Sacroiliac Joint Dysfunction:

As a Cause of Back Pain

 

Anatomy:
The sacroiliac (SI) joint is one of two large joints connecting the ilium(part of the pelvic bone) and the sacrum(the tail bone). The joints are also peculiar in having two types of cartilages covering its syrfaces. The surfaces also consist of ridges and depressions that lock the two bones together providing great stability. As it is not designed for motion, there is tendency for it to "lock" as we grow older.

Causes:
Common cause is injury especially a direct fall to the buttocks, motor vehicle accident, and a direct blow to the side of the pelvis leading to injuries to the tough ligaments that hold the surfaces of the joints together. This could further lead to increase motion of the joint with its associated wear and tear leading to arthritis/degenerative changes. It could also be caused by bony abnormality of the pelvic bones, ligament laxity during pregnancy from hormones (relaxin, progesterone) produced in preparation for the opening of the pelvic outlet for the delivery of the baby, and also other causes of wear and tear of the joints leading to arthritis.

Symptoms:
Several in nature and could mimic any type of back pain. Common symptoms include low back pain, buttock pain, thigh pain, sciatic-type of pain  and difficulty sitting for a prolong time in a particular position. It should be considered as a possible cause of any back pain and be ruled out

Diagnosis:
The process of diagnosis includes history with questions about the pain and any previous injury, examination which will include general neuro-muscular tests and specifics tests including patrick's test (in which the leg is brought up to the knee and the knee pushed upon to distract the joint), fortin's test (in which tender spots are elicited directly over the joint itself), and others including distraction test, compression test and Gaenslen test (the first descriptive of actions on the joint to elicit the pain). Then, investigative tests are requested including CAT Scan, MRI, Plain X-ray of the joint, Bone Scan and sometimes diagnostic steroid/local anesthetic injection into the joint. Tests to rule out other possible causes of back pain.

Treatment:
Treatment options vary depending on cause and nature of the pain. Often, a rehabilitative approach of mobilization (for a stiff joint) or stabilization for a hypermobile joint with other modalities for ligament strengthening. Series of injections to the joint using steroid and local anesthetics could also be offered. In recent times, a new option of radiofrequency ablation of the nerves supplying the joint and also injection of concentrated sugar solution into the ligaments around the joint (prolotherapy) could also be performed. If all these should fail, a surgical option of stabilization could also be offered.

 

 some of the above information were derived from http://www.spineuniversity.com/public/spinesub.asp?id=89

 

 

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