SIJ Clinical Presentations Flashcards
how common is SI dysfunction?
prevalence ~15% (individuals w/chronic LBP)
how is SI dysfunction diagnosed?
tend to think of it as a dx of exclusion
gold standard = local intra-articular anesthetic block
List common SIJ health conditions
- Spondylarthropathies
- ankylosing spondylitis
- Infection and Metabolic Diseases
- Sacral Stress Fracture
- Pregnancy-related sacroilits
- Mechanical Disorders
describe a sacral stress frx
the pelvic ring is a closed system so if the SIJ is fused, torsional stress will be placed on sacrum
repetitive loading can be related to ambulation
frx are often observed vertically at ala (parallel to SIJ)
Sacral Stress frxs are most common among:
- Athletes
- recent increase in training intensity
- recent stress frx in same area
- 1.7% of stress frx in LE
- Older Adults
- fused SIJ
- diminished bone density osteoporosis
- trauma
- Other predisposing factors
- steroid-induced osteoporosis
- osteoporosis related to malignancy
- irradiation-induced osteoporosis
symptomology of sacral stress frx
- LBP/pain into buttock
- possibly groin and L E
- may be similar to cauda equina syndrome
physical exam findings for a sacral stress frx
- may look similar to presentations assocaited with:
- HNP
- spinal stenosis
- tumors
- Antalgic gait
- TTP area of stress frx
- L/S ROM more likely normal
what is coccydynia?
ligamentous/bony injury involving coccyx
coccygeal flexion >25º
coccygeal extension >20º
likely Hx in a Coccydynia pt
- Trauma vs idiopathic
- often direct trauma/impact from falling
- Pelvic floor Sx/injury with muscle scarring
- Female (4x more likely)
- Higher BMI (3x more likely)
symptomology of Coccydynia
- pain in area of coccyx
- aggravated by asymmetric motions, especially:
- transitions
- sitting w/o weight shift (prolonged worse)
- defectation
- intercourse
Physical exam findings for Coccydynia
- TTP coccyx
- sitting posture → weight-shifted
- painful provocation testing
- anterior from external force
- posterior from internal force
interventions for Coccydynia
- Medical
- surgical excision
- guided steroid injection
- Manual Therapy → coccyx mobs
- Pt edu/activity modification
- pelvic floor exercises
Incidence of PPPP
Postpartum Posterior Pelvic Pain
incidence ~4-78%
severe pain reportedin 33%
what is PPPP?
Postpartm Posterior Pelvic Pain
pain that begins during pregnancy or within 3 weeks following delivery
what is the cause of PPPP?
not well understood, theorized to be related to:
- hormone-related ligamentous laxity
- increased lordosis
- paraspinal muscles
- sacrum positioning w/loading
what are the 5 proposed classifications of PPPP?
- Pelvic girdle syndrome
- Symphysiolysis
- One-sided sacroiliac syndrome
- Double-sided sacroiliac syndrome
- Miscellanous
describe Pelvic girdle syndrome
daily painin all 3 pelvic joints,
confirmed w/positive pain provoked by tests from the equivalent joints
describe symphysiolysis
daily pain in pubic symphysis only
confirmed with positive pain provoked by tests from the symphysis.
describe one-sided sacroiliac syndrome
daily pain from one SIJ
confirmed with positive pain provoked by the tests from the same joint
describe double-sided sacroiliac syndrome
daily pain from both SIJs
confirmed with positive pain provoked by the tests from both joints
describe the miscellanous category of PPPP
daily pain in one or more pelvic joints, but inconsistent objective findings
can also include findings indicating inflammatory RA
what is the most common category of PPPP
pelvic girdle syndrome
followed by double-sided SI syndrome
which PPPP classification(s) will most likely have chronic symptoms?
pelvic girdle syndrome
physical exam findings for PPPP
- findings consistent with mechanical SIJD
- postive active SLR test
SIJ mechanical disorders
- structures that could be affected include:
- capsule
- ligament
- contractile units
- Pathoanatomy → capsule tears thought to be a primary contributor to presentation
- minimal motion typically occurs at SIJ (1-2º)
- Dx best supported for local anesthetic block
symptomology of SIJ mechanical disorders
- pain buttock/groin/thigh (LE proximal to knee)
- aggravated by:
- transitions
- sitting (prolonged worse)
- activities that requrie longer strides (shear on SIJ with alternate hip flex/ext positions)
physical exam findings for SIJ mechanical disorders
- asymmetry with postural landmark exam common in clinic
- questionable reliability/validity
- TTP affected SIJ stabilizers
- provocation with procedures that stress affected SIJ ligament/capsule structure
- Laslett’s Cluster
