Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction refers to the disorder in the movement of the joints connecting the sacrum bone at the lowest part of the spine to the pelvis. It can cause pain in the lower back, buttocks or hips. It is a problem that is often confused with herniated disc . It can be thought that seeing a small hernia in the lumbar MRI (MR) film explains the person’s complaints. However, hernias do not always cause complaints. In fact, it is estimated that the sacroiliac joints may be responsible for 15-30% of all low back pain.

Anatomy

The sacrum is the large, triangular bone located below the lumbar spine. It consists of 5 sacral spine levels that are structurally fused with each other. It makes the pelvis and sacroiliac joints on the right and left . These joints act as shock absorbers in transferring the weight of the trunk to the legs and they move very little. Below the sacrum is the tailbone (coccyx). Strong ligaments support the sacroiliac joint. The gluteus maximus and piriformis muscles are also important in the function of the joint.

Over or Under Movement of the Joint

Sacroiliac joint dysfunction is when these joints move too little or too much. Excessive movement of the joint is hypermobility; This is because the ligaments holding the bones are loose. Damage to the ligaments, hormones produced by the woman during pregnancy, and structural flexibility of the ligaments can lead to this loosening. The movement of the joint less than normal is called hypomobility. It may be due to calcification (osteoarthritis). Fixing the spine with screws in low back surgery, restriction of hip and waist movements due to calcification may cause more stress on the sacroiliac joints. This also causes pain.

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If the joint moves too much, the pain is usually felt in the lower back and/or hip; may spread to the groin. Pain caused by little movement may mimic sciatica in the buttocks, along the back of the leg.

Inflammation of the sacroiliac joint (sacroiliitis) can cause pain and stiffness around the pelvis. Strains due to sacroiliac joint dysfunction can cause inflammation (inflammation), as well as infections such as rheumatic diseases (ankylosing spondylitis, etc.) or Brucella.

Symptoms of Sacroiliac Joint Dysfunction

  • Low back pain: It is usually felt on one side, but it can be on both sides. It can be mild or severe in the form of blunt, tingling.
  • Hip, leg and/or groin pain: Typically on the right or left side, but can also be bilateral.
  • Sciatica-like pain: Burning, stabbing, sharp pain in the back of the hip, starting from the buttocks and radiating along the leg. It usually does not go below knee level.
  • Arrest: Restriction of waist, hip movements; movements such as bending and standing up, climbing stairs may become difficult.
  • Feeling as if the hip is letting go when sitting and getting up (instability).
  • Increased complaints when putting weight on the problematic side (climbing stairs, running, walking).

Why Does It Happen?

Traumas such as leg length difference, scoliosis , pregnancy and childbirth, back surgery, strain on the joint due to occupational or sports activities, and falling can cause this problem. Sometimes no initiating cause can be found.

Diagnosis

There is no single standardized test for sacroiliac joint dysfunction. Conditions such as herniated disc, lumbar calcification may cause similar symptoms. Therefore, it can be difficult to diagnose. In the diagnosis, questioning the complaints and physical examination are essential. There are some specific tests and maneuvers to evaluate the sacroiliac joint on physical examination. In the sacral thrust test, force is applied to the back of the hips while the patient is lying face down. It is considered positive if pain occurs. Applying pressure from the front of the hips while lying on the back is a distraction test. It is positive if pain occurs again. In the FABER test, while the person is lying on their back, one leg is bent at the knee, the hip is opened to the side and light pressure is applied. Pain in the sacroiliac joints is a positive finding. Sensitivity assessment by pressing the sacroiliac joints with fingers is another examination method. The diagnosis can be made by excluding other possible causes and by positive physical examination findings. Pain relief by injecting local anesthetic into the joint can be used for diagnostic purposes. Ultrasonography or X-ray (fluoroscopy) imaging may be required for the needle to be placed in the right place.

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Treatment

In cases where the pain is severe, it can be rested for a few days. Cold or hot applications can be helpful in reducing pain and muscle spasm. Pain relievers from the non-steroidal anti-inflammatory group also have edema and inflammation-reducing effects. Manual therapy, needle treatments (sacroiliac joint injection), stretching exercises, strengthening waist and abdominal muscles, aerobic exercisesother methods of treatment. Exercises are more effective if they are planned individually. Various other physical therapy methods can also be applied. If physical therapy does not produce results, surgery may rarely be considered. In the technique called sacroiliac joint fusion, the sacrum and pelvis are fixed by attaching them to each other with metal screws and plates. Pain is reduced as the joint is immobilized. Among the risks of the surgery, we can count the fact that the complaints do not decrease and the transfer of the problem called adjacent segment disease to the adjacent joints such as the waist and hip.

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