Sacroiliitis
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Search Strategy[edit | edit source]
The vast majority of information regarding my Physiopedia subject has come from PubMed. However, this wasn’t the only search method I’ve used. Web of Science and the public library were too a reliable source of information. My preference however goes out to PubMed, since you can work with different sets of search parameters which can help you to really target your search. For example, I’ve checked on parameters such as ‘reviews’ and ‘rct’s’ in the function ‘Limits’. This allowed me to select articles that were fully accessible. I’ve also made use of ‘Mesh’-terms. The subject I’ve chosen, namely ‘sacroiliitis’, is one of which you really are not flooded by, by the amount information (articles, books). So I had to point out some key terms on which I could build around my search. These key words were: sacroiliac joint, sacroiliac pain, sacroiliac joint dysfunctions, etc… The use of these terms allowed me to select eight articles which helped me to gain and lift out interesting, relevant and more so useful information about my subject.
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]
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 pain provocation tests show sufficient inter-rater reliability. The following tests seem to have sufficient diagnostic accuracy:(Patrick-) FABER (=Flexion, ABduction, External Rotation) test , thigh thrust test*, Gaenslen test, Mennell’s test**, sacral thrust test***, compression test**** and distraction test. [2][3] [4] [5]
A combination of these tests give a better accuracy to differentiate sacroiliitis from low back pain. We can use a combination of 3 tests (ex. Gaenslen, Mennell, and thigh thrust tests) or 5 tests (ex. Gaenslen, Patrick-Faber, Mennell, thigh thrust, and sacral thrust tests), which give favorable results if respectively 2 or 4 tests are positive. A positive test means it provokes pain. [4] [6] [5]
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.[7] 2 3
MRI and CT are also uses in the early stage to diagnose sacroiliitis. [4]
Thigh thrust test*:
subject: Supine, contralateral leg extended
examiner: Stands next to the subject
technique: The examiner flexes the affected leg (contralateral), approximately hip at 90°, knees remain relaxed and graded force pressure is applied through the long axis of the femur (=posterior shearing stress), one hand underneath the sacrum, the other one around the knee to give pressure
Mennell’s test**:
Subject: Side-lying position, affected side is down, back towards the edge of the table. Affected (table contacting) side hip flexed to the abdomen, knee is flexed
Examiner: Stands behind the patient
Technique: Examiner puts one hand over the ipsilateral gluteal region and iliac crest, other hand grasps the semi flexed ipsilateral knee and lightly forces the leg to extension
Sacral thrust test***:
Subject: Prone, legs relaxed, semi abducted
Examiner: Stands behind the subject, close to the feet at the lower edge of the table
Technique: Puts hands over the sacrum applies anterior pressure to the sacrum
Compression test****:
Subject: Compression Side-lying position, affected side is up, close to the side of the table and back towards the edge of the table. Hips
flexed approximately 45°, knees are flexed approximately 90° degrees
Examiner: Stands behind the subject
Technique: Examiner’s Folded hands over the anterior edge of the iliac crest and applies downward pressure [4]
The sacroiliac joint can be examined by Special tests.
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. [8] If the patient has a leg length discrepancy or an altered gait mechanism, the most reliable treatment would be correcting the underlying defect.[9][10][11][12]
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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- ↑ 1.0 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
- ↑ 2.0 2.1 M. Monticone, A. Barbarino, C. Testi, S. Arzano, A. Moschi, S. Negrini, Evaluation of the Presence of Sacroiliac Joint Region DysfunctionfckLRUsing a Combination of Tests: A Multicenter Intertester Reliability Study, Physical Therapy . Volume 82 . Number 8 . August 2002
- ↑ 3.0 3.1 3.2 Peter Huijbregts, PT, MSc, MHSc, DPT, OCS, MTC, FAAOMPT, FCAMT fckLRSacroiliac joint dysfunction: Evidence-based diagnosis,fckLRAssistant 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)
- ↑ 4.0 4.1 4.2 4.3 Salih Ozgocmen, Zulkif Bozgeyik, Mehtap Kalcik, Arafe Yildirim. The value of sacroiliac pain provocation tests in early active sacroiliitis. Clinical Rheumatology 2008; 27:1275–1282 (B)
- ↑ 5.0 5.1 Kent Jason Stuber, BSc, DC. Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. J Can Chiropr Assoc 2007; 51(1) (A1)
- ↑ Dirk J. Kokmeyer, Peter van der Wurff, Geert Aufdemkampe, and Theresa C. M. Fickenscherd. The Reliability of Multitest Regimens With Sacroiliac Pain Provocation Tests. Journal of Manipulative and Physiological Therapeutics 2002; Vol.25, No.1 (B)
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedM. Monticone et al. - ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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.
- ↑ 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
