Sacroiliac Joint Dysfunction Research Articles

Pain and functional outcomes of the sacroiliac joint after platelet-rich plasma injection: a descriptive review.

The purpose of this manuscript is to highlight and review the status of literature regarding efficacy of platelet-rich plasma (PRP) in the treatment of sacroiliac joint (SIJ) dysfunction. A review of the literature on PRP interventions on the SIJor ligaments was performed.Seven studies had improvements in their respective primary end point and demonstrated a strong safety profile without any serious adverse events. Only five articles demonstrated clinical efficacy of >50% in their primary outcome measures.There appears to be inconsistent and insufficient evidence for a conclusive recommendation for or against SIJ PRP. There is a need for adequately powered well-designed, standardized, double-blinded randomized clinical trials to determine the effectiveness of PRP in SIJ-mediated pain.

Transiliac interpedicular screw rod with sacroiliac joint cannulated screw fixation: A treatment option for sacroiliac joint dysfunction

Transiliac interpedicular screw rod with sacroiliac joint cannulated screw fixation: A treatment option for sacroiliac joint dysfunction

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

Bilateral Sacroiliac Joint Fusion: A Case Report

Sacroiliac (SI) joint is the articulation which forms the part of the bony pelvis. It plays an important role in locomotor activity, and childbirth during labour. It helps in the transmission and distribution of axial body weight from the spine to the pelvis. This synovial joint exhibit limited gliding movements within the joint cavity. About 15-30% of low backache aetiologies are attributed to SI joint dysfunction. People who are overweight, have co-morbid conditions, and pregnant women are at higher risk of developing vertebral joint deformities called spondylarthropathies. They are group of inflammatory disorders which are involving the vertebral spines and peripheral joints, where the symptom of stiffness is prominently seen. The anatomical variations in the SI joint morphology like accessory SI joint, iliosacral complex and sacral defect, dismorphic joint, are of compelling interest concerning SI joint pathologies from the orthopaedic viewpoint. This case report presents a bilateral fusion of SI joint, found in a skeleton in the museum of medical college.

Relationship of the mobility of the sacroiliac joint with foot plant pressure.

[Purpose] To evaluate mobility of the sacroiliac joint and plantar pressure changes. [Participants and Methods] This was an analytical study comprised of 300 participants, using a functional kinetic evaluation involving the test of standing flexion (SFT), the test of Downing, the test of Gillet, and the analysis of baropodometry. [Results] There was an association between mobility of the sacroiliac joint and the standing center of gravity. However, the mobility of this joint was not associated with plantar pressure and the plantar contact area. [Conclusion] These data suggest that sacroiliac mobility is linked to the center of gravity. This connection may precede sacroiliac dysfunction and may help to improve the accuracy of the tests.

Comparative Analysis of the Pain Provocation Test and the HABER Test to Diagnose Nonspecific Low-Back Pain Associated with the Sacroiliac Joint.

BackgroundThis study aimed to investigate the correlation between the pain provocation test and the hip abduction-external rotation (HABER) test for diagnosing low-back pain (LBP)-related sacroiliac joint (SIJ) syndrome, and to determine the efficacy of the HABER test as a potential diagnostic tool for SIJ syndrome.Material/MethodsOne hundred patients with LBP participated. The first and second examiner examined the patients using the pain provocation test and the HABER test, respectively. Positive and negative findings were analyzed to determine the correlation and reliability.ResultsThe HABER test showed similar pain reproduction in groups that were positive or negative for SIJ syndrome (P<0.05). Based on the analysis of the receiver-operating characteristic curve, the cutoff values from the HABER test were found to be 29° and 32° of external rotation in the left and right hip joints, respectively.ConclusionsThe HABER test can reproduce similar level of pain in patients with chronic LBP associated with SIJ syndrome, and it can be used as a diagnostic tool in patients presenting with chronic LBP.

Are Hydroxyapatite-Coated Screws a Good Option for Sacroiliac Joint Stabilization? A Prospective Outcome Study

This is a single-surgeon series to prospectively evaluate the clinical and radiologic results of sacroiliac joint (SIJ) stabilization using hydroxyapatite (HA)-coated, fully threaded screws in patients with SIJ dysfunction. A total number of 40 patients underwent percutaneous SIJ stabilization using HA-coated screws between 2013 and 2015 at the University Hospital of LLandough with an age range of 33-84 years. Patients were followed up closely, and outcome scores were collected preoperative and 12 months after surgery. Preoperative and postoperative outcomes were evaluated using patient-reported outcome measures (PROMs), Short Form-36, Oswestry Disability Index, EuroQol-5D-5L, and Majeed Pelvic Scores. Thirty-three patients (8 male and 32 female) out of the 40 patients completed follow-up. There was an overall improvement in all PROMs; however, only mental component of SF-36, Oswestry Disability Index, Majeed Pelvic Scores, and EuroQol-5D-5L were statistically significant. Twenty-one patients (63%) had lysis around the screw, and a subgroup analysis showed that improvement in PROMs was significantly less in patients with lysis around the screw. Four patients with lysis around the screw were offered revision due to ongoing pain. Revision was successful in only 1 patient. Percutaneous SIJ fixation procedure has been shown to have good clinical outcomes, but the use of HA-coated fully threaded screws in this procedure is not recommended on the basis of patient-reported outcome measures and radiologic findings in this prospective study.

Reply to the Letter to the Editor for "Evaluation of the effect of chiropractic manipulative treatment on oxidative stress in sacroiliac joint dysfunction".

Reply to the Letter to the Editor for "Evaluation of the effect of chiropractic manipulative treatment on oxidative stress in sacroiliac joint dysfunction".

Comparison of Glutues Maximus Activation to Flexion Bias Exercises Along with MET Technique in Subjects with Anterior Rotated Sacroiliac Joint Dysfunction—a Randomised Controlled Trial

Background: Sacroiliac joint dysfunction (SIJD) is the primary source of lowback pain. Main muscles forming the force closure of sacroiliac joint are the biceps femoris and gluteus maximus which increase the stability through massive attachments via sacrotuberous ligament. However, there is a dearth of literature of the importance of activation of gluteus maximus in SIJD. Purpose: To study the effect of gluteus maximus activation on Oswestry Disability Index (ODI), visual analog scale (VAS), and pelvic tilt angle in subjects with anterior rotated sacrolilac joint dysfunction. Settings: The study was conducted in outpatient Physiotherapy Department, Manipal Hospital, Bangalore, India. Participants: Anterior rotated SIJD subjects were recruited in the study. They were divided into two groups (experimental and control groups) by block randomisation. Research Design: This is a randomised control trial. Controlled Treatment: Treatment order was determined by block randomisation. The subjects of both experimental and control group received Muscle Energy Technique (MET) technique on 1st session to correct the anterior rotated SIJD. The experimental group received gluteus maximus activation protocol, whereas the control group received flexion bias exercises. The groups received the treatment of 20 mins per session. There were two supervised sessions per week for four weeks. Main Outcome Measures: The primary outcome measure in the study is Oswestry Disability Index (ODI). The secondary outcome measures included visual analog scale (VAS) and Palpation Meter (PALM). Results: 48 subjects (26 females, 22 males) were randomised into experimental and control groups having anterior rotation SIJD, and average age in groups was 38.83 ± 11.4 years and 34.96 ± 9.5 years, respectively. The within-group analysis showed significant improvements in only ODI outcome of both the groups (p = .001). The between-group analysis in both groups did not show any statistical significant difference in ODI, VAS, or PALM. Conclusion: The flexion bias exercise and the gluteus maximus activation exercises used in this study were equally effective in improving physical function and reduction in pain, and maintaining the normal pelvic angle in subjects with anterior rotated SIJD.

The association of parturition scars and pelvic shape: A geometric morphometric study.

ObjectivesPelvic features, mostly known as parturition scars, have been extensively studied in the last decades and are frequently investigated in archaeological and forensic contexts. It is still unclear, however, whether they really relate to pregnancy and birth, or whether these features are caused by other biomechanical factors. Because the length and difficulty of labor correlates with the form of the birth canal, we studied the association between the expression of pelvic features and pelvic shape using geometric morphometrics.Materials and MethodsWe scored the expression of the preauricular sulcus, margo auricularis groove, sacral preauricular extension, dorsal and ventral pubic pitting for 54 individuals from a 19th century collection and 19 individuals from the Bronze Age cemetery of Hainburg‐Teichtal, Austria. Based on photogrammetric surface models, pelvic shape was captured by 331 landmarks and semilandmarks. The multivariate association between pelvic features and pelvic shape was explored by partial least squares analysis.ResultsWithin the female subsample, we detected a significant association of a constrained birth canal with a strong expression of the preauricular sulcus, the margo auricularis groove, and a retroverted position of the acetabulum. No significant association was found among males.DiscussionThis suggests that difficult or prolonged labor may indeed cause more strongly expressed pelvic features, presumably because of increased strain of the pelvic ligaments during birth. Furthermore, the retroversion of the acetabulum, which is known to cause sacroiliac joint dysfunction, changes the strain on pelvic ligaments and can thus also result in the development of pronounced pelvic features.

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.

The effect of sacroiliac chiropractic adjustments on innominate angles.

AimThe aim of this study was to determine whether or not a measurable change in the angle of the innominate bone could be identified after a chiropractic sacroiliac adjustment using a ‘PALM PALpation Meter’. Secondly, if a change in the angle of the innominate bone was identified, what was the degree of change in the angle of the innominate bone, induced by the sacroiliac joint (SIJ) adjustment.MethodThis was a true experimental study that consisted of 100 participants who met the inclusion criteria. The participants were randomly allocated to either the treatment or control group. Each group had 50 participants: 25 females and 25 males. Informed consent was obtained from participants prior to commencement of treatment. The treatment group received a chiropractic adjustment based on their specific SIJ dysfunction. The control group was treated with detuned ultrasound therapy (sham treatment).ProcedureTreatment consisted of a once-off treatment. The angles of the innominate bones were measured bilaterally pre- and post-treatment in both groups. Objective data were collected using the PALM PALpation Meter. Once the dysfunctional SIJ was identified, participants in group 1 were treated with specific chiropractic adjustment techniques based on the restriction. Group 2 participants were treated with detuned ultrasound only.ResultsThe results of this study showed that a specific chiropractic adjustment resulted in a measurable change in the angle of the innominate bone (p ≤ 0.001). The change in angle was evident bilaterally; however, the side that was adjusted shows the greatest degree of change. The mean change in angle for the treatment group was 2.25° on the side of dysfunction.ConclusionThe results of this study showed that a specific chiropractic adjustment can have a positive effect on the angles of the innominate bone, resulting in the tilt of the pelvis levelling into what is considered to be its correct anatomical alignment.

English

BACKGROUND Low back pain is a common condition in India. 90 % of Indian population experience low back pain at least once in their lifetime. Studies show that 98 % low back pain is because of mechanical disorder of spine. Piriformis tightness is one of the most misdiagnosed causes for low back pain or sacroiliac joint dysfunction. Various manual therapy approaches have been studied for reducing muscle tightness. We wanted to assess the effectiveness of muscle energy technique that is post-isometric relaxation technique on piriformis muscle tightness, its effectiveness in relieving low back pain with radiation, and increasing range of motion. METHODS 60 patients were included in the study as per inclusion and exclusion criteria from Ravi Nair Physiotherapy College, Sawangi Meghe, and were randomly assigned in to two groups. The duration of study was 12 days (6 sessions / week) and follow up was taken on 27th day. Subjects in muscle energy technique experimental group were treated with post isometric relaxation technique (PIR), subjects in control group were given simple passive stretching of piriformis. All subjects were educated about proper ergonomics. RESULTS Both interventions post isometric relaxation and simple stretching techniques were effective in terms of pain reduction, ROM (Range of Motion) improvement, piriformis tightness, disability with p &lt; 0.05 with post isometric relaxation technique superseding simple stretching. Moreover, post isometric relaxation technique in muscle energy technique had sustained effects on follow-up in terms of relieving pain, disability and tightness for longer period of time. CONCLUSIONS Muscle energy technique gives immediate relief of pain improving ROM and decreasing tightness of piriformis and disability and has longer lasting effects. KEY WORDS Piriformis Tightness, Muscle Energy Technique, Stretching.

A painful unknown: sacroiliac joint diagnosis and treatment.

The sacroiliac joint (SIJ) is a complex anatomical structure located near the centre of gravity of the body.Micro-traumatic SIJ disorders are very difficult to diagnose and require a complete clinical and radiological examination.To diagnose micro-trauma SIJ pain it is recommended to have at least three positive provocative specific manoeuvres and then a radiologically controlled infiltration test.Conservative treatment combining physiotherapy and steroid injections is the most common therapy but has a low level of efficiency. SIJ thermolysis is the most efficient non-invasive therapy.SIJ fusion using a percutaneous technique is a solution that has yet to be confirmed on a large cohort of patients resistant to other therapies.Cite this article: EFORT Open Rev 2020;5:691-698. DOI: 10.1302/2058-5241.5.190081

Role of Exercise Treatment of Low Back Pain in Pregnancy

This review identified exercise therapies for specific diagnoses underlying pregnancy-related low back (PLBP) and pelvic girdle pain (PPGP). We describe the biomechanical changes that may lead to sacroiliac dysfunction during pregnancy, pubic symphysis dysfunction, diastasis recti in the peripartum period, and pregnancy-related low back pain. Our focus was to examine the impact of exercise on each condition. We consolidated updated guidelines for physical activity throughout pregnancy, explored whether exercise is effective for stabilizing the low back and pelvic girdle in pregnant and postpartum patients as well as reviewed the absolute and relative contraindications to physical activity during pregnancy. PLBP and PPGP stem from multiple etiologies and can affect women during their pregnancy and in the postpartum period. Exercise during pregnancy is recommended for the cardiorespiratory fitness of pregnant women, appears to reduce disability and sick leave from work, and is considered to be relatively safe except for noted contraindications.

Sacroiliac joint syndrome after lumbosacral fusion

IntroductionOne-third of low back pain cases are due to the sacroiliac (SI) joint. The incidence increases after lumbosacral fusion. A positive Fortin Finger Test points to the SI joint being the origin of the pain; however, clinical examination and imaging are not specific and minimally contributory. The gold standard is a test injection of local anesthetic. More than 70% reduction in pain after this injection confirms the SI joint is the cause of the pain. The aim of this study was to evaluate the decrease in pain on a Numerical Rating Scale (NRS) after intra-articular injection into the SI joint. We hypothesised that intra-articular SI injection will significantly reduce SI pain after lumbosacral fusion. MethodsAll patients with pain (NRS>7/10) suspected of being caused by SI joint syndrome 1 year after lumbosacral fusion with positive Fortin test were included. Patients with lumbar or hip pathologies or inflammatory disease of the SI joint were excluded. Each patient underwent a 2D-guided injection of local anesthetic into the SI joint. If this failed, a second 2D-guided injection was done; if this also failed, a third 3D-guided injection was done. Reduction of pain on the NRS by>70% in the first 2 days after the injection confirmed the diagnosis. Whether the injection was intra-articular or not, it was recorded. Ninety-four patients with a mean age of 57 years were included, of which 70% were women. ResultsOf the 94 patients, 85 had less pain (90%) after one of the three injections. The mean NRS was 8.6/10 (7–10) before the injection and 1.7/10 after the injection (0–3) (p=0.0001). Of the 146 2D-guided injections, 41% were effective and 61% were intra-articular. Of the 34 3D-guided injections, 73% were effective and 100% were intra-articular. DiscussionThis study found a significant decrease in SI joint-related pain after intra-articular injection into the SI joint in patients who still had pain after lumbosacral fusion. If this injection is non-contributive when CT-guided under local anesthesia, it can be repeated under general anesthesia with 3D O-arm guidance. This diagnostic strategy allowed us to confirm that pain originates in the SI joint after lumbosacral fusion in 9 of 10 patients. ConclusionIf the first two CT-guided SI joint injections fail, 3D surgical navigation is an alternative means of doing the injection that helps to significantly reduce SI joint-related pain after lumbosacral fusion. Level of evidenceIV, retrospective study.

Puncture technologies in the treatment of pain syndrome caused by sacroiliac joint dysfunction

Sacroiliac joint (SIJ) dysfunction is a cause of low back pain in 10–30% of cases. In 1993, the International Association for the Study of Pain (IASP) defined the following set of diagnostic criteria necessary to diagnose SIJ dysfunction: 1) the presence of pain in the areas characteristic of SIJ lesions, with special attention to pain in the Fortin area projection, with possible different types of radiation; 2) positive pain provocation tests for a SIJ lesion; 3) reduced pain after intra-articular anesthetic injection; 4) the lack of a specific nature of the lesion (fracture, inflammation, tumor, etc.). Injection of 0.5–2.5 ml of solution of an anesthetic (bupivacaine, lidocaine) and 20–40 mg of triamcinolone or 5 mg of betamethasone (1 ml) into the SIJ area is used as interventional technologies. More prolonged analgesia involves radiofrequency denervation (RFD) of the SIJ, in which needles with electrodes are placed in the projection of the nerves that innervate the SIJ, and their local thermal destruction is performed. The effectiveness of RFD of SIJ requires further investigation.

МАНУАЛЬНА ТЕРАПІЯ В ЛІКУВАННІ БОЛЬОВИХ РОЗЛАДІВ КРИЖОВО-КЛУБОВОГО СУГЛОБУ

Болі в структурах крижово-клубових суглобів і їх дисфункція становлять значну частину патологій попереково-крижового відділу хребта. Їх симптоматика різноманітна, бо вона пов’язана як із запальними процесами в самих суглобах, так і з нестабільністю суглобів та підтримуючих їх зв'язок. Всі складові цих структур можуть бути джерелом болю, тому й діагностувати та лікувати захворювання доволі складно. Лікування патологій крижово-клубових суглобів багатопланове. Дана публікація доводить, що мануальна терапія в поєднанні з ударно-хвильовою терапією дозволяє успішно надавати допомогу хворим із стійкими до лікування больовими синдромами та дисфункцією крижово-клубових суглобів, які не отримали бажаного результату при використанні традиційних методів консервативних та хірургічних втручань.

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".