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Si Joint Dysfunction

Si Joint Dysfunction

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Published by Parthiban.
si joint
si joint

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Published by: Parthiban. on Feb 01, 2009
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12/04/2012

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» Causes of Sacroiliac Joint Dysfunction:
- Click on the image to enlarge
» Anatomy of Sacroiliac Joint:
o
Sacroiliac joints are weight bearing joints between the articular surfaces of sacrum and ilium.
o
Sacroiliac joints are made up of iliac, sacral auricular surfaces and tuberosities [1,2,3,4,5].
Auricular surfaces from a
 synovial joint 
, with acapsule and a cavity filled with fluid.
Tuberosities, connected by a interosseous ligament,constitute a fibrous form of a
 synarthrosis
.
o
SI joint is reinforced by some of the strongest and most massive ligaments of the body.
o
Ventral Sacroiliac Ligament 
 
Assists the symphysis pubis in resisting separation or horizontalmovement of the innominate bones at the SI joint.
Palpated at
 Baer's SI point 
(Point on a line from the umbilicus to theanterior superior iliac spine (ASIS) 5 cm from umbilicus).
Stressed using transverse anterior/posterior compression pain provocation test.
Weakest among the sacro iliac ligaments.
o
 Long Dorsal Sacroiliac Ligament 
During incremental loading of the sacrum, it becomes tense during
counternutation
(base of the sacrum moves backward) and slackenswith
nutation
(opposite movement of sacrum) [6].
 
Palpated in the area directly caudal to the posterior superior iliac spine(PSIS).
o
 Interosseous Sacroiliac Ligament 
 Largest syndesmosis
in the body and functions as the major bond between the bones filling the irregular space posterior-superior to the joint.
Resist anterior and inferior movement of the sacrum.
Primary barrier to direct palpation of SIJ.
o
 Sacrotuberous Ligament 
Plays significant role in
 stabilizing against nutation
of the sacrum, andconteracting against the dorsal and cranial migration of the sacral apexduring weight bearing.
Tension increaseswith contraction of Gluteus maximus.
o
 Sacrospinous Ligament 
Along with sacrotuberous ligament, it opposes forward tilting of thesacrum on the hip bone during weight bearing of the trunk andvertebral column.
o
Function of Sacroiliac Ligaments:
Works collectively as a
 force transfer 
for the hip and trunk muscles, producing innominate and/or sacral movements, in response to inducedforces from the femur and/or vertebrae.
They also help to prevent the following:
Craniocaudal dislocation of sacrum
Anterior gapping (lateral innominate rotation)
Posterior gapping (medial innominate rotation)
Hyperflexion (posterior innominate rotation, or mutation)
Hyperextension (anterior innominate rotation, or counternutation)
» Facts regarding Sacroiliac Joint:
o
Sacroiliac Joints are
inherently stable
[7,8,9].
o
The joints are designed for 
load transfer 
[10,11] and can safely transfer enormous compressive forces under normal conditions [9].
o
The sacroiliac joints has
very little movement in non-weight bearing (average2.5 degrees rotation)
[1,12,13,14,15] and even less in
weight-bearing (average 0.2 degrees)
[16].
o
Movements of the SI joint
cannot be reliably assessed by manual palpation
, particular in weight-bearing [16,17,18].
o
Due to its anatomical makeup, intra-articular displacements within the SI joints are unlikely to occur.
o
Distortions of the pelvis observed clinically are likely to occur secondary to
changes in the pelvic and trunk muscle activity
, resulting in direcitonal strainand not positional changes within the SI joints themselves [19].
o
Pain relief from from manipulation is likely to result from
nociceptiveinhibition based on neuro-inhibitory factors and/or altered patterns of motor activity
 
[20,21].
 
o
When clinical signs of 
reduced force closure have been identified (positive Active SLR)
, the increased movement is identified at the symphysis pubis -not the sacroiliac joints [22].
o
Pain from the sacroiliac joints is located
 primarily over the joint (inferior  sulcus) and may refer distally
, but not to the low back [23,24,25,26,27,28,29,30].
o
Sacroiliac joint disorders can be
diagnosed using clinical examination
[29,31,32,33,34] which includes finding of pain primarily located to theinferior sulcus of the SI joint, positive pain provocation tests for SI joints andabsence of painful lumbar spine impairment.
o
The SI joint has many muscles that act to compress and control it (forceclosure), thereby enhancing
 pelvic stability allowing for effective load trasnfer 
via pelvis during a variety of functional tasks[7,8,9,35,36,37,38,39,40,41,42,43,44].
» Motions at Sacroiliac Joint:
Three types of motion are available to the inominate bones:
 Symmetrical Motion
- Movement of both innominates as a unitrelation to the sacrum [45,46,47,48].
During trunk flexion or bilateral hip flexion, the
 sacrumnutates
(rotates anteriorly), so that the promontory movesventrocaudally while the apex moves dorsocranially.
This motion is resisted by following structures:
Wedge shape of the sacrum
Ridges & depressions of the articular surfaces
Friction coefficient of the joint surface
Integrity of the interosseous & sacrotuberous ligaments
The
 sacrum counternutates
, or moves in opposite direction,during trunk extension or bilateral hip extension.
This motion is resisted by the long dorsal sacroiliac ligament[6].
Combination of rotation and translation is angular movement of the sacrum, during which the iliac crests move closer together while the iliac tuberosities move further apart.
Greatest amount of movement, as much as 5.6+/-1.4 mm,occurs when going from recumbent to standing and reverses indirection when moving from standing to recumbent [47].
Rotation is accompanied by translation, which results inincreased ligamentous tension and absorption of energy [49].The SI joint thereby function as
 shock absorbers
.

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