Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment

Gartenberg, Ariella; Nessim, Adam; Cho, Woojin

doi:10.1007/s00586-021-06927-9

Cited by 53 publications

(41 citation statements)

References 32 publications

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“…7−9 Sacroiliac joint dysfunction is a common cause of low back pain, which usually centers around the unilateral/bilateral sacroiliac joint, but the accompanying symptoms can be complicated, depending on the adjacent structures involved. 10 The sacroiliac joints are a pair of auricular-shaped, diarthrodial joints located between the sacrum and ilium bones, linking them together and completing the pelvic ring. In addition to the bony joint structures, there are many ligaments, such as the sacroiliac, sacrotuberous, and sacrospinous ligaments, that help stabilize the largest axial joints of the body.…”

Section: Discussionmentioning

confidence: 99%

“…In certain settings, such as direct trauma to the pelvic ring, pregnancy and delivery, chronic strain, inappropriate posture/exercise, and systematic diseases, the joints can be dislocated and sacroiliac joint dysfunction (subluxation of sacroiliac joint) occurs. 10 Long-term sacroiliac joint dysfunction can lead to uneven load on the pelvic ring and cause pelvic tilt, which can lead to injury of the surrounding muscles, ligaments, and nerves.…”

Section: Discussionmentioning

confidence: 99%

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Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia caused by Sacroiliac Joint Dysfunction

Zhang

et al. 2022

Sexual Medicine

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Introduction Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) consists of persistent or recurrent unwanted sensations of genital arousal that may include other types of genito-pelvic dysesthesia, which occur without concomitant sexual interest or thoughts. There are multiple triggering factors for PGAD/GPD. Aim To report the case of a 38-year-old woman with low back pain and PGAD/GPD triggered by sacroiliac joint dysfunction. Methods The medical data of the female patient with low back pain and PGAD/GPD were reviewed and analyzed. Results Resetting of the subluxated sacroiliac joint resulted in complete remission of the patient's symptoms. Conclusion Sacroiliac joint dysfunction may be a trigger for PGAD/GPD in some cases. Lack of relevant knowledge among patients and healthcare providers is the biggest challenge of the proper diagnosis and treatment of PGAD/GPD at present.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia caused by Sacroiliac Joint Dysfunction

Zhang

et al. 2022

Sexual Medicine

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“…Patients were diagnosed with SIJ-related pain following lumbar spine surgery if they: (I) experienced pain within 2 years of surgery below the L5 spinous process, buttocks, posterior thighs and groin area, and had a SIJ score based on (i) one-finger test (3 scores), (ii) groin pain (2 scores), (iii) pain while sitting on a chair (1 score), (iv) SIJ shear test (1 score), (v) tenderness of posterosuperior iliac spine (1 score), or (vi) tenderness of sacrotuberous ligament (1 score) (24,25), the scores, ranging from 0 to 9 points, had a cutoff value of 4; (II) had no residual compression findings of the nerve roots and cauda equina on lumbar magnetic resonance imaging; and (III) had 3 or more provocation tests that were positive in 6 specialized physical diagnostic tests [i.e., the FABER (flexion, abduction, external rotation), gapping test/distraction test, compression test/approximation test, thigh thrust test/femoral shear test, Gaenslen test/ pelvic torsion test, and sacral thrust test/sacral base spring test] (26,27). If necessary, an SIJ intra-articular block was performed for patients with a difficult final diagnosis, and SIJP was diagnosed as 70% pain relief within 3 hours (28)(29)(30)(31)(32).…”

Section: Diagnosing Of Postoperative Sij-related Painmentioning

confidence: 99%

Special type of distal junctional failure exhibits pelvic incidence changes: sacroiliac joint-related pain following lumbar spine surgery

Yan¹,

Jiang²,

Zhang³

et al. 2022

Ann Transl Med

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Background: Currently, change in pelvic incidence (PI) in patients after spinal surgery have not been associated with clear clinical symptoms. This study sought to compare changes in the sagittal parameters of different patients before and after thoracolumbar spine surgery, the relationship between PI change and sacroiliac joint pain (SIJP) after surgery was clarified, and the correlation between PI change and sacroiliac joint (SIJ) activity was verified.Methods: This study retrospectively analyzed the data of patients who underwent thoracolumbar fusion at Sun Yat-sen Memorial Hospital from January 2019 to June 2021. The spinal and pelvic parameters [including pelvic tilt (PT), sacral slope (SS), PI, lumbar lordosis (LL) angle, etc.] of 409 patients with standard standing lateral radiographs before and after surgery were compared and analyzed. Postoperative follow-up of all patients with standardized SIJP assessment. The incidence of postoperative SIJP, and its correlation with sagittal parameters of the spine and pelvis, surgical methods, and the basic characteristics of patients were analyzed. The Chi-square test was used for categorical variables, the independent-sample t-test was used for generally conformed normally distributed continuous variables. Risk factors associated with the development of SIJP were analyzed using logistics regression. Correlations among SS, PI, and the 4 other sagittal parameters were analyzed using the Pearson correlation coefficient (r).Results: Postoperative PI changes tended to be larger in the lowest instrumented vertebra (LIV) (L4 and above: 1.63°; L5: 2.43°; S1: 3.83°; P<0.05) and longer fixed segment. The risk factors for SIJP included a PI >4° [odds ratio (OR) =13.051; P<0.001], LIV S1 (OR =3.378; P=0.023), and fixed total segment ≥3 (OR =2.632; P=0.038). ∆PI was significantly correlated with ∆SS in patients with non-S1 distal fixation vertebrae (R 2 =0.388; P<0.01), but no such correlation was found in patients with S1 distal fixation vertebrate. Conclusions:Changes in PI values after thoracolumbar spine surgery can correctly reflect the motion state of the SIJ. Excessive changes in PI (>4°) are similar to the mechanism of distal junctional kyphosis (DJK), while such changes make patients prone to SIJP following lumbar spine surgery.

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“…Clinical findings such as positive FABER (flexion abduction, and external rotation) test, sacroiliac joint shear test, or Gaenslen's test may point to the SI joint as a cause for hip pain ( 20 ). While no single provocation test can accurately identify pain related to SI dysfunction, positive response to 3 or more maneuvers has a sensitivity of 77%–87% ( 21 ). Additional imaging studies including MRI may be ordered if the SI joint is suspected to be a source of hip pain, as it is the most sensitive imaging technique for detecting sacroiliitis ( 22 ).…”

Section: Imbalance In Spinopelvic Alignment and Sacroiliac Pathologymentioning

confidence: 99%

Evaluation of additional causes of hip pain in patients with femoroacetabular impingement syndrome

et al. 2022

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Femoroacetabular impingement syndrome (FAIS) is an increasingly prevalent pathology in young and active patients, that has contributing factors from both abnormal hip morphology as well as abnormal hip motion. Disease progression can be detrimental to patient quality of life in the short term, from limitations on sport and activity, as well as the long term through early onset of hip arthritis. However, several concurrent or contributing pathologies may exist that exacerbate hip pain and are not addressed by arthroscopic intervention of cam and pincer morphologies. Lumbopelvic stiffness, for instance, places increased stress on the hip to achieve necessary flexion. Pathology at the pubic symphysis and sacroiliac joint may exist concurrently to FAIS through aberrant muscle forces. Additionally, both femoral and acetabular retro- or anteversion may contribute to impingement not associated with traditional cam/pincer lesions. Finally, microinstability of the hip from either osseous or capsuloligamentous pathology is increasingly being recognized as a source of hip pain. The present review investigates the pathophysiology and evaluation of alternate causes of hip pain in FAIS that must be evaluated to optimize patient outcomes.

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Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment

Cited by 53 publications

References 32 publications

Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia caused by Sacroiliac Joint Dysfunction

Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia caused by Sacroiliac Joint Dysfunction

Special type of distal junctional failure exhibits pelvic incidence changes: sacroiliac joint-related pain following lumbar spine surgery

Evaluation of additional causes of hip pain in patients with femoroacetabular impingement syndrome

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