12 - SI Disorders Flashcards by Kaylee Brabham

What joint surface in the Si joint is concave?

Sacral

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What joint surface in the SI is covered in fibrocartilage

Iliac

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Stability of the SI joint based on contours of the joint and ligaments

Form closure

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What is the most often injured SI joint ligament that is a common source of pain?

Anterior sacroiliac because it is very thin.

Aggravated by FABER test

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Other than the commonly injured anterior SI ligament, what other two ligaments are common sources of pain?

posterior sacroiliac

- sacrotuberous

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Where does the posterior sacroiliac ligament connect?

From PSIS to ischial tuberosity while also connecting to the lateral crest of the sacrum

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What ligament is often targeted in the Logan basic technique?

Sacrotuberous

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Stability of the SI joint based on co-contraction of muscle-fascial slings

Form closure

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No muscles act directly on the SIJ so the combination of muscles and fascia surrounding it influence mechanics. This is called ______

Force-couple stabilization

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What makes up the oblique dorsal fascia tendon sling?

lat dorsi
thoracolumbar fascia
contralateral glute max

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What is the vertical muscle fascial sling that supports the SI joint

erector spinae
long dorsal/posterior SI ligament
sacrotuberous ligament
long head of the biceps femoris

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What percentage of chronic LBP is attributed to SI disorders?

20%

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What are 3 injuries of the SI?

SI syndrome
SI sprain
SI joint dysfunction

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What are the 5 seronegative arthropathies that can cause sacroiliitis?

AS
Reiter’s
psoriatic
enteropathic
undifferentiated spondyloarthropathy

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What are some spinal symptoms associated with seronegative arthropathies?

local SI inflammation
progressive and insidious onset
pain may be migratory and episodic

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What are some extraspinal symptoms that are associated with seronegative arthropathies?

concomitant joint pains (hip), enthesis (plantar fascia and achilles), osteitis and synovitis

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What are some non-MSK symptoms that can be associated with seronegative arthropathies?

Fever
Malaise
Fatigue
Rash
GU or GI issues

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What are the results of ancillaries studies with seronegative arthropathies?

Negative ANA and RF
Increased CRP and ESR
Positive HLA-B27
Anemia of chronic disease
Radiographic evidence of sacroiliitis

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Berlin and ASAS have criteria that if met, should trigger radiographs and blood work to check for ankylosing spondylitis. What are these criteria?

symptoms present 3 months or more
morning stiffness for more than 30 minutes
improvement with exercise, worse with rest
alternating buttock pain
awakening in the second half of night
insidious onset under age of 40

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Who is most commonly affected by AS?

20-30 year old males

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How common is uveitis with AS?

20-40% will get it

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What are the symptoms of uveitis?

Pain
Redness
Photophobia
Blurred vision

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What is a bamboo spine and how long does it take to appear in AS patients?

Ligamentous calcification and vertebral body squaring/demineralization that appears on radiograph like bamboo
Can take 10+ years to appear in AS patients

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What muscles are commonly in spasm with AS?

Glute max and piriformis

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What is Schober’s test?

Two makes on spine that are 10 cm apart. When patient flexes, there should be an additional 5 cm between the marks. If not, patient has limited ROM of lumbar spine likely associated with AS

How is chest expansion measured when checking for AS?

Circumference at T4/nipple line measured at max exhale and max inhale. Normal chest expansion should be 5 cm or more

In addition to diagnostic purpose, what else are Schober’s and chest expansion measurements good for?

Monitoring progression of AS

What are the two common medical treatments for AS?

NSAIDs | TNF blockers

What CMT can be used in acute phase of AS?

Blocking or mobilization

What are the dermatological findings with psoriatic sacroiliitis?

Plaques on skin and pitting of nails

What is the common age of onset for psoriatic sacroiliitis?

30-50 years old

What percentage of patients with psoriasis develop arthritis in the SI (sacroiliits)?

One third * could also present as polyarthritis

What are common extraspinal findings associated with psoriatic sacroiliits?

- Enthesitis of the Achilles’ tendon and plantar fascia with development of insertional spurs - synovitis of the flexor tendon sheath (extensor sheath is spared)

What percentage of patients with psoriasis will have ocular involvement?

30% - 20% conjunctivitis - 10% uveitis

What are the common causes of enteropathic arthropathy?

- Crohn’s disease - Ulcerative colitis - reactive arthropathies from bacterial or parasitic infections

Are reactive arthropathies episodic or constant?

Most are episodic with waxing and waning over the course of 6 weeks to 6 months

Who is more commonly affected by Reiter’s syndrome?

Males 5:1

What are the classic symptoms fo Reiter’s syndrome?

- conjunctivitis - urethritis - sacroiliitis

How do the radiographs of Reiter’s syndrom differ from AS?

AS is usually bilateral and Reiter’s is usually asymmetric with its SI involvement

What is the treatment for Reiter’s syndrome

- maintain mobility with exercise, stretching, postural training and nutritional support that decreases inflammation

Although infectious scaroiliitis is very rare, who more commonly gets it?

Children and young adults | Men> women

What is infectious sacroiliitis?

Hematogenous spread of an infection to the SIJ causing LBP, SI joint dysfunction, fever and other systemic signs of infection

What is the primary SI test?

ASLR

How is ASLR performed?

Patient is supine and raises each leg to a designated height. Positive findings would include: - inability to lift either or both legs to designated height - more difficulty or pain when raising one leg to height than other - reproduction of pain * repeat test with abdominal bracing and trochanteric belt

What does a positive ASLR indicate?

- SI is paint generator - SI may be functional unstable - bracing may be therapeutically useful

ASLR should be followed up with what 5 tests?

- hip thrust - sacral thrust - Gaenslen’s - SI compression - SI distraction

If 3 out fo the 5 follow up SI tests are positive, what is the LR for SI lesion? What is there is also no pain centralization?

+LR 4.1 (3 positive SI tests) | +LR 6.9 (3 positive SI tests + no pain centralization)

What are the other SI tests that are an option but do not have has much research?

``` FABER Fortin’s finger test Belt test HIbb’s test Yeoman’s Ely’s ```

What SI injury will have deep referred leg pain/paresthesia

SI syndrome

What SI injury will have not leg pain and is often secondary to trauma?

SI sprain

What SI injury has a biomechanical/function lesion of the joint?

SI joint dysfunction

What is the pain presentation of SI joint conditions?

- Local pain (often sharp) - Referred pain and paresthesia possible to buttock, groin and thigh (occasionally past the knee) - relieved by recumbency, aggravated by weight bearing

Pain may be felt in medial knee, sartorius, scrotum, & gluteal muscles with what position of the ilium?

PI, because the leg has been made functional short with higher ASIS. This stretches the sartorius muscle which attaches at the medical knee and can cause pain

Pain may be felt in lateral knee & TFL with what position of the ilium?

AS (extended) because leg has been made functionally long, stretching the TFL and causing pain at insertion on lateral knee

What are important things to remember when adjusting the SI?

Often one side may become hypermobile in compensation to a fixed side. Although the hypermobile side is the one that is causing pain, the fixed side is the one that should be adjusted

What are 4 important contributors to SI problems?

- SI muscle imbalance - lower cross syndrome - tight hamstring - LLI

What is the pattern of muscle imbalance associated with SI joint dysfunction as stated by Janda?

- Inhibited ipsi glute max and contra glute med | - Short and tight ipsi priformis and iliopsoas

What is the treatment for the muscle imbalance pattern that exists with SI dysfunction?

- strengthen ipsi glute max and contra glute med - stretch and relax ipsi piriformis and iliopsoas - core stabilization - proprioceptive training

What are the 5 goals for treatment of SI dysfunction?

- restore joint alignment and motion - control pain and inflammation - treat associated muscle imbalances - maintain mobility with stretching and exercise - address predisposing factors to prevent recurrence

What are the 4 medical treatments for SI dysfunction?

- joint injection (anesthetic, contract, corticosteroid) - radiofrequency ablation from S1-S3 - prolotherapy (irritant injected to stimulate inflammatory response) - PRP (injected to activate macrophages, collagen proliferation and vascularization)

12 - SI Disorders Flashcards

(60 cards)