¡Descarga Lesiones en la articulacion sacroiliaca y más Traducciones en PDF de Inglés solo en Docsity! Submit Manuscript | http://medcraveonline.com Anatomy The sacroiliac articulation is a weight-bearing joint. It distributes weight from the spine to the lower extremities by way of the hips. Ventrally, the SI joint is supported by the anterior sacroiliac ligaments. While important, these ligaments are not the primary ligamentous stabilizers of the SI joint. Strong muscles course anteriorly such as the psoas and iliacus muscles which function to primarily flex the hip. The lumbosacral plexus also passes anterior to the SI joint, with the L5 nerve root passing over the sacral ala anteriorly.3 Dorsally, there are strong posterior ligaments that give the greatest amount of ligamentous support to the pelvic girdle.4 These ligaments must be evaluated in the setting of pelvic trauma. The piriformis originates from the anterior sacrum and passes posterior to the hip joint as it inserts on the greater trochanter of the femur. The sciatic nerve crosses inferior to the piriformis muscle as it exits the pelvis and courses down the posterior thigh and leg. Strong back muscles cover the posterior SI joint such as longissimus thoracis and iliocostalis muscles which function to extend the spine (Figure 1). Figure 1 Sacroiliac joint dysfunction and pain. Etiology There are multiple reasons patients may experience SI joint pain. Limb length discrepancy can be one of the causes and should be evaluated by observing the patient’s gait and comparing limb lengths on the exam table. Mechanical dysfunction is another possible cause. The SI joint allows for minimal movement in the normal setting, but excessive or abnormal movement may lead to dysfunction of the joint with instability and pain. SI joint infection can be a cause of pain and is often occult, or difficult to diagnosis. Ankylosing spondylitis is the most common rheumatic cause of SI joint pain. A blood test is needed to identify the HLA-B27 protein in afflicted patients. Other causes include crystal arthropathy, pyogenic arthropathy, post-spinal fusion pain, and stress fracture of the sacrum. Clinical presentation Patient symptoms of SI joint dysfunction include low back, buttock, posterior thigh, and knee pain. Occasionally groin pain may be reported as well as difficulty and discomfort while assuming a sitting position and the need to frequently change positions due to discomfort. Radiating radicular-type pain is not a typical presentation of SI joint dysfunction and can be used to differentiate lumbar stenosis from SI joint pathology. Diagnosis Physical exam techniques used to determine the presence of SI joint pain are not specific. The finger test is helpful in differentiating SI joint pain from other causes. Patients usually point with one finger to either side of their low back, in contrast to midline pain, corresponding to the painful area of the SI joint. If the patient points to the exact area of pain each time, the pain is likely coming from the SI joint. The FABER test is helpful in determining the presence of SI joint pathology. The purpose of this test is to stretch the SI joint to reproduce pain. To perform, press down towards the floor gently but firmly on the flexed knee as the hip is flexed, abducted, and externally rotated. Pain in the sacroiliac area may indicate a problem with the SI joint. MOJ Orthop Rheumatol. 2017;8(3):14‒12. 1 ©2017 Ebraheim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestrited use, distribution, and build upon your work non-commercially. Sacroiliac joint dysfunction Volume 8 Issue 3 - 2017 N Ebraheim, K Andrews, M Tanios Department of Orthopaedics, University of Toledo Medical Center, USA Correspondence: Nabil Ebraheim, Department of Orthopaedics, University of Toledo Medical Center, 1125, Hospital Drive, Toledo, OH 43614, USA, Email Received: March 11, 2017 | Published: May 16, 2017 MOJ Orthopedics & Rheumatology Mini Review Open Access Introduction Low back pain is one of the most commonly encountered ailments in medicine, and in orthopaedics in particular. It is a common cause of activity limitation in all demographics of patients with a lifetime prevalence of up to 80%.1 Low back pain is responsible for 3% of all emergency room visits and $30-$50 billion is healthcare costs annually.2 While there are many causes of low back pain, the sacroiliac (SI) joint has been implicated and often goes under- appreciated. Additionally, pain originating from the SI joint is often misunderstood, or attributed to other sources such as the hip or spine. Diagnostic injection of SI joint is the only means to truly confirm the diagnosis. Adding to the diagnostic challenge, pain from the spine, hips, or SI joint can present concomitantly and be associated with each other which can cloud the clinical picture.
