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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