SIJ Flashcards
SIJ pain
Primary source of pain in 10% to 27% of pt with mechanical low back pain.
causes:
- can be aggravated by prolonged sitting or standing, standing on one leg, stair climbing, going from sit to stand, and with running
- arthritis
- traumatic injury
- pregnancy and postpartum
- systemic inflammatory conditions (when you are pregnant, your body releases hormones called relaxing, causes the muscles and ligaments in pelvis to relax/soften.
RF:
- women as they go through pregnancy
CP:
- sharp, stabbing pain located in the lower back or back of the hip
- movements can worsen pain
Osteitis pubis
Painful condition affecting the pubic symphysis that develops after athletic activity.
Inflammation of the pubic symphysis
Causes:
- athletic activity
- Repetitive contraction of muscles connected to pubic bone
- vaginal birth
- pelvic and perineal surgery
- RA
- UTI
causes can be 2 different factors:
- overload (training errors):
– exercising on uneven ground
– increasing intensity or duration too quickly
- biomechanics inefficiencies:
– poor running or walking mechanics
– tight, stiff muscles in the hips, groin and buttocks
– muscular imbalances
– leg length differences
CP:
- anterior and medial groin pain
- pain can be directly over the pubic symphysis
- pain may also be felt in:
- adductors
- lower abdominal
- perineal
- inguinal or scrotum regions
prognosis:
- doesn’t require surgery
- the key to treating this condition is rest (due to it being caused by overload and exercise mostly).
Iliopsoas bursitis
Inflammation of bursa underneath the iliopsoas muscle.
causes:
- can develop in athletes, due to overuse
- tight iliopsoas can cause it, due to increased pressure on the bursa
- RA and OA
CP:
- pain starting at the front of the hips (pain can radiate down your thighs to the knees). Some people may have pain in the buttocks.
- might experience stiffness and tightness in mornings
- discomfort walking up stairs or exercising
- swelling
- limping can be caused
prognosis:
- if left untreated, the pain can become worse
- iliopsoas can also rupture if left untreated and become infected
- infections are rare, but signs include:
– fever
– joint pain
– red, warm skin
– feeling sick
Piriformis syndrome
Uncommon cause of sciatica that involves buttock pain referred to the leg.
Difficult to diagnose
Occurs when piriformis muscle presses on the sciatic nerve and results in inflammation.
Can be bilateral or unilateral.
causes:
- inflammation of piriformis or tissues around it
- muscles spasm
- scarring in the muscles
CP:
- aching
- burning
- numbness, tingling
- pain
- all down the back of the leg
prognosis:
- surgery not usually required unless all the therapies applied fail.
- surgery can involve, removing scar tissue or other sources of pressure on the nerve
Ischiogluteal bursitis
Rare, infrequently recognised soft tissue mass of the buttock region.
Inflammation of bursa between the gluteus Maximus and the ischial tuberosity.
While standing, the bursa is covered by the gluteus Maximus, however while sitting down the muscle contracts and slides upwards leaving only fibrous tissue between bursa and skin.
causes:
- could be severe weight loss or cachexia
- sitting for a prolonged period of time
- when the ischialgluteal bursa is damaged or irritated
– irritation can be caused by a direct blow to the bursa such as falling on a hard surface
CP:
- pain and tenderness at the ischial tuberosity
- pain stretching the hamstring muscles
- pain over the centre of the buttock and along the hamstring muscles of the legs
- reduced range of motion
- weakness
- numbness
- stiffness
- swelling maybe
prognosis:
- it will not get better on its own
- pain may disappear with a period of lay-off or treatment
Levator Ani Syndrome
Non relaxing pelvic floor dysfunction. Means the pelvic floor muscles are too tight.
Myofascial pain of the elevator ani syndrome. Chronic tension or spasticity of the pelvic floor musculature.
More common in women
causes:
- exact cause unknown
- chronic tension of pelvic floor muscles
- inflammation may be a contributing factor
- may be related to:
– not urinating when you need to
– vaginal shrinking or pain in the vulva
– continuing intercourse even when its painful
– injury to pelvic floor from trauma or surgery
– IBS, endometriosis, or interstitial cystitis
RF:
- more common in women than men, due to endometriosis
CP:
- pain in rectum, not associated with bowel movement. This pain may come and go
- feels like pressure in rectum
- pain can be worse when sitting
- relieved when standing up or lying down
Prognosis:
- no known cure
- however, with proper management over time, the symptoms can become less severe, less frequent or both
- doctor should be consulted for people who are suffering with chronic recurrent periods of anal or rectum pain
Investigations:
- stool sample taken
- blood test
- endoscopic procedures
- imaging tests
Coccydynia
Pain in the coccyx region
Most cases associated with abnormal mobility of the coccyx which may trigger a chronic inflammatory process leading to degeneration of this structure.
causes:
- most cases occur in conjunction with subluxated (partial dislocation) or hyper mobile coccyx, and it has been proposed that pathologic instability may give rise to chronic inflammatory changes.
- may report in patient with antecedent traumatic event, which has been associated with coccygeal instability, particularly posterior subluxation.
- falling
- repetitive strain injury
- pregnancy/childbirth
- obesity
- underweight
- sitting
- cancer
RF:
- common
- women 5x more likely than men
- adults and adolescents get it more than children
- obese people 3x more likely
- also more vulnerable if you loose weight too quickly
CP:
- achy or piercing pain in coccyx/tailbone
- more severe pain when changing from sitting to standing up
- pain during bowel movements
- pain during sex
- rectal pain can be caused
prognosis:
- rarely lifelong. Prognosis generally quite good
