Keyword and Related Terms: lymphedema, leg lymphedema, Lumbar Fusion; Lumbosacral Fusion; Postoperative Back Pain; Sacroiliac Joint Blocks; Sacroiliac Joint Pain, low back pain, tensegrity, ligament, Fascia, Disc, zygapophysical joint, SI joint inflammation, SI joint dysfunction, SI joint strain
What are the sacroiliac (SI) joints?
The sacroiliac (SI) joints are formed by the connection of the sacrum and the right and left iliac bones. The sacrum is the triangular-shaped bone in the lower portion of the spine, below the lumbar spine. While most of the bones (vertebrae) of the spine are mobile, the sacrum is made up of five vertebrae that are fused together and do not move. The iliac bones are the two large bones that make up the pelvis. As a result, the SI joints connect the spine to the pelvis. The sacrum and the iliac bones (ileum) are held together by a collection of strong ligaments.(1) Characteristics of the joint are small and very strong, does not have much motion, transmits forces of the upper body to the pelvis, hips, legs. It also acts like a shock absorbing structure.
Discussion of Sacroiliac joint dysfunction
Sacroiloac joint dysfunction is the term used to describe pain in the sacrol=iliac joint area that is caused by motion in the sacroiliac joint. It can be from either too much or too little motion. The result is typically inflammation of the SI joint or sacroilitis.
It is thought that an alteration in the normal joint motion may be the cause of sacroiliac pain.
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. (2)
Symptoms include lower back pain, buttock pain, hip pain, urinary frequency, sciatic leg pain, groin pain, transient numbeness, prickling, or tingling. The pain ranges from a dull ache to sharp and stanning. Generally the pain also increases with physical activity.
The diagnosis of sacroiliac joint dysfunction can be difficult as the symptoms are common with many other conditions. The diagnosis is usually arrived at through physical examination and.or an injection (to block the pain), In the physical examination, the doctor may use several tests in an attempt to reproduce the symptoms associated with sacroiliac. The correct diagnosis may be arrived at if several of the tests come back as positive for causing the pain.
These tests include the Gillette test in which the patient is standing. The patient stands on one leg while flexing the opposite hip and knee into the chest.
In the Fortrin finger test, the patient points to the area of pain with one finger. The result is positive if the site of the pain is within 1 cm of the posterior iliac spine.
The Patrick test of the Faber maneuver is flexion, abduction, and external rotation of the hip. The patient lies supine and the heel of the tested side is placed on the opposite knee. Pressure is placed on the flexed knww and the opposite anterior superior iliac spine area.
Other physical tests includes the Van Durson standing flexion test and the Piedallu seated flexion tests. (2) The injection that is given is called a sacroiliac joint block shot. The injection is usually guided by x-ray to make sure the joint is correctly injected. Sometimes a dye may be used.
In this test, a physician uses fluoroscopic guidance (live X-ray) and inserts a needle into the sacroiliac joint to inject lidocaine (a numbing solution). If the injection relieves the patient’s pain, it can be inferred that the sacroiliac joint is the source of the pain. (3)
The treatment includes injections to relieve the pain. Oral antai=inflammatory medications (NSAID’s) are helpful in pain relief as well. Oral steroid are give only for short periods of time.
Physical therapy is also helpful in the treatment of sacroiliac joint pain. The therapist will perform and teach various stretching exercisees that can help relieve the pain.
A sacroiliac belt is also used. This is a device that wraps around the hips to help stabilize the SI joints. Other physical therapies may include yoga, manual therapy and pilates (an exercise system focused on improving flexibility, strength, and body awareness, without necessarily building bulk. )
The cartilage is removed from the surfaces of the SI joints and the bones are then held together with plates and screws until they grow together or fuse. This eliminates all motion of the joint and thus relieves the pain.
In the most unresponsive and difficult cases, surgery may be used as a treatment option. This involves fusing the SI joints.
Sacroiliac joint dysfunction and Lymphedema
The question in your mind by now is probably, so what does this have to do with lymphedema?
The answer is really very simple.
With leg lymphedema, there is generally an alteration in the gait (walk) pattern caused by the increased volume or weight of the lymphedematous limb. Many of us, including myself have experienced severe pain of the hips as a result of this.
Think of it for a moment, what would the effect of an additional 10-50 lbs (or more) of weight in one leg effect the other, or effect how you walked. That adds an extreme amount of additional stress on you body and the joints used in our mobility.
For lymphedema patients the treatment must include complete decongestive therapy and the wearing of compression garments to hold down the swelling as much as is possible. This in itself will greatly contribute to the relieving of the joint pain. See the article below.
Management of sacroiliac dysfunction and lower extremity lymphedema using a comprehensive treatment approach: a case report.
3705 Genesee Drive, Philadelphia, PA, USA. firstname.lastname@example.org
Sacroiliac joint (SIJ) dysfunction, a common source of low back and buttock pain, can occur from cumulative shear or torsional forces during activities such as walking that require weight to transfer from one extremity to the other. Individuals with lower extremity lymphedema may also experience SIJ dysfunction. The purpose of this article was to describe the examination, diagnosis, and intervention for a patient with lower extremity lymphedema and sacroiliac jointdysfunction. The patient was a 50-year-old female with increased left lower extremity lymphedema and left buttock and groin pain that was previously treated unsuccessfully with physical therapy. SIJ dysfunction was attributable to an alteration in gait pattern caused by increased limb volume associated with lymphedema. The patient was treated for 19 visits over six weeks with complete decongestive therapy (CDT), muscle energy techniques, core stabilization, and the application of a pelvic support belt. Objective changes include decreased lymphedema, increased lower abdominal and lumbar extension strength, and decreased Oswetry Disability Index ratings. The patient was able to ambulate community distances without an assistive device and to resume unsupervised strength and conditioning without pain.
The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction.
Massoud Arab A, Reza Nourbakhsh M, Mohammadifar A.
Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
It has been suggested that tight hamstring muscle, due to its anatomical connections, could be a compensatory mechanism for providing sacroiliac (SI) joint stability in patients with gluteal muscle weakness and SIJ dysfunction. The purpose of this study was to determine the relationship between hamstring muscle length and gluteal muscle strength in subjects with sacroiliac joint dysfunction. A total of 159 subjects with and without low back pain (LBP) between the ages of 20 and 65 years participate in the study. Subjects were categorized into three groups: LBP without SIJ involvement (n = 53); back pain with SIJ dysfunction (n = 53); and no low back pain (n = 53). Hamstring muscle length and gluteal muscle strength were measured in all subjects. The number of individuals with gluteal weakness was significantly (P = 0.02) higher in subjects with SI joint dysfunction (66%) compared to those with LBP without SI joint dysfunctions (34%). In pooled data, there was no significant difference (P = 0.31) in hamstring muscle length between subjects with SI joint dysfunction and those with back pain without SI involvement. In subjects with SI joint dysfunction, however, those with gluteal muscle weakness had significantly (P = 0.02) shorter hamstring muscle length (mean = 158±11°) compared to individuals without gluteal weakness (mean = 165±10°). There was no statistically significant difference (P>0.05) in hamstring muscle length between individuals with and without gluteal muscle weakness in other groups. In conclusion, hamstring tightness in subjects with SI joint dysfunction could be related to gluteal muscle weakness. The slight difference in hamstring muscle length found in this study, although statistically significant, was not sufficient for making any definite conclusions. Further studies are needed to establish the role of hamstring muscle in SI joint stability.
Sacral nerve stimulation for the treatment of sacroiliac joint dysfunction: a case report.
Kim YH, Moon DE. Source Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea.
Introduction: Sacroiliac joint (SIJ) dysfunction Sacral nerve stimulation with a percutaneous retrograde cephalocaudal approach is considered to be a useful therapeutic option in the treatment of intractable SIJ Her VAS pain score decreased to 2-3/10 following sacral nerve stimulation to the left first sacral foramen via the retrograde cephalocaudal approach. Before undergoing sacral nerve stimulation, she had taken anti-depressants, anti-anxietics, analgesics, and anti-convulsants. After the procedure, she required intermittent analgesics only. Conclusions: We present a case of a 41-year-old woman with left buttock pain, referred pain to the left leg, and dyspareunia. Her visual analogue scale (VAS) pain score was 9/10. Although we performed intramuscular injection into piriformis muscle, intra-articular injection into SIJ, and radiofrequency denervation for the treatment of SIJ pain, her pain repeatedly improved and was reaggravated. Sacral nerve stimulation to the left first sacral foramen via the retrograde cephalocaudal approach was performed. Results: is a significant contributing factor in 10-30% of individuals with lower back pain. However, definitive diagnostic methods and treatments are still controversial. Methods: dysfunction.
Unexplained lower abdominal pain associated with sacroiliac joint dysfunction: report of 2 cases.
Morimoto D, Isu T, Kim K, Matsumoto R, Isobe M.
Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido. email@example.com
A 25-year-old woman and a 31-year-old man presented with chronic lower back pain and unexplained lower abdominal pain. Both patients had groin tenderness at the medial border of the anterior superior iliac spine. The results of radiographical and physical examinations suggested sacroiliac joint dysfunction. Sacroiliac joint injection relieved their symptoms, including groin tenderness. In our experience, groin tenderness is highly specific for sacroiliac joint dysfunction. We speculate that spasm of the iliac muscle can cause groin pain and tenderness. Groin pain and a history of unexplained abdominal pain, with lower back pain, are symptoms that suggest sacroiliac joint dysfunction. Additionally, compression of the iliac muscle is a simple and useful maneuver; therefore, it can be used as a screening test for sacroiliac joint dysfunction, alongside other provocation tests.
Sacroiliac joint dysfunction: a case study.
Murray W. Source US Army, Nurse Corps, Kailua, HI, USA.
Pain is a widespread issue in the United States. Nine of 10 Americans regularly suffer from pain, and nearly every person will experience low back pain at one point in their lives. Undertreated or unrelieved pain costs more than $60 billion a year from decreased productivity, lost income, and medical expenses. The ability to diagnose and provide appropriate medical treatment is imperative. This case study examines a 23-year-old Active Duty woman who is preparing to be involuntarily released from military duty for an easily correctable medical condition. She has complained of chronic low back pain that radiates into her hip and down her leg since experiencing a work-related injury. She has been seen by numerous providers for the previous 11 months before being referred to the chronic pain clinic. Upon the first appointment to the chronic pain clinic, she has been diagnosed with sacroiliac joint dysfunction. This case study will demonstrate the importance of a quality lower back pain assessment..
Imaging the back pain patient. Nov 2010
Sacroiliac joint pain. Sep 2010
Sacroiliac joint dysfunction. Jul 2010
ICD-9 724.6 ( Disorders of sacrum, Ankylosis, lumbosacral or sacroiliac (joint), Instability, lumbosacral or sacroiliac (joint)
ICD10 M43 Codes