Sacroiliac Joint Pathologies

Question 1

Explain the anatomy of the SIJ

Answer 1

Di-arthrodial - 2 components to the joint

L-Shaped

Anterior synovial part which has alot of movement

Fibrous posterior part which has minimal movement

Question 2

How are the hamstrings connected to the SIJ?

Answer 2

Sacrotuberous ligament can transmit force to the tendon of the long head of the bicep femoris muscle

Question 3

Name the muscles that are important for posterior stability of the SIJ

Answer 3

Gluteus maximus

Contralateral quadratus lumborum

Gluteus Medius

Bicep Femoris

Question 4

What are the 2 components of the SIJ?

Answer 4

Sacrum and ilium

Question 5

What are the SIJ movements?

Answer 5

Sacrum: Nutation and counter nutation

Ilium: Anterior and posterior rotation

Question 6

What are the functions of the SIJ?

Answer 6

Stress relieving

ROM is small

Has no muscles to facilitate AROM

Performs passive movements

Bony locking mechanism to sustain loads longitudinally

Question 7

Explain form closure

Answer 7

How joint surfaces lock together

Static component

Ligamentous system supports this (Sacrotuberous and sacrospinous)

Occurs due to gravity, no extra force needed

Question 8

Explain force closure

Answer 8

External forces that add additional compressive load to increase stability

Muscular/dynamic component

Myofascial slings and chains aid stability - Posterior Oblique sling and Anterior Oblique sling

Question 9

What muscles help force closure?

Answer 9

Internal obliques

Transverse abdominals

Latissimus dorsi

Gluteus Maximus

Iliotibial band (Tensor Fascia Latae)

Bicep Femoris (via sacrotuberous ligament)

Not well researched

Question 10

What is the subjective presentation of someone with SIJ pain?

Answer 10

Pain bellow L5 level

Pain does not refer up the spine

Deep seated buttock pain

Referral to buttock, groin or into posterior/lateral leg

Pain with unilateral movements e.g. rolling in bed, in/out car, STAIRS, unilateral weight bearing

Increase risk in pregnant women

Minimal research into subjective presentation and overall evidence is poor

Question 11

What can you use to help aid your differential diagnosis?

Answer 11

Broadhurst Triad

1. Pain over SIJ/PSIS (Fortin’s sign)
2. Tenderness over sacrospinous/sacrotuberous ligament
3. Pain reproduction over pubic symphysis or with compression through the SIJ

Level of evidence is poor

Question 12

What other things should you consider for your differential diagnosis?

Answer 12

Lx pain

Ankylosing spondylitis
Males early 30s
Pain on impact when running
Morning stiffness
Problems dissipating force

Psoriatic arthritis
Ask bout of psoriasis recently?

Reiter’s syndrome (Reactive arthritis)
Caused due to sexually transmitted disease
Pain when urinating
Swollen eyes

Spondylolisis and Spondylolithesis

Question 13

What are the 3 kinetic tests used for SIJ assessment?

Answer 13

Flexion in standing

Flexion in sitting

Stork / Gillet test

All have poor reliability and sensitivity

Question 14

What is the aim of kinetic testing?

Answer 14

Explore the SIJ contribution to active movement (how well does the joint move)

Hypomobility? or Hypermobility?

Causes can be intra and extra articular

Question 15

Name the 6 Pain Provocation tests

Answer 15

Thigh thrust

Distraction

Compression

Sacral thrust

FABERs

Gaenslens

Question 16

Which provocation test do you use 1st and why?

Answer 16

Thigh thrust due to high sensitivity

If -ve it is likely that the SIJ is not invovled

Question 17

How many provocation tests do you need to be positive to suggest an SIJ problem? And how many negative to exclude a SIJ problem?

Answer 17

3/5 +ve

3/5 -ve

Question 18

What does the literature state regarding the combination of the Kinetic tests and pain provocation tests?

Answer 18

No correlation between if someone has SIJ dysfunction (Kinetic tests) or SIJ pain (Provocation tests)

Moving poorly may not relate to pain and vice versa

Question 19

What are the 2 types of pain provocation test clusters called?

Answer 19

Van der Wuurf cluster

Laslett cluster

Question 20

How many vertebrae are in the sacrum and coccyx?

Answer 20

Sacrum - 5 fused vertebrae

Coccyx - 3-4 fused vertebrae

Question 21

What are the bony landmarks on the pelvis and SIJ?

Answer 21

Anterior Superior Iliac Spine (ASIS)

Posterior Superior Iliac Spine (PSIS)

Anterior Inferior Iliac Spine (AIIS)

Ischial Tuberosity

Iliac Crest

Pubis symphysis

Question 22

What are the 3 bones that make up the pelvis?

Answer 22

Ilium, Ischium and pubis

Question 23

What are the SIJ ligaments?

Answer 23

Sacrotuberous ligament - Sacrum to ischial tuberosity

Sacrospinous ligament - sacrum to the spine of the ischium

Posterior sacroiliac ligament - Big thick blended ligament that runs over the posterior aspect of the SIJ

Anterior sacroiliac ligament - x3 stronger than the posterior sacroiliac ligaments in combination

Question 24

What are the general red flags?

Answer 24

Hx of cancer

Constant progressive unremitting night pain

Unexpected weightloss

Radiotherapy / Chemotherapy

Drug and alcohol abuse

IV drug abuse

Long-term steroid use

Osteoporosis

Rheumatoid arthritis

Cauda equina symtoms

Cardiac and circulatory problems

5Ds & 3Ns - Diplopia, dysarthria, dysphagia, drop attacks, dizziness, nystagmus, numbness and nausea

Poor general health

Pregnancy

Diabetes

Asthma

Epliepsy

Hx of trauma

Anticoagulants