Sacroiliitis

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Original Editors - Charlotte Fastenaekels

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Search Strategy[edit | edit source]

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Definition/Description[edit | edit source]

Sacroiliitis is an inflammation of one or both sacroiliac joints, which can lead to inflammatory low back pain but sometimes patients remain asymptomatic. Sacroiliitis is linked to spondyloartropathies (a group of diseases) and it can be defined as a sacroiliac joint dysfunction, which seems to be in a state of altered mechanics. Pain caused by sacroiliitis can be related to either too much or not enough motion in the SI joint. That makes it less a pathological diagnosis and more a patho-mechanical diagnosis.[1][2]

Clinically Relevant Anatomy[edit | edit source]

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Epidemiology /Etiology[edit | edit source]

Spondyloartropathies: Ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis of chronic inflammatory bowel disease and undifferentiated spondyloarthropathy. Symmetrical sacroiliitis is found in more than 90% of ankylosing spondylitis and 2/3 in reactive arthritis and psoriatic arthritis. It is less severe and more likely to be unilateral and asymmetrical in reactive arthritis, psoriatic arthritis, arthritis of chronic inflammatory bowel disease and undifferentiated spondyloarthropathy. Also traumatic injuries, infections, inflammatory conditions like rheumatoid arthritis, degenerative joint diseases, metabolic conditions like gout and even pregnancy, sacroiliitis can occur in all of them.[1][3]

Characteristics/Clinical Presentation[edit | edit source]

Pain in the buttocks, lower lumbar and postero-lateral thigh region. It may extend down to one ore both legs, predominant unilateral pain inferior to the PSIS, groin pain (might not be a sensitive indicator). In some cases there are aggravating or improving factors but with no diagnostic value. Sometimes decreased or increased range of motion, but it may not be a useful predictor.[1][3]

Differential Diagnosis[edit | edit source]

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Diagnostic Procedures[edit | edit source]

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Outcome Measures[edit | edit source]

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Examination[edit | edit source]

Some individual provocation tests show sufficient inter-rater reliability. The following tests seem to have sufficient diagnostic accuracy: the FABER test, thigh thrust test and the hip abduction test. A complete physical examination with an excellent accuracy to diagnose sacroiliac joint related pain should involve a cluster of sacroiliac joint tests and a McKenzie evaluation.[2][3]

Medical Management
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Physical Therapy Management
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Cryotherapy is useful in the acute phase. Once the pain is under control the patient can start with specific stabilizing exercises, which will help reduce the pain. Specific pelvic stabilizing exercises, postural education and training muscles of the trunk, but also the lower extremities, can be useful in patients with sacroiliac joint dysfunctions. The transversus abdominis, lumbar multifidi muscles and pelvic floor are the muscles that will need training. Teaching your patient to activate and control these muscles together with relaxed breathing is an efficient exercise. We can do this exercise in many different positions (sitting, standing, four-point kneeling, supine and prone) and when the patient has local segmental control he can train these muscles by stabilizing the low back and pelvis during activities of daily living, work or even sports. In an early stage we can use a pelvic belt or girdle during exercise and activities of daily living. It stabilizes and reduces the pain in the sacroiliac joint. [4] If the patient has a leg length discrepancy or an altered gait mechanism, the most reliable treatment would be correcting the underlying defect.[5][6][7][8]

Key Research[edit | edit source]

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Resources
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Clinical Bottom Line[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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  1. ↑ 1.0 1.1 1.2 J. Braun, J. Sieper and M. Bollow, Review Article Imaging of Sacroiliitis, Section of Rheumatology, Department of Nephrology and Endocrinology, UK Benjamin Franklin, Free University, Berlin; Department of Radiology, UK Charite´ , Humboldt University, Berlin, Germany,©2000 Clinical Rheumatology
  2. ↑ 2.0 2.1 M. Monticone, A. Barbarino, C. Testi, S. Arzano, A. Moschi, S. Negrini, Evaluation of the Presence of Sacroiliac Joint Region Dysfunction Using a Combination of Tests: A Multicenter Intertester Reliability Study, Physical Therapy . Volume 82 . Number 8 . August 2002
  3. ↑ 3.0 3.1 3.2 Peter Huijbregts, PT, MSc, MHSc, DPT, OCS, MTC, FAAOMPT, FCAMT Sacroiliac joint dysfunction: Evidence-based diagnosis, Assistant Online Professor, University of St. Augustine for Health Sciences, St. Augustine, FL, USA, Consultant, Shelbourne Physiotherapy Clinic, Victoria, BC, Canada,Rehabilitacja Medyczna (Vol. 8, No. 1, 2004)
  4. ↑ Daniel L Riddle, Janet K Freburger, Symptomatic efficacy of stabilizing treatment versus laser therapy for sub-acute low back pain with positive tests for sacroiliac dysfunction: a randomized clinical controlled trial with 1 year follow-up, North American Orthopaedic Rehabilitation Research Network*, EUR MED PHYS 2004
  5. ↑ J. J. M. PEL, C. W. SPOOR, A. L. POOL-GOUDZWAARD, G. A. HOEK VAN DIJKE, and C. J. SNIJDERS, Biomechanical Analysis of Reducing Sacroiliac Joint Shear Load by Optimization of Pelvic Muscle and Ligament Forces, Department of Biomedical Physics and Technology, Erasmus MC, PO Box 2040, Rotterdam 3000 CA, The Netherlands, Annals of Biomedical Engineering, Vol. 36, No. 3, March 2008 (© 2008) pp. 415–424
  6. ↑ Steven P. Cohen, REVIEW ARTICLE Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment, MD, Pain Management Divisions, Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD and Walter Reed Army Medical Center, Washington, DC, ©2005 by the International Anesthesia Research Society
  7. ↑ Cusi, M.F., Paradigm for assessment and treatment of SIJ mechanical dysfunction, Journal of Bodywork & Movement Therapies (2010), doi:10.1016/j.jbmt.2009.12.004 ©2009 Elsevier Ltd. All rights reserved.
  8. ↑ Stacy L. Forst, PA-C, Michael T. Wheeler, DO, Joseph D. Fortin, DO, and Joel A. Vilensky, PhD, A Focused Review The Sacroiliac Joint: Anatomy, Physiology and Clinical Significance, Pain Physician. 2006;9:61-68, ISSN 1533-3159
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