Diagnosis Of Sacroiliac Joint Dysfunction Research Articles

Steroids Versus Steroids With Dexmedetomidine In Ultrasound Guided Sacroiliac Joint Injection In Patients With Chronic Low Back Pain

The goal of this study is to evaluate the effect of adding dexmedetomidine as an adjuvant to steroid injection versus steroid alone in chronic low back pain caused by sacroiliac joint arthritis. Sixty patients of both sex, ASA grade 1 and 2, between the ages of 18-70 years, BMI less than 30 kg/m2, after diagnosis of sacroiliac joint dysfunction and failure of conservative management were randomly allocated into two groups (n=30). Group (1): patients received SI injection with 2ml of long-acting corticosteroid (14 mg Betamethasone) and 0.5 ml of normal saline and group (2): patients received SI injection with 2ml of long-acting corticosteroid (14 mg Betamethasone) and 0.5ml dexmedetomidine (50 mcg). Patients were observed for vital signs, pain intensity and possible side effects in the recovery room for 4 hours then discharged. The patient’s pain intensity using Numerical Rating Scale, or functional improvement using Oswestry Disability Index and Functional Rating Scale and complications were followed up at 2 weeks, 4 weeks and 12 weeks. While, short assessment of patient satisfaction was assessed 2 weeks after injection. The results revealed that addition of dexmedetomidine to steroids in sacroiliac joint injection is of low value. There was no statistically significant difference between the steroid group and the dexmedetomidine group regarding the changes in the NRS, ODI and FRI scores at 2 weeks, 4 weeks and 12 weeks after injection.

Definitive diagnosis of sacroiliac joint dysfunction and indications of minimally invasive sacroiliac joint fixation in the history of surgical treatments

Definitive diagnosis of sacroiliac joint dysfunction and indications of minimally invasive sacroiliac joint fixation in the history of surgical treatments

A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain.

IntroductionThe sacroiliac joint (SIJ) has been estimated to contribute to pain in as much as 38% of cases of lower back pain. There are no clear diagnostic or treatment pathways. This article seeks to establish a clearer pathway and algorithm for treating patients.MethodsThe literature was reviewed in order to review the biomechanics, as well as establish the various diagnostic and treatment options. Diagnostic factors addressed include etiology, history, physical exam, and imaging studies. Treatment options reviewed include conservative measures, as well as interventional and surgical options.ResultsProposed criteria for diagnosis of sacroiliac joint dysfunction can include pain in the area of the sacroiliac joint, reproducible pain with provocative maneuvers, and pain relief with a local anesthetic injection into the SIJ. Conventional non-surgical therapies such as medications, physical therapy, radiofrequency denervation, and direct SI joint injections may have some limited durability in therapeutic benefit. Surgical fixation can be by a lateral or posterior/posterior oblique approach with the literature supporting minimally invasive options for improving pain and function and maintaining a low adverse event profile.ConclusionSIJ pain is felt to be an underdiagnosed and undertreated element of LBP. There is an emerging disconnect between the growing incidence of diagnosed SI pathology and underwhelming treatment efficacy of medical treatment. This has led to an increase in SI joint fixation. We have created a clearer diagnostic and treatment pathway to establish an algorithm for patients that can include conservative measures and interventional techniques once the diagnosis is identified.

Letter to the editor regarding "Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life".

Letter to the editor regarding "Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life".

Recurrent Hamstring Injuries in Elite Athletes - A Paradigm Shift to Mechanical Dysfunction of the Sacroiliac Joint as One Causation

Recurrent hamstring injuries are a significant and troubling issue in the elite athletic community. Reinjury may occur in up to 34% of patients in the kicking and running sports. We hypothesised that a proportion of these patients may have mechanical dysfunction of the sacroiliac joint as a causative mechanism. We recruited 23 elite athletes with recurrent hamstring injuries and lateralising lower back pain into the study after careful screening. Diagnosis was confirmed by scintigraphic SPECT/ CT imaging. Patients who failed directed physiotherapy were offered injection of the sacroiliac joint with platelet rich plasma (PRP). All 23 athletes (Av age 35 years, 19 M, 4F) had MRI evidence of hamstring tears (Av 4.2 tears) and met criteria for a diagnosis of sacroiliac joint dysfunction with mean clinical scores of 6.8 (Range: 7-9). Four patients returned to sport after physiotherapy and 19 underwent peri-articular PRP injection under ultrasound guidance. The baseline VAS was 80 (mean) and after treatment 9, indicating a significant response to treatment (p=0.002). All patients with SIJ dysfunction and recurrent hamstring tears responded to treatment. A plausible explanation for the relationship is the alteration in muscle sequencing around the pelvis following SIJ dysfunction.

Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life.

A prospective cross-sectional study. To evaluate the prevalence of sacroiliac joint dysfunction in patients with lumbar disc hernia and examine the variations in clinical parameters cause by this combination. Although one of the many agents leading to lumbar pain is sacroiliac dysfunction, little progress has still been made to evaluate mechanical pain from sacroiliac joint dysfunction within the context of differential diagnosis of lumbar pain. Two hundred thirty-four patients already diagnosed with lumbar disc hernia were included in the study. During the evaluation, sacroiliac joint dysfunction was investigated using specific tests, pain levels with a Visual Analog Scale, and the presence of neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Other clinical assessments were performed using the Beck Depression Inventory, Health Assessment Questionnaire, and Tampa Kinesiophobia Scale. 63.2% of patients were female and 36.8% were male. Mean age was 46.72 ± 11.14 years. The level of sacroiliac joint dysfunction was 33.3% in the research population. In terms of sex distribution, the proportion of women was higher in the group with sacroiliac joint dysfunction (P < 0.05). No significant difference was observed in pain intensity assessed using a Visual Pain Scale between the groups (P > 0.05), but the level of neuropathic pain was significantly higher in the group with dysfunction (P < 0.05). In the group with sacroiliac joint dysfunction, the presence of depression was significantly higher (P = 0.009), functional capacity was worse (P < 0.001), and the presence of kinesophobia was higher (P = 0.02). Our study results will be useful in attracting the attention of clinicians away from the intervertebral disc to the sacroiliac joint in order to avoid unnecessary and aggressive treatments. 2.

The Validity and Reliability of Provocation Tests in the Diagnosis of Sacroiliac Joint Dysfunction

Although sacroiliac joint dysfunction (SIJD) is generally regarded as a source of lumbar pain, its anatomical position and the absence of a diagnostic 'gold standard' lead to difficulties at examination and differential diagnosis. However, since sacroiliac (SI) joint blocks only provide information about pathologies of joint origin and since SIJD developing secondary to pathologies in structures around the joint can be missed. Provocation and palpation tests also need to be used in diagnosis. The purpose of this study was to examine the reliability of clinical examination and provocation tests used in the diagnosis of SIJD. Retrospective analysis of prospectively collected data. Outpatient physical medicine and rehabilitation clinic. One hundred and seventeen patients presenting with lumbar and/or leg pain and diagnosed with SIJD through clinical evaluation were included in the study. Range of lumbar joint movement, pain location and specific tests used in the diagnosis of SIJD were evaluated. Positivity in 3 out of 6 provocation tests was adopted as the criterion. 75.2% of patients were female and 24.8% were male. Mean age was 46.41 ± 10.45 years. A higher level of females was determined in ender distribution. SIJD was determined on the right in 52.6% of patients and on the left in 47.4%. When SI joint provocation tests were analyzed individually, the highest positivity, in 91.4% patients diagnosed with SIJD, was in the FABER test. The lowest positivity, in 56.4% of patients, was determined in the Ganslen test. The same patients were assessed by the same clinician at 2 different times. In these data, the simple consistence, kappa and PABAK coefficient values of all tests were close to 1 and indicating good agreement. The thigh thrust (POSH) and sacral thrust tests exhibited very good agreement with a kappa coefficient of 0.90 and a PABAK coefficient of 0.92, while the FABER test exhibited good agreement with a kappa coefficient of 0.78 and a PABAK coefficient of 0.92. Agreement between different observers was not evaluated, and also no comparison was performed with SI joint injection, regarded as a widely used diagnostic technique. The anatomical position of the SI joint and the lack of a diagnostic 'gold standard' make the examination and diagnosis of SIJD difficult. Most SI joint clinical tests have limited reliability and validity on their own, while a multitest regimen consisting of SI joint pain provocation tests is a reliable method, and these tests can be used instead of unnecessary invasive diagnostic SI joint procedures. Dysfunction, lumbar, sacroiliac joint, provocation test, sacroiliac joint pain, pain pattern.

Lumbar Radiofrequency Rhizotomy in Patients with Chronic Low Back Pain Increases the Diagnosis of Sacroiliac Joint Dysfunction in Subsequent Follow-Up Visits

Chronic back pain is often a result of coexisting pathologies; secondary causes of pain can become more apparent sources of pain once the primary pathology has been addressed. The objective of our study was to determine if there is an increase in diagnosis of Sacroiliac joint pain following a Lumbar Rhizotomy. A list of patients who underwent Lumbar Radiofrequency during a 6-month period in our clinic was generated. Records from subsequent clinic visits were reviewed to determine if a new diagnosis of SI joint pathology was made. In patients who underwent a recent Lumbar Rhizotomy procedure to treat facetogenic pain, the prevalence of Sacroiliac joint pain increased to 70%. We infer that there is a significant increase in the diagnosis of Sacroiliac joint syndrome following a Lumbar Rhizotomy, potentially due to unmasking of a preexisting condition. In patients presenting with persistent back pain after Lumbar Rhizotomy, the clinician must have a high degree of suspicion for latent Sacroiliac joint pain prior to attributing the pain to block failure. It would be prudent to use >80% relief of pain after a diagnostic medial branch block as a diagnostic criterion for facetogenic pain rather than the currently accepted >50% in order to minimize unmasking of preexisting subclinical pain from the SI joint.

Sacroiliac Joint Pain: Clinical and Impairment Rating Issues

AbstractThe sacroiliac joint (SIJ) is an accepted source of pain in patients with ankylosing spondylitis and other spondyloarthropathies, osteoarthritis, infections, and tumors, but the occurrence of isolated SIJ pain in the absence of such diseases is controversial. The term, sacroiliac joint dysfunction, which is used widely, describes pain from an SIJ that has no identifiable lesion but is presumed to have some mechanical etiology. Practitioners currently have no universally accepted gold standard for identifying a disc, facet joint, of SIJ as the pain generator. Treatment options for SIJ pain include medications, physical therapy, bracing, manual therapy, injections, radiofrequency neurotomy, and arthrodesis. Optimal management of patients with SIJ pain remains controversial. In the AMA Guides, Sixth Edition, a clinically established and causally related diagnosis of SIJ dysfunction is rated using the first row in Table 17-4. Surgery does not change the diagnosis or rating: The SIJ is not a motion segment of the lumbar spine, and SIJ fusion is not an alteration of motion segment integrity. Clinically, pain presumed to be from SIJ dysfunction is low back pain, so if this is the clinical diagnosis, the spine chapter in the AMA Guides, Fifth Edition, should be used. In such cases, the first step is to determine whether to use the diagnosis-related estimate or the range-of-motion method, and the article provides guidance about situations in which the use of each is appropriate.

Relative Sensitivity, Specificity and Perceived Exertion of Some Provocative Tests in the Mechanical Diagnosis of Sacro-Iliac Joint Dysfunction among Patients with Low Back Pain

Purpose: Provocative tests are known to be clinically useful in the identification of soft tissue and articular dysfunctions, however, the proportion of patients with Sacro-Iliac Joint (SIJ) dysfunction who have positive tests (sensitivity) and the proportion who have negative tests (specificity) for these tests are not well known. This study examined the relative sensitivity, specificity and associated stress of Gross SIJ Compression (GSIJC) and Distraction (GSIJD), Supine-Long Sitting (SLS) and Posterior Dimple Compression (PDC) tests among patients with Low Back Pain (LBP). Method: Fifty three subjects (male-24, female-29; age range 19-90 years, mean age 57.6yrs) went through the four tests and the test that elicited pain and/or limb length discrepancy (positive test) were noted. Pain intensity was rated using semantic differential scale before and after testing, while test induce exertion was assessed using Borge scale after testing. GSIJC test was set as gold standard for the purpose of analysis. Result: PDC (0.91) was more sensitive than SLS (0.67) and GSIJD (0.57, while GSIJD was more specific (0.91) than SLS (0.84) and PDC (0.56). However, PDC was the least exerting (7.2) followed by GSIJD (7.5), SLS (13.0) and GSIJC (13.9). Conclusion: PDC test is the least exerting and more able to identify the proportion of LBP patients having SIJ dysfunction while GSIJD is more able to identify the proportion of Patients with LBP without SIJ dysfunction but exert more stress on the patient without gender bias.

Diagnosis and manipulative therapy of sacroiliac joint disorder

AbstractObjectiveTo present a case study and discuss the role of an orthopaedic medicine approach (OMA) to clinical diagnosis and treatment of sacroiliac joint (SIJ) disorder in the light of recent research evidence.Case studyA 38-year-old female suffering from pain over the SIJ and right buttock was diagnosed to have an SIJ disorder using an orthopaedic medicine assessment. She was managed by a multi-disciplinary treatment approach in which improvement coincided with the addition of manipulation. The patient showed an improvement in the numerical pain rating scale from 6 to 0 and the revised Oswestry back disability score reduced from 25 to 3% at discharge.DiscussionLatest research evidence suggests that a composite of tests is more valid and reliable in the diagnosis of SIJ dysfunction than individual tests.ConclusionThe OMA may be improved by the use of a composite of tests for the diagnosis of SIJ disorder.

Sacroiliac Joint Dysfunction: Evaluation and Treatment

Sacroiliac joint (SIJ) dysfunction is once again garnering attention as a treatable diagnosis for the millions of individuals suffering from acute and chronic low back pain. Theoretically, excessive or restricted motion at the SIJ can alter the mechanics of the spine and pelvis causing pain. Often the clinician's history and physical examination are nonspecific in the evaluation of low back pain and a high index of suspicion is required to consider SIJ dysfunction as the cause for the patient's symptoms. Multiple physical examination maneuvers exist to detect SIJ dysfunction, but none are individually sensitive or specific enough to diagnose SIJ dysfunction alone. The clinician should learn 3 to 5 tests that can easily be performed and replicated for the evaluation of SIJ dysfunction and use them consistently in patients presenting with low back pain. Sacroiliac joint anesthetic blocks using computed tomography (CT) or fluoroscopic-guided injection are considered the gold standards for diagnosing SIJ dysfunction as the cause for nonspecific low back pain. Imaging studies and laboratory evaluations are generally unnecessary for the diagnosis of SIJ dysfunction unless specific elements of the history and physical suggest alternate etiologies. Interventions to treat the pain of SIJ dysfunction include nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, corticosteroid injections, osteopathic manipulation, radiofrequency denervation, SIJ belts, and surgery. While there are few high-level evidence studies evaluating and comparing these treatments in individuals with SIJ pain, patients may respond to one, or a combination of these treatments.

The role of sacroiliac joint dysfunction in the genesis of low back pain: the obvious is not always right

It is a common practice to the link low back pain with protruding disc even when neurological signs are absent. Because pain caused by sacroiliac joint dysfunction can mimic discogenic or radicular low back pain, we assumed that the diagnosis of sacroiliac joint dysfunction is frequently overlooked. To assess the incidence of sacroiliac joint dysfunction in patients with low back pain and positive disc findings on CT scan or MRI, but without claudication or objective neurological deficits. Fifty patients with low back pain and disc herniation, without claudication or neurological abnormalities such as decreased motor strength, sensory alterations or sphincter incontinence and with positive pain provocation tests for sacroiliac joint dysfunction were submitted to fluoroscopic diagnostic sacroiliac joint infiltration. The mean baseline VAS pain score was 7.8 +/- 1.77 (range 5-10). Thirty minutes after infiltration, the mean VAS score was 1.3 +/- 1.76 (median 0.000E+00 with an average deviation from median = 1.30) (P = 0.0002). Forty-six patients had a VAS score ranging from 0 to 3, 8 weeks after the fluoroscopic guided infiltration. There were no serious complications after treatment. An unanticipated motor block that required hospitalization was seen in four patients, lasting from 12 to 36 h. Sacroiliac joint dysfunction should be considered strongly in the differential diagnosis of low back pain in this group of patients.

Diagnostic Tests for Mechanical Dysfunction of the Sacroiliac Joints

Despite almost a century of management of mechanical dysfunction of the sacroiliac joints, no testing procedures have been satisfactorily validated for diagnosis. This paper presents tests that proved to be the most reliable for the management of 57 patients referred by their GPs for treatment of back and leg pain. The patients all regained normal pain-free function after manipulation of the sacroiliac joint(s) followed by a program of modified living and progressively increased walking. The tests include a version of Gillet's test (alternate hip and knee flexion in support standing) revised by the author, passive hip rotations in supine with 90 degrees of hip and knee flexion, and palpation of the superior ligament of the symphysis pubis. This paper proposes that when performed as described, these four tests are worth validating for the diagnosis of sacroiliac joint dysfunction.