 attached via a compression rod was evaluated on pelvic models to be applied in sacroiliac joint injuries. METHODS: Quantitative caliper measurements of dry bone specimens including 20 os coxae and 10 sacrum were made on the articular surfaces of the sacrum and the posterior ilium, thickness of the posterior iliac bone at different levels, and the distance from the outer walls of S1 and S2 foramina to the sacral facies articularis. After the construction of a plate matching the projection of the lateral sacral mass on the outer table of the posterior ilium, four transiliosacral screws were applied lateral to the sacral foramina on pelvic models. A pedicular screw sent to S1 was attached to the plate with a threaded compression rod. RESULTS: The mean values for the articular surface of (i) the posterior ilium were 53.3 mm (base length), 38.5 mm (height), and 56.2 mm (the distance from the anterior margin of the articular surface to the spina iliaca posterior superior); and (ii) the sacrum, 57.2 mm (base length), and 34.6 mm (height). The mean thickness of the posterior ilium was 19.2 mm, and the mean distance from the lateral walls of the sacral foramina at S1 and S2 levels to the articular surface was 21.7 mm. For the deduced projection, the perpendicular line from the middle of the base was found to be the safe zone for screw applications. CONCLUSION: Through a plate applied matching the projection area, multiple screws may be sent lateral to S1 and S2 foraminal levels without damage to the sacral neural and surrounding vital structures. A stable fixation can be achieved by combining the plate/screw system with a S1 pedicular screw.

Bone Plates↗
PubMedDate not supplied

Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint.

OBJECTIVE: To investigate the efficacy of periarticular corticosteroid treatment of the sacroiliac joint (SIJ) in non-spondylarthropathic patients with chronic low back pain in the region of the SIJ in a double blind, controlled study. METHODS: Twenty-four consecutive non-spondylarthropathic patients with chronic pain in the region of the SIJ entered the study. Thirteen patients were treated with a periarticular injection of methylprednisoloneacetate and lidocaine (MP group) of the SIJ, whereas 11 patients received isotonic sodium chloride and lidocaine. Clinical assessment at the onset of the study and after one month included the patient's estimation of pain in the region of 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 one month's follow-up examination both the VAS (p = 0.047) and the pain index (0.017) had improved significantly in the MP group compared with the non-MP group. CONCLUSION: These results suggest that periarticular injection of methylprednisolone may be effective in the treatment of pain in the region of the SIJ in non-spondylarthropathic patients.

Adult↗
PubMedDate not supplied

Morphometric analysis of the sacroiliac joint.

The sacroiliac (SI) joint is the point of articulation between the sacrum and the innominate bone of the pelvis. The anterior portion is synovial, and the posterosuperior portion is a typical syndesmosis. The SI joint may be affected by inflammatory or degenerative changes which include narrowing, minor sclerosis and erosion. Alterations in the anatomy of this joint may be involved in causing lower back pain. Radiodiagnosis of the width of the articular space is one of the tools utilized to evaluate the normal state of any joint. Scanty data is available on the morphometric characteristics of the SI joint. Therefore, the articular width space of the SI joint was measured to define its normal size in relation to age and sex. The study included 198 x-rays of the abdomen, in anteroposterior projection, of 112 males and 86 females (age range: 17 to 91 yrs). Individual films were divided into four classes according to age (< 50; 50-59; 60-69; > 70). The articular space of the SI joint is made up of a lateral and a medial part: the first representing the anterior articular space; the latter the posterior one. The anterior articular space of both the right and left joint, which was more easily visible and measurable was measured at the medium and inferior levels. Measurements were taken from the radiograms using a semiautomatic computerized system (Videoplan II, Image Analysis system-Kontron). The mean value of the articular space width a the medium and inferior levels, according to age group, was measured in both the males and females. The values obtained were studied using variance analysis. No significant differences were found in the mean values of the articular space width at the SI joint, when males and females were compared in relation to age. Moreover, the articular space width diminished with increasing the age. This fact was not always statistically significant.

Adolescent↗
PubMed1993

Sacroiliac joint pyarthrosis.

Sacroiliac (SI) joint infection is rare, and symptoms are idiosyncratic and often confusing. This paper reviews six cases of SI joint infection with regard to their clinical manifestations, diagnostic imaging, and treatment. The six patients were seen over a 15-year period and had a mean age of 16.2 years and a mean follow-up of 44.2 months. The most common presenting symptom was fever (71.4%). The most common physical findings were elevated temperature and limited ipsilateral hip motion. In most cases the white blood cell count and erythrocyte sedimentation rate were elevated, and 71% of the cases had positive blood cultures. The most specific imaging study was the technetium bone scan. All patients were treated with 3 to 6 weeks of appropriate antibiotics and were asymptomatic and had a normal physical examination on follow-up. Routine anteroposterior roentgenograms of the pelvis demonstrated sclerosis of the affected SI joint in one third of the cases. There appeared to be no long-term sequelae in this group of patients.

Acute Disease↗
PubMed2003

Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests.

Research suggests that clinical examination of the lumbar spine and pelvis is unable to predict the results of diagnostic injections used as reference standards. The purpose of this study was to assess the diagnostic accuracy of a clinical examination in identifying symptomatic and asymptomatic sacroiliac joints using double diagnostic injections as the reference standard. In a blinded concurrent criterion-related validity design study, 48 patients with chronic lumbopelvic pain referred for diagnostic spinal injection procedures were examined using a specific clinical examination and received diagnostic intraarticular sacroiliac joint injections. The centralisation and peripheralisation phenomena were used to identify possible discogenic pain and the results from provocation sacroiliac joint tests were used as part of the clinical reasoning process. Eleven patients had sacroiliac joint pain confirmed by double diagnostic injection. Ten of the 11 sacroiliac joint patients met clinical examination criteria for having sacroiliac joint pain. In the primary subset analysis of 34 patients, sensitivity, specificity and positive likelihood ratio (95% confidence intervals) of the clinical evaluation were 91% (62 to 98), 83% (68 to 96) and 6.97(2.70 to 20.27) respectively. The diagnostic accuracy of the clinical examination and clinical reasoning process was superior to the sacroiliac joint pain provocation tests alone. A specific clinical examination and reasoning process can differentiate between symptomatic and asymptomatic sacroiliac joints

Adult↗
PubMed1997

Radiology of the sacroiliac joint.

STUDY DESIGN: Radiology of the sacroiliac joint was investigated by obtaining different and multiple radiographs of cadaveric pelves marked with solder metal wire and radiopaque paint. OBJECTIVES: To demonstrate the orientation of the sacroiliac joint on various, radiographic views. SUMMARY OF BACKGROUND DATA: Interpretation of the sacroiliac joint projection on plain radiography is difficult. It requires an understanding and appreciation of its components and their orientation. Emphasizing the definition of the orientation of the plane of the joint on the different projection views of the sacroiliac joints can aid the orthopaedic surgeon in obtaining the proper radiographs and in the proper interpretation of the different radiographic views. METHODS: Nineteen sacroiliac joints from 10 cadaveric pelves, 5 male and 5 females were studied. Each joint was found to be composed of three portions: anterosuperior, middle, and posteroinferior portions, each lying in a different plane. Each sacroiliac joint was marked with solder wires and radiopaque paint to define the orientation of each of the three portions of the joint on radiographs. The following radiographic projection views were taken for each joint anteroposterior, lateral, inlet, craniocaudal axial, outlet, lithotomy and oblique views. For the oblique views, the angulation of the x-ray tube needed to view each portion of the joint tangentially was recorded. RESULTS: There was a wide variation in the orientation of the planes of the joint portions between the right and the left sides as well as between different pelves. Although the twisting of the plane of the whole joint produced by the successive examination of the portions could be either internal or external, it was the same bilaterally in a given specimen. The outlet and lithotomy views provided the best tangential representation of the two sacroiliac joints on one film. CONCLUSION: The sacroiliac joint is composed of three portions oriented in different planes. To study the sacroiliac joints, it seems desirable to obtain an anteroposterior view of the pelvis with the patient in a lithotomy position; then, if needed, each joint can be radiographed separately by using oblique views. It is important to not that the plane of the articular portion of the joint can be directed from anterolateral to posteromedial, and therefore, the oblique views should be obtained accordingly.

Aged↗
PubMed1998

Mechanical behavior of the female sacroiliac joint and influence of the anterior and posterior sacroiliac ligaments under sagittal loads.

OBJECTIVE: The purpose of this study was to examine the mechanical behaviour of the female sacroiliac joint and the effects of its two major ligaments to joint stability. DESIGN: A cadaveric model was used to study the mechanical behaviour of the sacroiliac joints, and sequential dissection was performed to examine the contribution of the anterior and posterior sacroiliac ligaments in joint stability. BACKGROUND: Instability of the sacroiliac joints have been suspected as a possible cause of low back pain. Despite several investigations on joint anatomy and joint mobility, its stabilising mechanism is still not clear. METHODS: Four fresh cadaveric specimens of the female pelvis were tested on an Instron material testing machine. Eccentric compressive force of 60% of the subject's body weight was applied to the pelvis through the sacrum. Relative three-dimensional six-degree-of-freedom movement at the left sacroiliac joints was recorded with a specially designed motion tracking device. The device has an accuracy of 0.01 mm and is compact enough to be mounted across the joint. The test was repeated after sequential selective dissection of the bilateral anterior, and then posterior sacroiliac ligaments. RESULTS: Rotation up to 1.2 degrees and translation up to 0.9 mm were measured from the intact specimens. Lateral rotation, which tended to open the top portion of the joint, and sacral nutation were the primary rotations. On average, the rotation angles increased 10% when either the anterior or posterior ligaments were cut, and 30% when both ligaments were cut. CONCLUSIONS: Lateral rotation and nutation rotation of the sacrum were found to be the predominant motion, though the values were limited to less than 1.2 degrees. Both the anterior and posterior sacroiliac ligaments were found to play an important role in resisting rotations at the joints.

Journal Article↗