SI JOINT DYSFUNCTIONSDr.DhruvTaneja

The sacroiliac joint lies next to the bottom of the spine, below the lumbar spine and above the tailbone (coccyx). It connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest).

The joint typically has the following characteristics:1. Small and very strong, reinforced by strong ligaments that surround it2. Does not have much motion3. Transmits all the forces of the upper body to the pelvis (hips) and legs4. Acts as a shock-absorbing structure

Brief Anatomy to refresh your memory

While it is not clear how the pain is caused, it is

thought that an alteration in the normal joint motion may be the culprit that causes sacroiliac pain. This source of pain can be caused by either:

Too much movement (hypermobility or instability): The pain is typically felt in the lower back and/or hip and may radiate into groin area.

Too little movement (hypomobility or fixation): The pain is typically felt on one side of the low back or buttocks, and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the ankle or foot. The pain is similar to sciatica, or pain that radiates down the sciatic nerve and is caused by a radiculopathy.

SI Joint Dysfunction

Low back pain LBA with radiculopathy Pain on one side of hip Ipsilateral pain in back Pain in posterior aspect of SI joint.

Signs and symptoms

Physical examination a. Palpation In physical examination, try to determine if the sacroiliac joint is the cause of pain through movement of the joint. If the movement recreates the patient’s pain, and no other cause of pain can explain the patient's pain and symptoms (such as a disc herniation on an MRI scan), the sacroiliac joint may be the cause of the pain.b. X-Raysc. CT/MRI scand. Special tests Fabers test/patricks test/figure 4 test

Accurate diagnosis

The test is performed by having the tested leg flexed, abducted, and externally rotated.

If pain is elicited on the ipsilateral side anteriorly, it is suggestive of a hip joint disorder on the same side.

If pain is elicited on the contralateral side posteriorly around the sacroiliac joint, it is suggestive of pain mediated by dysfunction in that joint.

Fabers test

Ice packs/hot packs/rest . Initial treatment

recommendations will typically include use of ice or cold packs

Apply in 15 to 20 minute intervals as needed to reduce inflammation in the area, along with rest to reduce irritation.

Depending on the duration of sharp, intense pain, ice can be continued anywhere between 2 days to 2 weeks. Once the inflammation is less, gradual return to normal activities may be advisable.

Application of heat (such as a heat wrap or hot bath) may help the healing process, but not during the acute, high intense pain time frame.

Treatment

Medications a. Anaelgesics (acetaminophen)b. NSAIDS (ibuprofen/naproxen)c. Anaesthetic with steroid (lidocaine with

corticosteroid) to reduce inflammation and swelling with associated pain.

Supports/bracesWhen the SI joint is "hypermobile" or too loose, an "orthotic" or brace about the size of a rather wide belt can be wrapped around the waist and pulled snugly to stabilize the area. This can sometimes be very helpful at times when the joint is inflamed or painful. When it calms down, the orthotic can be weaned away.

Physiotherapeutic rehabilitationa. Electrical modalitiesb. Strengthening/stretching exercisesc. Hydrotherapy

IFT TENS ULTRASOUND THERAPY LASER SWD

Electrical modalities

Exercises

Hydrotherapy