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Spinal Disorders- LeFebvre > 12 - SI Disorders > Flashcards

12 - SI Disorders Flashcards

1
Q

What joint surface in the Si joint is concave?

A

Sacral

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2
Q

What joint surface in the SI is covered in fibrocartilage

A

Iliac

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3
Q

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

A

Form closure

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4
Q

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

A

Anterior sacroiliac because it is very thin.

Aggravated by FABER test

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5
Q

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

A
  • posterior sacroiliac

- sacrotuberous

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6
Q

Where does the posterior sacroiliac ligament connect?

A

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

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7
Q

What ligament is often targeted in the Logan basic technique?

A

Sacrotuberous

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8
Q

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

A

Form closure

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9
Q

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

A

Force-couple stabilization

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10
Q

What makes up the oblique dorsal fascia tendon sling?

A
  • lat dorsi
  • thoracolumbar fascia
  • contralateral glute max
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11
Q

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

A
  • erector spinae
  • long dorsal/posterior SI ligament
  • sacrotuberous ligament
  • long head of the biceps femoris
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12
Q

What percentage of chronic LBP is attributed to SI disorders?

A

20%

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13
Q

What are 3 injuries of the SI?

A

SI syndrome
SI sprain
SI joint dysfunction

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14
Q

What are the 5 seronegative arthropathies that can cause sacroiliitis?

A
  • AS
  • Reiter’s
  • psoriatic
  • enteropathic
  • undifferentiated spondyloarthropathy
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15
Q

What are some spinal symptoms associated with seronegative arthropathies?

A
  • local SI inflammation
  • progressive and insidious onset
  • pain may be migratory and episodic
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16
Q

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

A
  • concomitant joint pains (hip), enthesis (plantar fascia and achilles), osteitis and synovitis
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17
Q

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

A 
Fever
Malaise
Fatigue
Rash
GU or GI issues
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18
Q

What are the results of ancillaries studies with seronegative arthropathies?

A 
Negative ANA and RF
Increased CRP and ESR
Positive HLA-B27
Anemia of chronic disease
Radiographic evidence of sacroiliitis
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19
Q

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

A
  • 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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20
Q

Who is most commonly affected by AS?

A

20-30 year old males

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21
Q

How common is uveitis with AS?

A

20-40% will get it

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22
Q

What are the symptoms of uveitis?

A

Pain
Redness
Photophobia
Blurred vision

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23
Q

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

A

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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24
Q

What muscles are commonly in spasm with AS?

A

Glute max and piriformis

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25
Q

What is Schober’s test?

A

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

26
Q

How is chest expansion measured when checking for AS?

A

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

27
Q

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

A

Monitoring progression of AS

28
Q

What are the two common medical treatments for AS?

A

NSAIDs

TNF blockers

29
Q

What CMT can be used in acute phase of AS?

A

Blocking or mobilization

30
Q

What are the dermatological findings with psoriatic sacroiliitis?

A

Plaques on skin and pitting of nails

31
Q

What is the common age of onset for psoriatic sacroiliitis?

A

30-50 years old

32
Q

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

A

One third

  • could also present as polyarthritis
33
Q

What are common extraspinal findings associated with psoriatic sacroiliits?

A
  • Enthesitis of the Achilles’ tendon and plantar fascia with development of insertional spurs
  • synovitis of the flexor tendon sheath (extensor sheath is spared)
34
Q

What percentage of patients with psoriasis will have ocular involvement?

A

30%

  • 20% conjunctivitis
  • 10% uveitis
35
Q

What are the common causes of enteropathic arthropathy?

A
  • Crohn’s disease
  • Ulcerative colitis
  • reactive arthropathies from bacterial or parasitic infections
36
Q

Are reactive arthropathies episodic or constant?

A

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

37
Q

Who is more commonly affected by Reiter’s syndrome?

A

Males 5:1

38
Q

What are the classic symptoms fo Reiter’s syndrome?

A
  • conjunctivitis
  • urethritis
  • sacroiliitis
39
Q

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

A

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

40
Q

What is the treatment for Reiter’s syndrome

A
  • maintain mobility with exercise, stretching, postural training and nutritional support that decreases inflammation
41
Q

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

A

Children and young adults

Men> women

42
Q

What is infectious sacroiliitis?

A

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

43
Q

What is the primary SI test?

A

ASLR

44
Q

How is ASLR performed?

A

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
45
Q

What does a positive ASLR indicate?

A
  • SI is paint generator
  • SI may be functional unstable
  • bracing may be therapeutically useful
46
Q

ASLR should be followed up with what 5 tests?

A
  • hip thrust
  • sacral thrust
  • Gaenslen’s
  • SI compression
  • SI distraction
47
Q

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?

A

+LR 4.1 (3 positive SI tests)

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

48
Q

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

A 
FABER
Fortin’s finger test
Belt test
HIbb’s test
Yeoman’s 
Ely’s
49
Q

What SI injury will have deep referred leg pain/paresthesia

A

SI syndrome

50
Q

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

A

SI sprain

51
Q

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

A

SI joint dysfunction

52
Q

What is the pain presentation of SI joint conditions?

A
  • 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
53
Q

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

A

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

54
Q

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

A

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

55
Q

What are important things to remember when adjusting the SI?

A

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

56
Q

What are 4 important contributors to SI problems?

A
  • SI muscle imbalance
  • lower cross syndrome
  • tight hamstring
  • LLI
57
Q

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

A
  • Inhibited ipsi glute max and contra glute med

- Short and tight ipsi priformis and iliopsoas

58
Q

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

A
  • strengthen ipsi glute max and contra glute med
  • stretch and relax ipsi piriformis and iliopsoas
  • core stabilization
  • proprioceptive training
59
Q

What are the 5 goals for treatment of SI dysfunction?

A
  • 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
60
Q

What are the 4 medical treatments for SI dysfunction?

A
  • 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)

Spinal Disorders- LeFebvre (25 decks)

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