Sacroiliac joint dysfunction generally refers to pain in the sacroiliac joint region caused by abnormal movement of the sacroiliac joint, too much motion or too little movement. This usually causes arthritis sacroiliac, and can be debilitating.
Video Sacroiliac joint dysfunction
Signs and symptoms
Common symptoms include lower back pain, buttock pain, sciatic foot pain, groin pain, hip pain (for leg explanation, groin, and hip pain, refer to referred pain), urinary frequency, and "temporary, stabbing, or tingling numbness. " Pain may vary from dull pain to sharp and piercing and increase with physical activity. Symptoms also worsen with prolonged or ongoing positions (ie, sitting, standing, lying). Bending forward, climbing stairs, climbing hills, and getting up from a sitting position can also provoke pain. Pain is reported to increase during menstruation in women. People with severe and crippling sacroiliac joint dysfunction can suffer from insomnia and depression.
Maps Sacroiliac joint dysfunction
Cause
Hypermobility
SI joint dysfunction is sometimes referred to as "sacroiliac joint instability" or "sacroiliac joint insufficiency" due to lack of strong and tense ligament support that can no longer be maintained. When hypermobile or loose joints, it is classified as extra-articular dysfunction due to normal joint movement and alignment is a consequence of weakened, injured, or sprained ligaments, whereas the joint itself is structurally normal and healthy. The sacroiliaka joint itself often will not exhibit degenerative changes, such as arthritis, until years of dysfunction are allowed to continue. Injuries to the ligaments holding the sacroiliac joint in proper support are thought to be caused by torque or high impact injury (such as a car accident) or crashing hard, resulting in hypermobility. As many as 58% of people diagnosed with sacroiliac joint pain have some that trigger traumatic injury based on clinical examination findings. The joints that have been stabilized by a strong ligament, which is now too stretched, sprained, or torn, will move beyond its normal range. This is thought to produce ilium and sacral surfaces "locking" in an asymmetrical or incoherent way (one innominate bone is tilted forward, the other innominate bone tilted posteriorly) causing debilitating pain.
Hormonal imbalances, especially those associated with pregnancy and relaxin hormones, can also cause ligament ligands resulting in weakening of the sacroiliac structure. During pregnancy, relaxin serves as a natural way to allow the female pelvis to reach the distension of the delivery ducts. Pelvic joint pain in post-pregnant women is thought to result from the ligament's inability to stretch back to normal tautness. Women who have given birth to a large baby or who have prolonged labor also tend to experience chronic sacroiliac joint pain and instability.
In some people, the sacroiliac joints invert the 'normal convex-conveying locking' relationship, which may cause a misalignment of rotation. Variations in joint configuration results across multiple sacroiliac joints are inherently weaker or more susceptible to misalignment. A certain biomechanical or muscle imbalance may ultimately affect a person against dysfunction and sacroiliac pain. Possibly, this is the result of changing path patterns and repetitive stresses to the SI joint and related structures. This condition occurs in people with leg-length inequalities, scoliosis, history of polio, poor quality footwear, and osteoarthritis of the hip. There is also an incidence of lumbar spinal inclusions present with sacroiliac pain and hypermobility, which may be caused by a fixed lumbar joint that is fixed and immobilized. Clinical studies have found up to 75% of post-lumbar fusion patients develop SI joint degeneration within five years of surgery.
Hypomobility
Pathological hyipomobility (too little movement) of the sacroiliac joints is an intra-articular disorder in which the joint lock is due to age loss or degenerative joint disease. Such hypermobility can also occur with inflammatory diseases such as ankylosing spondylitis, rheumatoid arthritis, or infection.
Pathophysiology
The sacroiliaka joint is a true diarthrodial joint that joins the sacrum to the pelvis. The sacrum connects on the right and left sides to the ilia (pelvic bone) to form the sacroiliac joint. The pelvic girdle consists of two innominate bones (iliac bones) and a sacrum. The innominate bone joins in front of the pelvis to form the pubic symphysis, and behind the sacrum to form the sacroiliac joint (SI). Each innominate bone (ilium) joins the thighbone to form the hip joint; thus sacroiliac joints move with walking and movement of the torso.
In this joint, hyaline cartilage on the sacral side moves against fibrocartilage on the iliac side. The sacroiliac joint contains many bulges and depressions that function in stability. Studies have documented that motion does occur in joints; therefore, slightly sublux and even locked positions may occur.
Muscles and ligaments surround and adhere to the SI joints in front and back, especially on the ilial or sacral surfaces. All of these can be a source of pain and inflammation if the SI joint is dysfunctional. The sacroiliac joint relies heavily on its strong ligament structure for support and stability. The most frequently disturbed and/or torn ligaments are the iliolumbar ligaments and the posterior sacroiliac ligaments. The ligament structure offers resistance to shear and loading. The anterior, posterior, and deep interosseous ligaments hold the sacrum load relative to the ilium. More superficial ligaments (eg, sacrotuberous ligaments) react to dynamic movements (such as lifting the legs straight during physical movement). The long dorsal sacroiliac ligament may stretch within a reduced lumbar lemosis period (eg, during pregnancy).
Muscle group affected
Many large and small muscles have links to the ligaments of the sacroiliac joints including piriformis (see "Piriformis syndrome", conditions often associated with sacroiliac joint dysfunction), rectus femoris, gluteus maximus and minimus, erector spinae, latissimus dorsi, thoracolumbar fascia, and iliacus. One of these muscles can be involved or spasm with painful and dysfunctional sacroiliac joints. The SI joint is a pain-sensitive structure innervated by a combination of nerve-free endless nerve endings and the posterior prime hemisphere of the L2-S3 spine segment. The widespread possibility of innervation may explain why joint pain can manifest in different ways, with different and unique referral patterns (see "referred pain") for each patient. Patients with sacroiliac joint dysfunction may also develop congestion and dysfunction in hamstring, quadriceps, iliotibial channels (see iliotibial band syndrome) and hip flexors, including psoas muscle. Individuals with severe and prolonged sacroiliac joint dysfunction may experience decreased muscle and atrophic function throughout the body due to the limited activity and exercise that cause pain in the lower back.
Diagnosis
Perhaps the greatest reason for misdiagnosis or lack of diagnosis of sacroiliac joint dysfunction is based on a general inability of radiological imaging to distinguish the disorder. Diagnostic tests, such as X-rays, CT scans, or MRI, usually show no abnormalities; Therefore, they are not reliably used for the diagnosis of sacroiliac joint dysfunction. There is a new definitive SPECT/CT imaging test that can sometimes detect sacroiliac joint dysfunction. There is also a lack of evidence that the sacroiliac joint mobility maneuver (Gillet, Standing flexion test, and Seated Flexion test) detect motion abnormalities. Given the technical limitations inherent in the visible and palpable signs of this sacroiliac joint mobility maneuver, another major category of clinical signs has been described as provocative maneuvers. This maneuver is designed to reproduce or enhance the pain that comes from the sacroiliac joint.
A physician (ie, a spinal surgeon, orthopedic surgeon, sports medicine doctor, medical massage therapist, physical therapist, physiotherapist, osteopath or chiropractor) may develop a possible diagnosis of sacroiliac joint dysfunction by hand approach via palpation painful areas and perform the following provocative maneuvers below:
- Gaenslen test - This pain provocation test applies torque to the joint. With one hip flexed to the abdomen, the other legs were left hanging over the edge of the table. The pressure should then be directed downward on the foot to reach the pelvic extension and emphasize the sacroiliac joint.
- Iliac Gapping Test - Distraction can be performed on the anterior sacroiliac ligament by applying pressure to the anterior superior iliac spine.
- Iliac Compression Test - Apply compression to the joint with the patient lying next to it. Pressure applied downward to the top of the upper iliac.
- FABER or Patrick's test - To identify whether pain can originate from the sacroiliac joint during external flexion, abduction, and rotation, the physician externally rotates the hip when the patient is lying on his back. Then, downward pressure is applied to the medial knee that emphasizes the hip joint and sacroiliac.
- Thigh Thrust - This test applies an anteroposterior shear stress to the SI joint. The patient is lying on his back with one hip flexed to 90 degrees. The examiner stood on the same side as the bent leg. The examiner provides a rapid boost or increased pressure through the femur line. The pelvis is stabilized on the sacrum or on ASIS opposite to the examiner's hand
Careful interpretation is justified because no biomechanical studies show that Thigh Thrust tests isolate forces in SIJ when performed at 90 degrees and because of intra-individual variations in body type, hip flexibility, general flexibility of the stem and pelvis. In all tests, pain along typical regions raises suspicion for sacroiliac joint dysfunction. However, there is no single reliable test in the diagnosis of sacroiliac joint dysfunction. It is important to remember the true neurogenic weakness, numbness, or loss of reflexes should alert the doctor to consider the pathology of nerve roots.
The current "gold standard" for the diagnosis of sacroiliac joint dysfunction radiating inside the joint is a confirmed sacroiliac joint injury with fluoroscopy or CT-guidance using local anesthetic solutions. Diagnosis is confirmed when the patient reports significant changes in relief from pain and the diagnostic injection is performed on two separate visits. Published studies have used at least 75 percent change in pain relief before response is considered positive and sacroiliac joints are considered a source of pain. However, several other injection studies have compared intra-articular with extra-articular injection, and suggest that ligament injection behind the joint is often superior to injection in the joint and appears to be a very under-used diagnostic tool.
Misdiagnosis
In the early 1900s, sacroiliac joint dysfunction was a common diagnosis associated with lower back and sciatic nerve pain. However, research by Danforth and Wilson in 1925 concluded that the sacroiliac joints can not cause sciatic nerve pain because the joint does not have a duct where the nerve can get trapped against the joint. The biomechanical relationship between the sacroiliac joint, piriformis muscle (see "Piriformis syndrome"), and sciatic nerve has not been found.
In 1934, the work of Mixter and Barr transferred all the emphasis in research and treatment from sacroiliac to interernative herniated disks, namely lumbar discs. The medical focus on herniated discs was continued further by MRI discovery in 1977. Over-diagnosis and attention to herniated discs has caused SI joints to be less valued pain relief in about 15% to 25% of patients with lower back axial pain.
The ligaments in sacroiliac are one of the strongest in the body and are not suspected by many doctors to be vulnerable to sprains or tears. The skepticism of sacroiliac joint dysfunction in the medical community is increasingly distant by the debate about how little or much of the sacroiliac joint movements. A difference of 2-17 degrees has been reported in clinical findings.
Treatment
Treatment often depends on the duration and severity of pain and dysfunction. In the acute phase (1-2 weeks) for mild sprains from sacroiliac, it is typical for patients prescribed rest, ice/heat, and physical therapy; anti-inflammatory drugs can also help.
If the pain does not disappear within the first 1-2 weeks, then the patient may benefit from a mixture of fluoroscopic steroids and anesthesia into the joint (this also serves to make the diagnosis), as well as manipulative or manual therapy. For the most severe and chronic sacroiliac dysfunction, care should be continued with the support of the sacroiliac belt, injection therapy, and finally, surgery. The anti-inflammatory effect of injection therapy is not permanent, and injections do not offer an opportunity to stabilize an incompetent joint. Surgery is often regarded as a last resort, but for some patients, it is the only effective method of stabilizing loose joints. Fixation of joints (screws or similar hardware, without the use of bone grafting) is more common than spinal fusion, as it is much less invasive, is easily performed surgically, and results in faster recovery time for the patient. Some experts in the field believe it is important to ensure the sacroiliac joint is in the correct anatomical position prior to fixation or fusion, but published research conflicts with this belief.
See also
- Pelvic floor dysfunction
- Pelvic pain
- Sacroiliitis
References
Source of the article : Wikipedia
0 Comments