Sacrum Injury

Abstract

HISTORY: A 44-year-old secretary fell down from 4 meter above from the ground. After detailed physical and neurologic examination she had fixation operation due to fracture of left sacrum and pubic bones. While staying at the hospital, she had an decubitus ulceration on left sacroiliac joint and posterior inferior iliac spine. In spite of decubitus ulceration needed flapping, she rejected operatively treatment. After decubitus ulceration healed itself, she had pain on right side of sacrum and she had an corticostreoid injection on right sacroiliac joint. After injection, pain decreased but still exists. PHYSICAL EXAMINATION: Examination of paravertebral muscles and T12- L5 spinos processes pain and moderate tenderness detected. There was no numbness, allodynia and reflex deficits. Both flexion and extension movements of back were painful. active lomber flexion, her hands reached knee level. She could not sit symetrically. When she sits longer than ten minutes, she felt severe pain on sacrum. DIFFERENTIAL DIAGNOSIS: – Strain of paravertebral, piriformis and Quadratus Lumborum muscles. – Sacroiliac dysfunction – Facet Joint Syndrome TEST AND RESULTS: – Special provocation tests for sacroiliac joint – Lomber facet Joint stress tests – Pressure Pain Thresholds – Back Performance Scale TREATMENT AND OUTCOMES: – Myofascial releasing technics applied to muscles and thoracolomber fascia. – Post-isometric relaxation technics for Piriformis and Quadratus Lumborum muscles on right side. – Physiotherapist guided lomber stabilization exercise – Kinesiotaping application for scar tissue on decubitus ulceration area. – After 4 months later she had painless sitting, standing and walking abilities.