SIJ Clinical Presentations

Question 1

how common is SI dysfunction?

Answer 1

prevalence ~15% (individuals w/chronic LBP)

Question 2

how is SI dysfunction diagnosed?

Answer 2

tend to think of it as a dx of exclusion

gold standard = local intra-articular anesthetic block

Question 3

List common SIJ health conditions

Answer 3

1. Spondylarthropathies
   
   • ankylosing spondylitis
2. Infection and Metabolic Diseases
3. Sacral Stress Fracture
4. Pregnancy-related sacroilits
5. Mechanical Disorders

Question 4

describe a sacral stress frx

Answer 4

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)

Question 5

Sacral Stress frxs are most common among:

Answer 5

1. Athletes
   
   • recent increase in training intensity
   • recent stress frx in same area
   • 1.7% of stress frx in LE
2. Older Adults
   
   • fused SIJ
   • diminished bone density osteoporosis
   • trauma
3. Other predisposing factors
   
   • steroid-induced osteoporosis
   • osteoporosis related to malignancy
   • irradiation-induced osteoporosis

Question 6

symptomology of sacral stress frx

Answer 6

1. LBP/pain into buttock
   
   • possibly groin and L E
2. may be similar to cauda equina syndrome

Question 7

physical exam findings for a sacral stress frx

Answer 7

1. may look similar to presentations assocaited with:
   
   • HNP
   • spinal stenosis
   • tumors
2. Antalgic gait
3. TTP area of stress frx
4. L/S ROM more likely normal

Question 8

what is coccydynia?

Answer 8

ligamentous/bony injury involving coccyx

coccygeal flexion >25º

coccygeal extension >20º

Question 9

likely Hx in a Coccydynia pt

Answer 9

1. Trauma vs idiopathic
   
   • often direct trauma/impact from falling
2. Pelvic floor Sx/injury with muscle scarring
3. Female (4x more likely)
4. Higher BMI (3x more likely)

Question 10

symptomology of Coccydynia

Answer 10

1. pain in area of coccyx
2. aggravated by asymmetric motions, especially:
   
   • transitions
   • sitting w/o weight shift (prolonged worse)
   • defectation
   • intercourse

Question 11

Physical exam findings for Coccydynia

Answer 11

1. TTP coccyx
2. sitting posture → weight-shifted
3. painful provocation testing
   
   • anterior from external force
   • posterior from internal force

Question 12

interventions for Coccydynia

Answer 12

1. Medical
   
   • surgical excision
   • guided steroid injection
2. Manual Therapy → coccyx mobs
3. Pt edu/activity modification
4. pelvic floor exercises

Question 13

Incidence of PPPP

Answer 13

Postpartum Posterior Pelvic Pain

incidence ~4-78%

severe pain reportedin 33%

Question 14

what is PPPP?

Answer 14

Postpartm Posterior Pelvic Pain

pain that begins during pregnancy or within 3 weeks following delivery

Question 15

what is the cause of PPPP?

Answer 15

not well understood, theorized to be related to:

1. hormone-related ligamentous laxity
2. increased lordosis
   
   • paraspinal muscles
   • sacrum positioning w/loading

Question 16

what are the 5 proposed classifications of PPPP?

Answer 16

1. Pelvic girdle syndrome
2. Symphysiolysis
3. One-sided sacroiliac syndrome
4. Double-sided sacroiliac syndrome
5. Miscellanous

Question 17

describe Pelvic girdle syndrome

Answer 17

daily painin all 3 pelvic joints,

confirmed w/positive pain provoked by tests from the equivalent joints

Question 18

describe symphysiolysis

Answer 18

daily pain in pubic symphysis only

confirmed with positive pain provoked by tests from the symphysis.

Question 19

describe one-sided sacroiliac syndrome

Answer 19

daily pain from one SIJ

confirmed with positive pain provoked by the tests from the same joint

Question 20

describe double-sided sacroiliac syndrome

Answer 20

daily pain from both SIJs

confirmed with positive pain provoked by the tests from both joints

Question 21

describe the miscellanous category of PPPP

Answer 21

daily pain in one or more pelvic joints, but inconsistent objective findings

can also include findings indicating inflammatory RA

Question 22

what is the most common category of PPPP

Answer 22

pelvic girdle syndrome

followed by double-sided SI syndrome

Question 23

which PPPP classification(s) will most likely have chronic symptoms?

Answer 23

pelvic girdle syndrome

Question 24

physical exam findings for PPPP

Answer 24

1. findings consistent with mechanical SIJD
2. postive active SLR test

Question 25

SIJ mechanical disorders

Answer 25

1. structures that could be affected include:
   
   • capsule
   • ligament
   • contractile units
2. Pathoanatomy → capsule tears thought to be a primary contributor to presentation
3. minimal motion typically occurs at SIJ (1-2º)
4. Dx best supported for local anesthetic block

Question 26

symptomology of SIJ mechanical disorders

Answer 26

1. pain buttock/groin/thigh (LE proximal to knee)
2. aggravated by:
   
   • transitions
   • sitting (prolonged worse)
   • activities that requrie longer strides (shear on SIJ with alternate hip flex/ext positions)

Question 27

physical exam findings for SIJ mechanical disorders

Answer 27

1. asymmetry with postural landmark exam common in clinic
   
   • questionable reliability/validity
2. TTP affected SIJ stabilizers
3. provocation with procedures that stress affected SIJ ligament/capsule structure
4. Laslett’s Cluster