SI Joint dysfunction
- Mechanical and Arthritic |
- Mechanical: alters normal joint mechanics - LL inequality, lower extremity joint pain, pes planus, improper shoes, scoliosis, prior lx fusion, LP muscular dysfunction, repetitive strenuous activity, pregnancy and trauma |
- Arthritic: OA/inflammatory (AS, PA, enteropathic arthritis, Reiters (morning pain >30 minutes, resolves with exercise) |
Hx
- Points to pain over PSIS |
- Pain referring to low back, buttock, thigh or sometimes in the lower leg |
- Upper 1/3 affected = pain over PSIS
Mid section - pain in mid-gluteal region
lower section = pain in lower gluts |
- Aggravated by weight bearing and arising from seating, flexing forward whilst standing, rolling from side to side in bed, getting in and out of car and long car rides |
- Relieved by shifting weight off the leg |
PE
- +ve SI distraction |
- +ve Thigh thrust |
- +ve SI compression |
- +ve sacral thrust |
- +ve Gaeslens |
- +ve FABER |
- May be +ve in Disc pts |
- MP stiffness/hypomobility/apprehension in SI joint |
- TTP gluts, ES, iliopsoas |
- Assess Lx spine, lower extremely |
DDx
- Inflammatory arthropathy |
- Maigne's |
- LS referral (discogenic) |
- Hip DJD/pathology |
- Myofascial pain (piriformis) |
- Sacral insufficiency f# |
- Neoplasm |
- Infection |
- Viserosomatic referral |
Imaging
- Showing grade II sacroilitis (Erosions, sclerosis, joint space narrowing, then ankylosis)
- Usually no imaging unless suspected inflammatory arthropathy
- If sacroilitis, consider CBC, ESR, CRP, HLA-B27 blood tests
- MRI and CT more sensitive for sacroilitis (bone marrow oedema) - rule out lumbar disc
Management
- SI manipulation |
- US |
- Ice |
- Electrostimulation |
- Cross friction massage/IASTM of tendons and ligaments of SIJ |
- Myofascial release of gluts, hammies, piriformis, TFL, QL, ES, contralateral Lats |
- Core stability (transverse abdominis, abdominal obliques, ES, gluts, hip abductors and adductors |
- Avoidance of prolonged standing, sitting and forced hip abduction |
- Sx/steroid if failure of conservative care, recalcitrant |
|
