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Sacroilitis
Sacroiliitis
Sacroiliitis are common terms used to describe the pain of the sacroiliac joint. It is usually caused by abnormal motion (i.e. hyper- or hypo-mobile) or malalignment of the sacroiliac joint. The joint can be hyper or hypo-mobile which can cause pain. Pain is usually localized over the buttock. Patients usually describe the pain as sharp, dull, achy, stabbing, or shooting pain directly over the affected joint.
Symptoms Of Sacroiliitis
- Sciatic-like pain – in the buttocks and/or backs of the thighs that feels hot, sharp, and stabbing and may include numbness and tingling. Sciatic-like pain from sacroiliac joint dysfunction rarely extends below the knee.
- Stiffness – and reduced range-of-motion in the lower back, hips, pelvis, and groin, which may cause difficulty with movements such as walking up stairs or bending at the waist.
- Worsened pain – when putting added pressure on the sacroiliac joint, such as climbing stairs, running or jogging, and lying or putting weight on one side.
- Instability – in the pelvis and/or lower back, which may cause the pelvis to feel like it will buckle or give way when standing, walking, or moving from standing to sitting.
Sacroiliac joint (SIJ) pain refers to the pain arising from the SIJ joint structures. SIJ dysfunction generally refers to an aberrant position or movement of SIJ structures that may or may not result in pain.
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Anatomy Of Sacroiliitis
Six variants of the sacroiliac joints have been observed: accessory joints, iliosacral complex, bipartite iliac bony plate, crescent-like iliac bony plate, semicircular defects at the sacral or iliac side and ossification centers.
- Accessory sacroiliac joint – Accessory sacroiliac joint is found medial to the posterior superior iliac spine and lateral to the second sacral foramen amongst a rudimentary transverse tuberosity. On CT imaging, accessory joints have articular surfaces that resemble osseous projects from the ilium to the sacrum. An accessory joint can be present at birth; however, they more commonly result from the stress of weight-bearing. Accessory joints are more commonly present in the obese population and the older population, as well as a higher prevalence in women with 3 or more childbirths, compared to 2 or less.
- Iliosacral complex – Iliosacral complex forms from a projection from the ilium articulating with a complementary sacral recess. These complexes can be unilateral or bilateral, and like accessory joints, these complexes exist at the posterior sacroiliac joint from the level of first to the second sacral foramen. This variant has been seen more in older patients greater than 60 years, as well as obese women more so than normal-weight women.
- Bipartite iliac bony plate – Bipartite iliac bony plate is located at the posterior portion of the sacroiliac joint and appears as described, consisting of two parts and appears unilaterally.
- Semicircular defects on the iliac/sacral side – The fourth variant is semicircular defects on either the sacral or iliac aspects of the articular surface of the sacroiliac joint. These can be unilateral or bilateral and again are present at the posterior portion of the sacroiliac joint from the level of the first to the second sacral foramen. This defect has been observed more in women than men and in patients older than 60 years.
- Crescent-like iliac bony plate – The fifth variant is a crescent-like articular surface which may be present unilaterally or bilaterally. CT imaging demonstrates a crescent-like iliac plate with accompanying a bulged sacral surface. This defect is found usually at the posterior portion of the sacral iliac joint spanning the levels of the first and second sacral foramen. This defect was observed only in women and more commonly in patients greater than 60 years old.
- Ossification centers of the sacral wings – The sixth anatomical variant observed is ossification centers presenting as triangular osseous bodies located within the joint space at the anterior portion of the sacroiliac joint. This defect is found at the level of the first sacral foramen, typically unilaterally.
Treatment Of Sacroiliac Joint Dislocation
- Massages – Various massage techniques are used to relax muscles and ease tension.
- Heating and cooling – This includes the use of hot packs and plasters, a hot bath, going to the sauna, or using an infrared lamp. Heat can also help relax tense muscles. Cold packs, like cold wraps or gel packs, are also used to help with irritated nerves.
- Ultrasound therapy – Here the lower back is treated with sound waves. The small vibrations that are produced generate heat to relax body tissue.
- Lumbar Manipulation – There is limited evidence suggesting that cervical manipulation may provide short-term benefits for neck pain. Complications from manipulation are rare and can include worsening radiculopathy, myelopathy, spinal cord injury, and vertebral artery injury. These complications occur ranging from 5 to 10 per 10 million manipulations.
- Lumbar Corset or Collar for Immobilization – In patients with acute neck pain, a short course (approximately one week) of collar immobilization may be beneficial during the acute inflammatory period.
- Traction – May be beneficial in reducing the radicular symptoms associated with disc herniations. Theoretically, traction would widen the neuroforamen and relieve the stress placed on the affected nerve, which, in turn, would result in the improvement of symptoms. This therapy involves placing approximately 8 to 12 lbs of traction at an angle of approximately 24 degrees of neck flexion over a period of 15 to 20 minutes.
- Supports or braces – When the SI joint is too loose (hypermobile), a pelvic brace can be wrapped around the waist and pulled snugly to stabilize the area. A pelvic brace is about the size of a wide belt and can be helpful when the joint is inflamed and painful.