Article

The sacroiliac joint: anatomy, physiology and clinical significance.

Spine Technology and Rehabilitation & Indiana University School of Medicine Fort Wayne, Indiana, USA.
Pain physician (Impact Factor: 4.77). 02/2006; 9(1):61-7.
Source: PubMed

ABSTRACT The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and function, diagnostic indicators of SIJ-mediated pain, and therapeutic considerations. The SIJ is a true diarthrodial joint with unique characteristics not typically found in other diarthrodial joints. The joint differs with others in that it has fibrocartilage in addition to hyaline cartilage, there is discontinuity of the posterior capsule, and articular surfaces have many ridges and depressions. The sacroiliac joint is well innervated. Histological analysis of the sacroiliac joint has verified the presence of nerve fibers within the joint capsule and adjoining ligaments. It has been variously described that the sacroiliac joint receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami. Even though the sacroiliac joint is a known putative source of low back and lower extremity pain, there are few findings that are pathognomonic of sacroiliac joint pain. The controlled diagnostic blocks utilizing the International Association for the Study of Pain (IASP) criteria demonstrated the prevalence of pain of sacroiliac joint origin in 19% to 30% of the patients suspected to have sacroiliac joint pain. Conservative management includes manual medicine techniques, pelvic stabilization exercises to allow dynamic postural control, and muscle balancing of the trunk and lower extremities. Interventional treatments include sacroiliac joint, intra-articular joint injections, radiofrequency neurotomy, prolotherapy, cryotherapy, and surgical treatment. The evidence for intra-articular injections and radiofrequency neurotomy has been shown to be limited in managing sacroiliac joint pain.

Full-text

Available from: Joseph D. Fortin, Apr 18, 2015
12 Followers
 · 
680 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Konzepte zur Behandlung von Rückenschmerzen sind in den letzten Jahren unter dem Einfluss der Erkenntnisse zur Schmerzchronifizierung verstärkt in die Diskussion gekommen. Jede Art der Therapie setzt in jedem Falle eine möglichst exakte Diagnose voraus. Die Zuordnung klinischer Befunde zu bestehenden strukturellen Pathologien ist bei lumbalem Rückenschmerz jedoch nicht immer einfach. Die stationäre Stufendiagnostik im hier vorgestellten Konzept erfasst eine abgestufte strukturelle und funktionelle Diagnostik bei Rückenschmerzpatienten. Neben den spezifischen (klassifizierbaren) Faktoren der Schmerzverursachung (z. B. Wurzelkompression, facettenassoziierte Schmerzsyndrome, sakroiliakale Dysfunktion, segmentale Instabilität) sind auch unspezifische (nicht klassifizierbare) Krankheitsursachen und begleitende, die Krankheit beeinflussende oder sogar wesentlich bestimmende Faktoren der biopsychosozialen Ebenen zu differenzieren. Ziel dieses Beitrages ist es, den Wert und das Vorgehen stationärer Stufendiagnostik vorzustellen. Es werden verschieden Verfahren aufgezeigt und deren Wert für bestimmte Indikationen beschrieben.
    Der Orthopäde 01/2008; 37(4). DOI:10.1007/s00132-008-1225-5 · 0.67 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Low back pain (LBP) is one of the most common causes of disability that leads to discomfort and imposes heavy expenses on individuals and the society. Sacroiliac joint (SIJ) dysfunction is one of the courses of low back pain and difficult to diagnose. Therefore, it is usually neglected in evaluation and treatment of patients with low back pain. Materials and Methods: This epidemiological study carried out to determine the prevalence of SIJ dysfunction among LBP clients referred to the based hospitals in Isfahan (June to August 2007). According to the previous studies, 114 patients with LBP were selected by simple randomized sampling. Results: The results showed that more than 30 percent of LBP patients suffer from SIJ dysfunction simultaneously. Conclusion: According to this study, it is very important to pay attention to the signs and symptoms of SIJ dysfunction in LBP patients; because any pain relieving factors will satisfy patients from their physiotherapy treatment. Keywords: Sacroiliac joint, Low back pain, Prevalence
  • [Show abstract] [Hide abstract]
    ABSTRACT: Back pain in the pediatric population is a common complaint presenting to sports medicine clinics. There is a wide differential that should be considered, including mechanical, infectious, neoplastic, inflammatory, and amplified musculoskeletal pain. The history, pain quality, and examination are key components to help distinguish the etiologies of the pain and direct further evaluation. Laboratory investigations, including blood counts and inflammatory markers, can provide insight into the diagnosis. The HLA-B27 antigen can be helpful if a spondyloarthropathy is suspected. Imaging as clinically indicated typically begins with radiographs, and the use of MRI, CT, or bone scan can provide additional information. Proper diagnosis of back pain is important because prognosis and treatments are significantly different. We review the pertinent evaluation, differential diagnoses, and treatment of low back pain in the pediatric population.
    The Physician and sportsmedicine 02/2014; 42(1):94-104. DOI:10.3810/psm.2014.02.2052 · 1.49 Impact Factor