SACROILIITIS

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Sacroiliac joint (SI) inflammation, known as sacroiliitis, typically causes pain. Because its symptoms are similar to those of numerous other frequent causes of back pain, sacroiliitis can be particularly challenging to diagnose. It is frequently overlooked as a cause of back or buttock pain. While being relatively rare, persistent degenerative causes of this condition's pain are common. Rheumatic, viral, drug-related, or oncologic causes can all result in secondary sacroiliitis. Ankylosing spondylitis, psoriatic arthropathy, Bechet disease, hyperparathyroidism, and numerous pyogenic causes are some particular instances of non-degenerative disorders that can result in sacroiliitis.

CAUSES 

The SI joint can become inflamed for a number of reasons, which can be very painful. 
  • Osteoarthritis can result in joint degeneration, which leads to pathologic articulation and motion, ultimately causing this disorder. 
  • The joint itself may experience substantial inflammation as a result of spondyloarthropathies. 
  • Another factor contributing to the inflammation is pregnancy, which results in the SI joint relaxing, stretching, and possibly expanding due to the hormone relaxin (s). 
  • Pregnancy's added weight places the joint under additional mechanical stress, which accelerates wear and tear. 
  • Trauma can stress and harm the SI joint directly or indirectly.
  •  The most frequently mentioned cause of acute sacroiliitis is pyogenic sacroiliitis.
  • Osteomyelitis
  • Urinary tract infection
  • Endocarditis
  • IV drug use/drug addition
  •  The posterior sacral ligaments and the synovial joint are also potential sources of Pain .
CLINICAL PRESENTATION 

  • Lower back pain is the most frequent symptom of sacroiliitis. 
  • Patients may report experiencing discomfort in one or both buttocks, their hips, their thighs, or even further away from the buttocks. 
  • Patients may claim that sitting for extended periods of time or doing rotational motions make their pain worse. 
  • Hip and low back stiffness, especially after rising from bed in the morning or after spending a lot of time sitting still.
  • The way that pain is described also varies greatly; it is frequently called intense and stabbing pain, but it can also be described as dull and achy. 
  • The timing and descriptions of the pain alone should not be the only information gathered.
DIAGNOSIS
It is necessary to collect medical history, which should include any prior inflammatory diseases. 
Additional testing consist of:
  • Physical examination and movement tests are conducted, and the spine is checked for correct alignment and rotation 
PHYSICAL EXAMINATION

Check the pelvis for correct alignment and rotation; a pelvic examination may show asymmetry. A difference in leg length can be ruled out by measuring the limbs. Look for any unusual rotational or curvature patterns in the spine.

Special provocative tests can be very helpful in reproducing the patient’s pain:

  • “Fortin finger sign”- reproduction of pain after applying a deep palpation with the four-hand fingers posteriorly at the patient's SI joint(s).

The test is positive if the site of pain is within 1 cm of the posterior superior iliac spine. Usually, the pain is inferomedial to the posterior superior iliac spine on the affected side.
  • FABER test- reproduction of pain after flexing the hip while also abducting and externally rotating the hip.


  • Sacral distraction test- reproduction of pain after applying pressure to the anterior superior iliac spine.


  • Iliac compression test- reproduction of pain after applying pressure downward on the superior aspect of the iliac crest.


  • Gaenslen test- reproduction of pain after having the patient flex the hip on the unaffected side and then dangle the affected leg off the examining table. Pressure is then directed downward on the leg to extend further the hip, which causes stress on the SI joint.



  • Thigh thrust test- reproduction of pain after flexing the hip and applying a posterior shearing force to the SI joint.


  • Sacral thrust test- reproduction of pain with the patient prone and then applying an anterior pressure through the sacrum.

3 of 5 positive tests provides discriminative power for diagnosing SI joint pain


  • Blood testing to check for inflammation-related symptoms.
  • It is possible to order imaging tests like X-rays, CT scans, and/or MRI scans.
  • Injecting steroids into the sacroiliac joint can serve as both a diagnostic test and a treatment, depending on whether it improves pain.
DIFFERENTIAL DIAGNOSIS


MANAGEMENT

CONSERVATIVE TREATMENT 

Symptom Management

• Medications (Non-steroidal anti-inflammatory drugs [NSAIDs], Oral Steroids & Pain Medications) 
• External SI joint stabilization with belting
• Therapeutic SI Injections 
• Radiofrequency Ablation (RFA)

Physical Therapy

• Motor control & core strength
• Restore normal functional movement patterns / proper gait 
• Soft tissue mobilization
• Restore muscle length and balance 
• Manual therapy (muscle energy techniques/ mobilization etc.)
• Modification of ADLs (Patient education on posture, body mechanics, positioning)

REHABILITATION

PELVIC CLOCK EXERCISES
Rest flat on your back with your feet flat on the mat and your knees bent (this is called the semi-supine position). Hip distance should separate the feet.

  • Your pelvis should be raised 1-3 inches above the ground. 
  • Put the gadget between your sacrum and the floor, beneath your sacrum. 
  • Your sacrum should be resting in the depression of the flat upper surface when you lower your pelvis. 
  • The apparatus maintains contact with the ground because to its convex lower surface.
  •  The device's 12 o'clock marker should face your head.
Pelvic Clock Stretches

Knees-to-Chest Stretch



Exercise “6-1-6-11”

Rock back and forth slowly in a 6-1-6-11 pattern.
Lean backwards towards the 1 o'clock position while you bend forward towards the 6 o'clock marker (a back-left tilt).
6- 11 Tilt in the direction of the 6 o'clock position, then lean back towards the 11 o'clock position (a back-right tilt).
Ten times in total.
In contrast the two sides. Hold stretches for 15 to 30 seconds on the tighter side.

Exercise “5-11”

Extend your left leg and move it in the direction of the five o'clock position (a forward-left tilt).
The right side of your stomach should be "CRUNCHED" while you "DROP" your right ribs towards 11 o'clock (a back-right tilt).
Ten times in total.

Exercise “1-7”  

Extend your right leg and move it in the direction of the 7 o'clock position (a forward-right tilt).
The left side of your stomach should be "CRUNCHED" as you "DROP" your left ribs towards 1 o'clock (a back-left tilt).
Ten times in total.


Pelvic Clock Strengthening Exercises

keeping the flat surface of the device perfectly parallel to the floor

Balance on Heels 

Stretch your arms up. Hands aligned with shoulders.
 Lift the soles of your feet up and try to balance on your heels. 
Take five deep breaths, as you balance in this position, keeping the flat surface of the device perfectly parallel to the floor. 
Repeat 5 times.

Balance on One Heel 

Stretch your arms up. Hands aligned with shoulders.
 Lift the soles of your feet up and balance on your heels, keeping the flat surface of the device perfectly parallel to the floor. 
Lift your right leg up. Right knee bent at a 90 degree angle.
 Take 5 deep breaths, as you balance in this position. 
Lift your left leg up. Left knee bent at a 90 degree angle. 
Take 5 deep breaths, as you balance in this position.

Dead Bug 

Lift legs up in the air with your knees bent at a 90 degree angle. 
Stretch your arms upwards. 
Hands aligned with your shoulders. 
Take 5 deep breaths, as you balance in this position, keeping the flat surface of the device perfectly parallel to the floor. 
Repeat 5 times.

Dead Bug Moving Legs
Lift your legs up in the air with the knees bent at a 90 degree angle.
 Stretch your arms upwards. 
Hands aligned with shoulders. 
Balance in this position for a few seconds, keeping the flat surface of the device perfectly parallel to the floor. 
Stretch your right leg forward towards the 6 o'clock marker. 
Keep the leg in the air parallel to the floor. 
Take 5 deep breaths, as you balance in this position. 
Stretch your left leg forward towards the 6 o'clock marker. 
Keep the leg in the air parallel to the floor. 
Take 5 deep breaths, as you balance in this position. 
Repeat 5 times.


Exercise "3-9” with legs up
Get into position with your legs stretched upward; your knees can be slightly bent. 
Open your arms wide and lay them flat on the floor to anchor yourself. 
Tilt your hips toward the 3 o'clock marker and lower your legs 20 degrees to the left. 
Balance in this position for a few seconds before bringing your legs back up to center. 
Now tilt your hips toward the 9 o'clock marker and lower your legs 20 degrees to the right. Balance in this position for a few seconds before bringing your legs back up to center. 
Repeat 10 times on each side


Dead Bug Moving Legs Diagonally
 Lift your legs up in the air with slightly bent knees. 
Stretch your arms upwards. 
Hands aligned with shoulders. 
Balance in this position for a few seconds, keeping the flat surface of the device perfectly parallel to the floor. 
Stretch your right leg forward to the right towards the 7 o'clock marker. 
Keep the leg in the air parallel to the floor. 
Take 5 deep breaths, as you balance in this position. 
Stretch your left leg forward the left towards the 5 o'clock marker. 
Keep the leg in the air parallel to the floor. 
Take 5 deep breaths, as you balance in this position. 
Repeat 5 times.

Bridge for Gluteus Medius 
Lie down with your knees bent.
 Place the flat surface of the Pelvic Clock® Exercise Device on the floor between your feet. Turn the soles of your feet inward and wrap them around the round surface of the device. Mimic squeezing a huge orthotic arch support between your feet.
 Keep your knees apart with your weight on the outer sides of your feet. 
Lift your pelvis off the floor. Hold the bridge for 5 seconds. 
Return to the starting position. 
Repeat 10-20 times

NON-CONSERVATIVE MANAGEMENT

Joint fusion
 Although surgery is rarely used to treat sacroiliitis, fusing the two bones together with metal hardware can sometimes relieve sacroiliitis pain




 

 
















 













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