Sacroiliac Joint Dysfunction Overview

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Questions and Answers

What are the potential pain areas associated with sacroiliac joint (SIJ) dysfunction?

Lumbar, buttock, hamstring, or groin pain.

Explain the phenomenon of lumbarization of S1.

Lumbarization of S1 occurs when the S1 segment is mobile, resulting in a sixth lumbar vertebra.

What happens to the mobility of sacroiliac joints as a person ages?

SIJ mobility decreases progressively with age.

Describe the lumbosacral angle and its significance.

The lumbosacral angle is formed by a line parallel to the sacrum and a horizontal line; increased angles lead to higher shear stresses. Signup and view all the answers

What are the differences in articular surfaces of the SIJ from childhood to post-puberty?

In childhood, articular surfaces are flat and smooth, becoming irregular and puzzle-like in post-pubertal individuals. Signup and view all the answers

What type of cartilage covers the sacrum and ilia in the SIJs?

The sacrum is covered with hyaline cartilage, while the ilia are covered with fibrocartilage. Signup and view all the answers

What structural changes occur in the sacroiliac joints as an individual matures?

The SIJs change from being relatively mobile to progressively stiffer with age. Signup and view all the answers

How do the articular facets of the sacrum and lumbar vertebrae interact?

The auricular facets of the sacrum articulate with the inferior facets of the fifth lumbar vertebra. Signup and view all the answers

What is the primary aim of the Forward Flexion Test in sacroiliac joint mobility testing?

To test the mobility of the sacroiliac joint. Signup and view all the answers

Explain the purpose of the Seated Flexion Test.

It tests the mobility of the sacrum moving on the ilium while eliminating the influence of the lower extremities. Signup and view all the answers

What does Gillet’s Test assess regarding sacroiliac joint movement?

It assesses sacroiliac hypomobility. Signup and view all the answers

What distinguishes true leg length discrepancies from functional leg length discrepancies?

True leg length discrepancies cause asymmetry and pain, while functional discrepancies result from SIJ and/or pelvic dysfunction. Signup and view all the answers

In the Gillet's Test, what indicates a fixed joint when the patient raises their left leg?

The examiner's left thumb moves upward instead of downward. Signup and view all the answers

Describe the typical characteristics of SIJ pain.

SIJ pain is classically described as deep, dull, and undefined, often unilateral and located below L5. Signup and view all the answers

What is the role of Relaxin hormone in postpartum women concerning SIJ and ligament function?

Relaxin hormone causes softening of ligaments, which may take 3 to 4 months to return to normal after childbirth. Signup and view all the answers

Describe the test position for the Passive Movement—Hip Quadrant assessment.

The patient stands with feet shoulder-width apart while the examiner stands behind, grasping the patient's shoulders. Signup and view all the answers

List two symptoms that may suggest SIJ dysfunction.

Stiffness and pain with prolonged walking or standing, and pain with standing from a sitting position. Signup and view all the answers

What are positive findings in the Hip Quadrant test that might indicate SI joint dysfunction?

Reproduction of the patient’s symptoms localized to the PSIS area. Signup and view all the answers

What is the procedure for the Anterior Gapping Test?

The examiner applies outward and downward pressure on the ASISs while the subject is supine. Signup and view all the answers

What specific physical examination techniques can be employed to assess SIJ dysfunction?

Palpation of SI joints and PSIS, and functional tests including mobility and pain provocation tests. Signup and view all the answers

How can psychosocial issues like anxiety and depression impact SI joint pain?

Anxiety and depression can exacerbate the perception of pain and contribute to dysfunction in the SIJ. Signup and view all the answers

What finding indicates an anterior SI ligament sprain during the Anterior Gapping Test?

Unilateral pain at the SI joint or in the gluteal region. Signup and view all the answers

What specific indicators should be observed during the inspection phase of a physical examination for SI joint issues?

Levels of iliac crests, ASIS, PSIS, and assessment for leg length discrepancies. Signup and view all the answers

Which activities may elicit pain in individuals with SI joint dysfunction?

Climbing or descending stairs, turning in bed, or getting out of bed may cause pain. Signup and view all the answers

What are two common soft tissue abnormalities associated with unilateral anterior pelvic tilt?

Tight psoas and rectus femoris muscles. Signup and view all the answers

Describe the purpose of sacroiliac joint mobilization techniques.

To increase ROM, decrease pain, and correct positional faults in the sacroiliac joint. Signup and view all the answers

What distinguishes Grade I joint mobilization from Grade II?

Grade I involves small amplitude movements at the beginning range, while Grade II involves large amplitude movements at midrange. Signup and view all the answers

What is the main aim of applying ischemic pressure to the hip abductors?

To alleviate tension and restore function in tight muscles. Signup and view all the answers

Explain the technique involved in the posterior glide of the iliac crest.

The mobilizing hand glides the iliac crest posteriorly while the guiding hand moves the ischium anteriorly. Signup and view all the answers

What is a primary reason that sacroiliac belts may not be effective?

They have not been shown to provide significant help in clinical studies. Signup and view all the answers

What benefits does Grade III mobilization provide?

It reduces pain, increases periarticular extensibility, and corrects positional faults. Signup and view all the answers

In the context of sacroiliac joint treatment, what does 'accessory motion' refer to?

It refers to the small, voluntary movements that contribute to the joint's overall function. Signup and view all the answers

What occurs when counternutation is pathological on one side of the sacroiliac joint?

The ASIS is lower and the PSIS is higher on that side. Signup and view all the answers

Define 'form closure' in the context of sacroiliac joint stability.

Form closure refers to the inherent stability provided by the specific shape and close fit of joint surfaces, independent of external loads. Signup and view all the answers

Explain how body weight affects the sacrum in terms of nutation torque.

The force of body weight generates a nutation torque on the sacrum, influencing pelvic stability. Signup and view all the answers

Which muscles reinforce the stability of the sacroiliac joint through ligamentous tension?

The quadratus lumborum, erector spinae, gluteus maximus, gluteus minimus, piriformis, and iliacus muscles. Signup and view all the answers

What role does the biceps femoris muscle play in sacroiliac joint stability?

The biceps femoris, often found shortened during SIJ dysfunction, compensates to help stabilize the joint. Signup and view all the answers

Describe the posterior oblique muscle system and its components.

The posterior oblique muscle system includes the latissimus dorsi, gluteus maximus, and thoracolumbar fascia. Signup and view all the answers

Identify a common muscle imbalance affecting the sacroiliac joint.

Tight psoas and rectus femoris muscles are commonly associated with SIJ dysfunction. Signup and view all the answers

What is the effect of leg length imbalance on sacroiliac joint function?

Leg length imbalance can contribute to dysfunction and instability of the sacroiliac joint. Signup and view all the answers

What are the two main categories of the interosseous sacroiliac ligament?

Superficial and Deep. Signup and view all the answers

How does the sacroiliac joint absorb forces from the spine?

It absorbs vertical forces and transmits them to the pelvis and lower extremities. Signup and view all the answers

What is the primary movement that defines 'nutation' of the sacrum?

Forward motion of the base of the sacrum into the pelvis. Signup and view all the answers

What occurs at the sacroiliac joint if nutation happens only on one side?

The ASIS will be higher and the PSIS will be lower on that side. Signup and view all the answers

What ligaments limit the motion of nutation in the sacroiliac joint?

The anterior sacroiliac ligaments, sacrospinous ligament, and sacrotuberous ligament. Signup and view all the answers

What is counternutation and how does it occur?

Counternutation is the anterior rotation of the ilium on the sacrum, occurring when the base of the sacrum moves backward. Signup and view all the answers

What is the significance of the sacrospinous and sacrotuberous ligaments in pelvic structure?

They connect the ischial spines and tuberosities to the sacrum and coccyx, forming borders of the sciatic notches. Signup and view all the answers

During pregnancy, how is the range of motion (ROM) in the pelvis altered?

All ligaments of the pelvis become loose under the influence of hormones. Signup and view all the answers

Study Notes

Sacroiliac Joint (SIJ) Dysfunction

The SIJ is a pain generator.
Dysfunction stems from abnormal function (like hypermobility or hypomobility) at the joint, due to altered mechanics.
This causes stress on surrounding structures, leading to pain and discomfort.
SIJ dysfunction can contribute to lumbar, buttock, hamstring, or groin pain.

The Sacrum

The sacrum is a fused bone formed by five sacral vertebrae.
Its shape is triangular or wedge-shaped.
The base of the sacrum supports articular facets that articulate with the fifth lumbar vertebra.
The apex of the triangle articulates with the coccyx.

Lumbosacral Angle

Measured by the angle between a line parallel to the superior aspect of the sacrum and a horizontal line.
Increased angle correlates with increased shear stresses at the lumbosacral joint.

Sacroiliac Joint Structure

The two SIJs articulate between the first three sacral segments and the two ilia of the pelvis.
Sacrum: Auricular (C-shaped) on sides of fused sacral vertebrae (concave). Covered with hyaline cartilage, which is thicker than the iliac cartilage.
Ilia: Convex. Covered with fibrocartilage.

Sacroiliac Joint Changes with Age

Young people have relatively mobile SI joints.
With age, SI joints progressively stiffen.
In pre-pubertal and child development: articular surfaces are flat and smooth, acting as a plane synovial joint with gliding motion in all directions.
Post-pubertal: surfaces become irregular, with ridges and grooves on the ilium and sacrum creating a 'puzzle-like' fitting ("form closure").

SIJ Ligaments

Interosseous SI ligament: Strong, massive, superficial and deep.
Anterior Sacroiliac Ligament
Posterior Sacroiliac Ligament: Stronger than the anterior ligament; connects the sacrum to the PSIS.
Sacrospinous Ligament: Connects ischial spines to lateral borders of sacrum and coccyx; forms the inferior border of the greater sciatic notch.
Sacrotuberous Ligament: Connects ischial tuberosities to lateral sacrum and coccyx; forms the inferior border of the lesser sciatic notch.

SIJ Function

Connects the spine to the pelvis.
Absorbs vertical forces transmitted from the spine to the lower extremities.
Allows for slight rotational and translational motion, stress-relieving joint.
Close-packed position: nutation, with base moving forward and apex backward.
Loose-packed position: counter-nutation.

SIJ Kinematics

Rotational motion: 2.5°.
Translational motion: 0.3 to 0.7 mm or 1 cm.
SIJs are linked to the symphysis pubis which means any motion in the symphysis pubis is accompanied by motion at the SIJs.
During pregnancy, ROM increases due to hormonal changes, loosening ligaments to aid with childbirth.

Sacrum Movements: Nutation and Counternutation

Nutation: Forward movement of the sacral base into the pelvis, or backward rotation of the ilium on the sacrum; a stable position for the SI joint ("form closure"). Limited by anterior sacroiliac ligaments, sacrospinous ligament, and sacrotuberous ligament.
Counternutation: Reverse of nutation. Limited by posterior sacroiliac ligaments. Occurs when a person assumes a "lordotic" or "anterior pelvic tilt" position.

Pathological SI Joint Nutation

If unilateral, ASIS will often be higher and the PSIS lower on the affected side (resulting in an apparent or functional short leg).

Precipitating Factors for SIJ Disorders

Muscle Imbalance: Tight hip flexors and extensors (psoas and rectus femoris muscles), and hip external and internal rotators.
Leg Length Discrepancy: True discrepancies cause asymmetry and pain; functional discrepancies result from SIJ and/or pelvic dysfunction.

Clinical Evaluation of SIJ Disorders

Pain Location: Deep, dull, undefined pain, often unilateral, and can radiate to the low back, buttock, groin, or posterolateral thigh.
Pain Onset: Acute or insidious.
Mechanism of Injury: Was there a known mechanism of injury (e.g., tripping, fall)?

Biomechanical and Other Contributing Factors

Biomechanical abnormalities such as excessive subtalar pronation or scoliosis can contribute to SIJ disorders.
Postpartum period can cause SIJ pain as ligaments take time (3-4 months or longer) to return to their normal state.
Conditions like rheumatoid arthritis or ankylosing spondylitis.
Psychosocial issues such as anxiety, depression are relevant factors.

SIJ Symptoms

Stiffness and pain with prolonged walking / standing, particularly unilateral.
Pain with standing from a sitting position.
Difficulty climbing or descending stairs.
Pain when getting out of bed or stepping up.
Tenderness over SI joints and PSIS.
Pain reproduction over the pubic symphysis.

SIJ Physical Examination

Inspection: Iliac crests, ASIS, PSIS, leg length discrepancies.
Palpation: Pain over SI joints, PSIS.
Functional Assessment: hips and lumbar spine assessment.
Neurological Testing: Lower quarter screen.
Special Tests: E.g., Mobility tests, Pain provocation tests, FABRE, Gaenslen's, quadrant tests, anterior gapping, compression tests.

SIJ Treatment

Muscle energy techniques.
Joint mobilization.
Joint manipulation.
Muscle stretching.
Trunk stabilization (core stability).
Sacroiliac belts are not particularly helpful.

SIJ Mobilization Techniques

Aims: Increasing ROM, decreasing pain.
Increasing accessory motion at the SI joint.
Correcting positional faults.
Examination for SIJ impairment.

Maitland's 5 Grades

Grade I: Small amplitude movement.
Grade II: Large amplitude movement.
Grade III: Large amplitude movement at end-range.
Grade IV: Small amplitude movement at end-range.

Specific SI Joint Mobilization Techniques

Posterior Glide of the Iliac Crest: Correct anterior rotation positional fault.
Anterior Glide of the Iliac Crest: Correct posterior rotation positional fault.
Correction of Bilateral Anterior/Posterior Nutated Sacrum: Specific mobilization techniques for correcting bilateral sacral nutation types.

Clinical Prediction Rule (CPR)

Three or more positive tests for SIJD have high sensitivity and specificity in aiding prediction of the likelihood of the condition.

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Description

This quiz explores the anatomy and dysfunction of the sacroiliac joint (SIJ). Understand how abnormalities in the SIJ can lead to pain in various regions, including the lumbar area and lower limbs. Discover the structural role of the sacrum and the significance of the lumbosacral angle.