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Al-Mnayyis A, Obeidat S, Badr A, Jouryyeh B, Azzam S, Al Bibi H, Al-Gwairy Y, Al Sharie S, Varrassi G. Radiological Insights into Sacroiliitis: A Narrative Review. Clin Pract 2024; 14:106-121. [PMID: 38248433 PMCID: PMC10801489 DOI: 10.3390/clinpract14010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Sacroiliitis is the inflammation of the sacroiliac joint, the largest axial joint in the human body, contributing to 25% of lower back pain cases. It can be detected using various imaging techniques like radiography, MRI, and CT scans. Treatments range from conservative methods to invasive procedures. Recent advancements in artificial intelligence offer precise detection of this condition through imaging. Treatment options range from physical therapy and medications to invasive methods like joint injections and surgery. Future management looks promising with advanced imaging, regenerative medicine, and biologic therapies, especially for conditions like ankylosing spondylitis. We conducted a review on sacroiliitis using imaging data from sources like PubMed and Scopus. Only English studies focusing on sacroiliitis's radiological aspects were included. The findings were organized and presented narratively.
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Affiliation(s)
- Asma’a Al-Mnayyis
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Shrouq Obeidat
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Ammar Badr
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Basil Jouryyeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Saif Azzam
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Hayat Al Bibi
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Yara Al-Gwairy
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
| | - Sarah Al Sharie
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (S.O.); (A.B.); (B.J.); (S.A.); (H.A.B.); (Y.A.-G.)
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Dall BE. Letter: Neurosurgical Educational Societies Need to Be More Involved in Surgical Education and Certification for Sacroiliac Joint Surgery. Neurosurgery 2022; 91:e120-e121. [PMID: 35916579 DOI: 10.1227/neu.0000000000002106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Bruce E Dall
- School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
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Öztürk GT, Erden E, Erden E, Ulašlı AM. Effects of ultrasound-guided platelet rich plasma injection in patients with piriformis syndrome. J Back Musculoskelet Rehabil 2022; 35:633-639. [PMID: 34397402 DOI: 10.3233/bmr-210032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Piriformis syndrome (PS) is the common entrapment neuropathy causing buttock pain. Patients are conventionally treated with lifestyle modification, exercise, non-steroidal anti-inflammatory drugs, corticosteroid or botulinum toxin injections. However, some patients may not respond to these conventional treatment methods. Platelet rich plasma (PRP) injection has been shown to be beneficial in various muscular injuries, but its effects have not yet been investigated in PS. OBJECTIVE The aim of this study was to explore the effect of PRP on pain and functional status in patients with PS, and to identify any correlations between clinical changes and demographic features. METHODS A total of 60 patients with PS were randomly separated into two groups (PRP and control groups). All patients received one session of either PRP or saline injection performed under ultrasound guidance. The pain was measured with a visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were noted at three intervals in both groups: before treatment, 1 week after treatment and 1 month after treatment. RESULTS The VAS and ODI scores were improved in both groups. The improvement was more obvious in the PRP group in the first week, and the results were similar for both groups when measured 1 month after the treatment. CONCLUSION Ultrasound-guided PRP injection provided greater improvements in both pain and functional status in patients with PS, starting in the early period after treatment. A repeat injection might be needed for a long-term effect.
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Affiliation(s)
- Gökhan Tuna Öztürk
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ender Erden
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ebru Erden
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Alper Murat Ulašlı
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
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Baronio M, Sadia H, Paolacci S, Prestamburgo D, Miotti D, Guardamagna VA, Natalini G, Bertelli M. Etiopathogenesis of sacroiliitis: implications for assessment and management. Korean J Pain 2020; 33:294-304. [PMID: 32989194 PMCID: PMC7532300 DOI: 10.3344/kjp.2020.33.4.294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/17/2020] [Accepted: 04/16/2020] [Indexed: 12/24/2022] Open
Abstract
The sacroiliac joints connect the base of the sacrum to the ilium. When inflamed, they are suspected to cause low back pain. Inflammation of the sacroiliac joints is called sacroiliitis. The severity of the pain varies and depends on the degree of inflammation. Sacroiliitis is a hallmark of seronegative spondyloarthropathies. The presence or absence of chronic sacroiliitis is an important clue in the diagnosis of low back pain. This article aims to provide a concise overview of the anatomy, physiology, and molecular biology of sacroiliitis to aid clinicians in the assessment and management of sacroiliitis. For this narrative review, we evaluated articles in English published before August 2019 in PubMed. Then, we selected articles related to the painful manifestations of the sacroiliac joint. From the retrieved articles, we found that chronic sacroiliitis may be caused by various forms of spondyloarthritis, such as ankylosing spondyloarthritis. Sacroiliitis can also be associated with inflammatory bowel disease, Crohn’s disease, gout, tuberculosis, brucellosis, and osteoarthritis, indicating common underlying etiological factors. The pathophysiology of sacroiliitis is complex and may involve internal, environmental, immunological, and genetic factors. Finally, genetic factors may also play a central role in progression of the disease. Knowing the genetic pre-disposition for sacroiliitis can be useful for diagnosis and for formulating treatment regimens, and may lead to a substantial reduction in disease severity and duration and to improved patient performance.
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Affiliation(s)
- Manuela Baronio
- Dipartimento di Anestesia, Rianimazione, Terapia Intensiva e del Dolore, Fondazione Poliambulanza, Brescia, Italy
| | - Hajra Sadia
- Atta-ur-Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
| | | | | | - Danilo Miotti
- Cure Palliative e Terapia del Dolore, ICS Maugeri, Pavia, Italy
| | | | - Giuseppe Natalini
- Dipartimento di Anestesia, Rianimazione, Terapia Intensiva e del Dolore, Fondazione Poliambulanza, Brescia, Italy
| | - Matteo Bertelli
- MAGI's Lab, Rovereto, Italy.,MAGI Euregio, Bolzano, Italy.,EBTNA-LAB, Rovereto, Italy
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Newman DP, McLean BC, Scozzafava AM. Evaluation and Management of Sacroiliac Dysfunction Utilizing an Evidence-Based Algorithmic Approach: A Case Study. Cureus 2020; 12:e9907. [PMID: 32968570 PMCID: PMC7505610 DOI: 10.7759/cureus.9907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The sacroiliac joint (SIJ) is an important contributor to persistent and functionally limiting lower back pain. Despite extensive debate and research, there is no definitive treatment recommendation or high-level evidence to support a conservative care treatment approach, nor interventional or surgical management procedures for the alleviation of pain originating from the SIJ. Traditional physical therapy and conservative approaches to generalized lower back pain often fail in this patient subset prompting sub-specialty consultation to a pain management center. Diagnosis of the SIJ as the pain generator can be accomplished through physical exam maneuvers and comparative diagnostic blocks; however, upon diagnosis, management remains a challenge. After the diagnosis of SIJ dysfunction is made in our young and active patient population, we have seen significant success in the application of an interdisciplinary and evidence-based treatment algorithm similar to the presented case. To our knowledge, this treatment approach has not been previously described.
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Affiliation(s)
- David P Newman
- Pain Management-Physiotherapy, Interdisciplinary Pain Management Center, Tripler Army Medical Center, Honolulu, USA
| | - Brian C McLean
- Anesthesiology, Interdisciplinary Pain Management Center, Tripler Army Medical Center, Honolulu, USA
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Schenker A, Schiltenwolf M, Schwarze M, Pepke W, Hemmer S, Akbar M. [Pain generator sacroiliac joint : Functional anatomy, symptoms and clinical significance]. DER ORTHOPADE 2019; 49:1000-1005. [PMID: 31811321 DOI: 10.1007/s00132-019-03843-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The sacroiliac joint is a common cause of low back pain. Due to variable symptoms, the diagnosis is often very difficult. For diagnosis, systemic disease, as well as pathologies in the hips and lumbar spine must be excluded. OBJECTIVES To describe anatomy and function of the joint and underlying pathologies. To present the evidence of actual diagnostic and therapeutic options. MATERIALS AND METHODS An extensive literature research was carried out on PubMed. RESULTS The sacroiliac joint is an important and biomechanically complex joint. There are many controversial diagnostic tests to identify the sacroiliac joint as a source of pain. The cause of the dysfunction must be identified in order to treat it correctly and to prevent a chronification of the pain. The gold standard is conservative care. CONCLUSION The sacroiliac joint must be included in the differential diagnosis in patients with low back pain. Diagnostic tests are often insufficient for the diagnosis of sacroiliac joint pain. Many of the current diagnostic and therapeutic options present weak evidence.
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Affiliation(s)
- A Schenker
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, Heidelberg, Deutschland
| | - M Schiltenwolf
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, Heidelberg, Deutschland
| | - M Schwarze
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, Heidelberg, Deutschland
| | - W Pepke
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, Heidelberg, Deutschland
| | - S Hemmer
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, Heidelberg, Deutschland
| | - M Akbar
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, Heidelberg, Deutschland.
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Neamat Allah N, Sigward S, Mohamed G, Elhafez S, Emran I. Effect of repeated application of rigid tape on pain and mobility deficits associated with sacroiliac joint dysfunction. J Back Musculoskelet Rehabil 2019; 32:487-496. [PMID: 30584116 DOI: 10.3233/bmr-181156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sacroiliac joint dysfunction (SIJD) accounts for up to 30% of patients with low back pain. Rigid taping techniques are often used for conservative treatment of SIJD related symptoms; however, its effectiveness has not been systematically evaluated. OBJECTIVES The aim of our study was to investigate the effect of rigid tape on pain, malalignment and mobility deficits associated with anterior innominate SIJD. METHODS Two groups (n= 37; experimental and control) diagnosed with SIJD participated in a randomized, controlled trial. Tape was applied for 2 weeks in the experimental group, whereas the control group received no treatment. 2 × 2 (group × time) GLM-MANOVA assessed effects of tape on pain; innominate rotation; and hip rotation range of motion. Chi-square and McNemar tests assessed the effect of tape on Gillet and Sitting forward flexion mobility tests; the Patrick, Posterior shear and Gaenslen pain provocation tests were used to test pain. Variables were assessed before (PRE) and after (POST) two weeks. RESULTS No group differences were observed for any variable PRE. Pain intensity, innominate rotation (p< 0.05) and number of positive mobility and pain provocation tests (p< 0.05) decreased from PRE versus POST in the experimental group. No differences were observed in the control group. CONCLUSION Two weeks of rigid tape for anterior innominate correction successfully reduced symptoms related to SIJD.
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Affiliation(s)
- Neama Neamat Allah
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12612, Egypt.,Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Susan Sigward
- Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Ghada Mohamed
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12612, Egypt
| | - Salam Elhafez
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12612, Egypt
| | - Ihab Emran
- Department of Orthopaedic Surgery, Kasr Al Ainy, Faculty of Medicine, Cairo University, Cairo 11559, Egypt
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Enix DE, Mayer JM. Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients. PM R 2019; 11 Suppl 1:S32-S39. [DOI: 10.1002/pmrj.12176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
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Hodgetts CJ, Walker BF. Testing a strength and conditioning program to prevent common manipulative technique training injuries in chiropractic students: a study protocol for a randomised controlled trial. Chiropr Man Therap 2018; 26:23. [PMID: 29988310 PMCID: PMC6022343 DOI: 10.1186/s12998-018-0192-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/27/2018] [Indexed: 12/22/2022] Open
Abstract
Background Spinal manipulation is the primary therapy utilised by chiropractors in the management of their patients. The skills required may feel foreign to chiropractic students as they need strength and endurance in movement patterns they may not have otherwise been exposed to. This may lead to injury while learning manipulative techniques. It is plausible to suggest that the implementation of a strength and conditioning program early in a practitioner’s career could reduce the incidence and progression of injuries. The study aims to test the effectiveness of a strength and conditioning program in reducing the risk of chiropractic students’ acquiring injuries while learning the skill of spinal manipulation. Methods This study will involve a prospective cohort of chiropractic students who are currently learning manual therapy at an undergraduate level. Participants will be eligible for inclusion if they are enrolled in 3rd or 4th-year chiropractic manual therapy units at Murdoch University chiropractic course. The intervention group will follow a 12-week strength and conditioning program comprised of preventative exercises that address each body region previously identified as being prone to injury. The control group will complete a 12-week walking program. The primary outcome is injury rate, measured via a short questionnaire. The secondary outcome will be strength, measured via submaximal strength tests. Discussion The prescribed exercises are aimed at improving the strength and endurance of those muscle groups involved in commonly taught manual therapy tasks. The resistance bands have been chosen as they are inexpensive, simple to implement for the purposes of the study, and acceptably safe. A video format was selected to allow ease of access for participants, provide a detailed description and a visual representation of the exercises to be performed. A questionnaire was designed as a means to assess the influence of the strength and conditioning program on injury rate and the impact this may have on the students’ ability to continue practicing. The International Physical Activity Questionnaire has been chosen to measure the participants level of activity before beginning the exercise program. Conclusion This research protocol will be the first large-scale study to investigate the effectiveness of a strength and conditioning program to reduce injuries within chiropractic students learning manual therapy. Trial registration Australia New Zealand Clinical Trials Registry (ACTRN12617001638325p). Electronic supplementary material The online version of this article (10.1186/s12998-018-0192-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Bruce F Walker
- School of Health Professions, Murdoch University, Perth, Western Australia
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Havran M, Scholten JD, Breuer P, Lundberg J, Kochersberger G, Newman D, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult—Step-by-Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part XII: Leg Length Discrepancy. PAIN MEDICINE 2016; 17:2230-2237. [DOI: 10.1093/pm/pnw270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
In summary, LBP is a common problem for the young adult athlete, with discogenic pain being the most common of all etiologies. Although rare, more serious etiologies such as tumor or infection should be included in the differential diagnosis until effectively ruled out. Regardless of the cause, nonoperative and conservative strategies should be the cornerstone of treatment, owing to the favorable natural history of most LBP etiologies. Short-term non-narcotic medications are helpful, and avoidance of bed rest is critical for the athletic population. Rehabilitation should focus on stabilization and strengthening of the core and pelvic muscle groups, and biomechanical imbalances should be addressed. Surgical intervention ought to be utilized as a last resort in this population. Return to play should be considered only when the athlete is pain free with full range of motion and daily medications have been discontinued. Careful monitoring of the training regimen should always be undertaken,especially with chronic pain or recurrent injuries.
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Affiliation(s)
- Ken R Mautner
- Department of Physical Medicine and Rehabilitation, Department of Orthopedics, Emory University, Atlanta, GA 30329, USA.
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Ruhe A, Bos T, Herbert A. Pain originating from the sacroiliac joint is a common non-traumatic musculoskeletal complaint in elite inline-speedskaters - an observational study. Chiropr Man Therap 2012; 20:5. [PMID: 22404796 PMCID: PMC3317439 DOI: 10.1186/2045-709x-20-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 03/09/2012] [Indexed: 11/10/2022] Open
Abstract
STUDY DESIGN Observational study OBJECTIVES To investigate common non-traumatic musculoskeletal complaints of the low back in elite inline-speedskaters of the German national team. SUMMARY OF BACKGROUND DATA Traumatic injuries associated with falls or collisions are well documented in speedskaters but so far no studies have investigated non-traumatic low back pain. Previously, the sacroiliac joint was suspected as a frequent origin of complaint, we aimed to investigate this assumption. METHODS Two chiropractors examined elite inline-speedskaters of the German national team during three sports events between summer 2010 and 2011. A test cluster of five provocative tests for the sacroiliac joint was selected based on reliability and validity. RESULTS A total of 37 examinations were conducted on 34 athletes with low back pain during the three sport events. The reported pain intensities ranged from mild to moderate pain (VAS 23.4 ± 13.4 to 35.1 ± 19.2). About 90% of cases showed involvement of the SI joint of which again 90% presented with left sided symptoms. CONCLUSIONS Non-traumatic complaints of the low back originating from the left sacroiliac joint frequently occur in competitive inline speedskaters.
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Affiliation(s)
- Alexander Ruhe
- Deutsche Gesellschaft fuer Sportchiropraktik, Porschestrasse 1, 38440 Wolfsburg, Germany.
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Aydin SM, Gharibo CG, Mehnert M, Stitik TP. The role of radiofrequency ablation for sacroiliac joint pain: a meta-analysis. PM R 2010; 2:842-51. [PMID: 20869684 DOI: 10.1016/j.pmrj.2010.03.035] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 03/30/2010] [Accepted: 03/31/2010] [Indexed: 11/17/2022]
Abstract
Radiofrequency ablation (RFA) has become an option for those with chronic or refractory sacroiliac (SI) joint pain. The purpose of this critical review is to assess the existing literature and conduct a meta-analysis to assess the effectiveness of RFA of the SI joint for pain relief at 3 and 6 months' after an RFA procedure. An electronic search of PubMed, OVID, Medline, and CINAHL were conducted with keywords; sacroiliac joint, sacroiliac pain, sacroiliac syndrome, sacroiliac radiofrequency ablation, sacroiliac neurolysis, sacroiliac injection, and low back pain. Articles that addressed RFA of the SI joint were reviewed. Ten articles ranging from inception to January 1, 2010, were found. The main outcome measure was a reduction of pain by ≥50% post-RFA procedure. At 3 months, 7 groups met the criteria and at 6 months, 6 groups met the criteria. A meta-analysis with a forest plot was done at the 3- and 6-month patient follow-up intervals. The associated standard error was calculated for each study group. An overall weighted average with respective standard error was also obtained. A calculation of 95% confidence intervals (95% CI) was then derived. A test for heterogeneity, publication bias, and file drawer effect was also done at the 3- and 6-month intervals. At 3 months, a range of 0.538-0.693 was found to have a 95% CI, with a pooled mean of 0.616. At 6 months, a 95% CI of 0.423-0.576 was found, with a pooled mean of 0.499. The meta-analysis demonstrated that RFA is an effective treatment for SI joint pain at 3 months and 6 months. This study is limited by the available literature and lack of randomized controlled trials. Further standardization of RFA lesion techniques needs to be established, coupled with prospective randomized controlled trials.
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Affiliation(s)
- Steve M Aydin
- Department of Anesthesia, Pain, 85 Walsh Dr, University of Michigan, Mahwah, NJ 07430, USA.
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Paradigm for assessment and treatment of SIJ mechanical dysfunction. J Bodyw Mov Ther 2010; 14:152-61. [DOI: 10.1016/j.jbmt.2009.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 12/15/2009] [Accepted: 12/16/2009] [Indexed: 01/13/2023]
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Prather H, Dugan S, Fitzgerald C, Hunt D. Review of Anatomy, Evaluation, and Treatment of Musculoskeletal Pelvic Floor Pain in Women. PM R 2009; 1:346-58. [DOI: 10.1016/j.pmrj.2009.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/10/2008] [Accepted: 01/02/2009] [Indexed: 10/20/2022]
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Abstract
STUDY DESIGN Consecutive case series cohort. OBJECTIVE To determine the relative frequencies of the spine, the sacroiliac (SI) joint, and the hip joint being the primary pain generator among patients presenting at a spine surgery clinic for low back pain (LBP). SUMMARY OF BACKGROUND DATA Identification of the primary pain generator in a patient with LBP is difficult. Possible pain sources include the lumbar spine, the SI joint, and the hip joint. Their relative frequencies among patients presenting at a spine surgeon's clinic have not been well established. METHODS Three hundred sixty-eight new patients were seen at a single spine surgeon's clinic during a 10-month period. Of these, 289 (78.5%) complained primarily of LBP with or without leg pain. Seventy-seven had previous surgery. The remaining 200 cases were reviewed for all diagnostic tests performed, as well as the final diagnosis. RESULTS One hundred sixty-four (82%) had spine pathology, but only 130 (65%) had spine-only pathology, whereas 35 (17.5%) had a combination of spine plus hip and/or SI joint pathology. An additional 16 (8%) had hip and/or SI joint pathology without spine pathology. Twenty (10%) had an undefined pain source. Overall, 25 (12.5%) had hip pathology, and 29 (14.5%) had SI joint pathology. CONCLUSION For patients presenting to a spine surgeon's clinic for LBP, up to 25% of patients may have significant pain contribution from the hip or SI joints, and an additional 10% will still have an undefined pain source even after diagnostic workup. This underscores the need for clinicians to be aware of nonspinal pain generators and to appropriately pursue alternative diagnoses.
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Abstract
BACKGROUND AND PURPOSE This case report describes the examination, evaluation, and intervention by a physical therapist for a female collegiate tennis player with a right ilial anterior rotation hypermobility. CASE DESCRIPTION The patient was a 21-year-old, female collegiate tennis player who developed a right anterior ilial rotation hypermobility as a result of her tennis stroke. Functional limitations were related to sitting, squatting, gait, and playing tennis. Treatment interventions consisted of massage, joint manipulation, stretching, stabilization exercises, sport-specific exercises and modification of tennis stroke, proprioceptive taping, and the use of a sacroiliac belt. OUTCOMES After 26 weeks (33 treatments), tissue tenderness of the sacroiliac joint region was normalized, pelvic/trunk and lower-extremity mobility and flexibility were restored, sacroiliac symmetry and stability were regained, and the patient achieved her goal of returning to competitive tennis at the collegiate level. DISCUSSION The patient's right ilial anterior rotation hypermobility was directly related to the mechanics of her tennis stroke. Her outcomes suggest that rehabilitation should focus on the entire abdomino-sacro-pelvic-hip complex, addressing articular, neural, and muscular inhibitions and deficiencies.
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Abstract
UNLABELLED 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. Oft en 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, corti costeroid 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. KEYWORDS sarcoiliac joint; sarcoiliac joint dysfunction; spine; low back pain.
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Affiliation(s)
- Robert E Poley
- Department of Family Medicine, The Ohio State University, Columbus, OH, 43211, USA
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Borowsky CD, Fagen G. Sources of sacroiliac region pain: insights gained from a study comparing standard intra-articular injection with a technique combining intra- and peri-articular injection. Arch Phys Med Rehabil 2008; 89:2048-56. [PMID: 18996232 DOI: 10.1016/j.apmr.2008.06.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 06/02/2008] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To present evidence supporting the existence of extra-articular sources for sacroiliac region pain and to present evidence that intra-articular anesthetic blockade may underestimate the true prevalence of sacroiliac region pain. DESIGN Retrospective review of 2 large case series comparing patient responses to intra-articular injection versus combined intra-articular and peri-articular injection of anesthetic and corticosteroid. SETTING Private practice chronic pain clinic set in a hospital outpatient clinic. PARTICIPANTS Patients (N=120) sequentially enrolled from practice billing records. Inclusion criteria included pain in the low back below L4 and in the buttock, thigh, groin, or lower leg. If disk herniation, lumbar stenosis, or facet syndrome was previously treated with appropriately chosen injections, response to treatment had to be negative. Patients failed to respond to treatment with physical therapy. Exclusion criteria included records with an incomplete database, patients increasing pain medication use greater than 15% for pain not related to the sacroiliac region, severe psychiatric illness, and nonspecific anesthetic blockade. One hundred sixty-seven records were reviewed to obtain the 120 study subjects. INTERVENTIONS Intra-articular injection was done according to the standard technique described by Fortin. Peri-articular injection was done by a slight modification of the procedure described by Yin. MAIN OUTCOME MEASURES Percentage change in visual analog scale (VAS) pain scores at 3 weeks and 3 months postinjection; patients' self reported activities of daily living (ADLs) improvement at 3 weeks and 3 months postinjection; and percentage change in VAS pain score within 1 hour of injection. RESULTS For intra-articular injection alone, the rate of positive response at 3 months was 12.50% versus 31.25% for the combined injection (P=.025). Positive response was defined as greater than 50% drop in VAS pain score or patients describing ADLs as "greatly improved." Anesthetic response rates were higher in the combined injection group (62.5% vs 42.5%; P=.037). CONCLUSIONS Significant extra-articular sources of sacroiliac region pain exist. Intra-articular diagnostic blocks underestimate the prevalence of sacroiliac region pain.
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Foley BS, Buschbacher RM. Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil 2006; 85:997-1006. [PMID: 17117004 DOI: 10.1097/01.phm.0000247633.68694.c1] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The sacroiliac joint is an underappreciated cause of low back and buttock pain. It is thought to cause at least 15% of low back pain. It is more common in the presence of trauma, pregnancy, or in certain athletes. The pelvic anatomy is complex, with the joint space being variable and irregular. The joint transmits vertical forces from the spine to the lower extremities and has a role in lumbopelvic dynamic motion. History and physical examination findings can be helpful in screening for sacroiliac joint pain, but individual provocative maneuvers have unproven validity. Fluoroscopically guided injections into the joint have been found to be helpful for diagnostic and therapeutic purposes. Conservative treatment, which also can include joint mobilization, antiinflammatory medicines, and sacroiliac joint belts, generally is effective. Surgical arthrodesis should be considered a procedure of last resort.
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Affiliation(s)
- Brian S Foley
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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Ling BC, Lee JW, Man HSJ, Jhangri GS, Grace MGA, Lambert RGW. Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection. Skeletal Radiol 2006; 35:838-46. [PMID: 16715244 DOI: 10.1007/s00256-006-0137-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 03/30/2006] [Accepted: 03/31/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. DESIGN AND PATIENTS CT scans of pelvises were reformatted on 41 subjects, aged 51.7 (+/-15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 degrees to +30 degrees at 15 degrees increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. RESULTS Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation. CONCLUSION Angulation of the reconstruction plane considerably affects the appearance of the sacroiliac joints. By shortening joint depth, an inferiorly directed approach to SI joint injection may make fluoroscopic guidance easier, although associated bony interposition can prevent access to the synovial compartment. A superiorly directed approach is more likely to have adverse effects.
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Affiliation(s)
- Bernice C Ling
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 2A2.41 Walter C. Mackenzie Centre, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
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Abstract
UNLABELLED Sacroiliac joint dysfunction is believed to be a significant source of low back and posterior pelvic pain. METHODS To assess the clinical presentation, diagnostic testing, and treatment options for sacroiliac joint dysfunction, a systematic literature review was performed using MEDLINE. RESULTS Presently, there are no widely accepted guidelines in the literature for the diagnosis and treatment of sacroiliac instability. Establishing management guidelines for this disorder has been complicated by the large spectrum of different etiologic factors, the variability of patient history and clinical symptoms, limited availability of objective testing, and incomplete understanding of the biomechanics of the sacroiliac joint. CONCLUSIONS A reliable examination technique to identify the sacroiliac joint as a source of low back pain seems to be pain relief following a radiologically guided injection of a local anaesthetic into the sacroiliac joint. Most patients respond to non-operative treatment. Patients who do not respond to non-operative treatment should be considered for operative sacroiliac joint stabilization.
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Affiliation(s)
- Boris A Zelle
- Department of Orthopaedic Surgery, Division of Orthopaedic Traumatology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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