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dysfunction
Sakunrat Sarikit, MD.
REFERENCES
SCOPE
01 04
Introduction History
02 05
Anatomy Physical examination and
special test
03 06
Diseases of Sacroiliac joint Treatment
SI joint dysfunction
Outer group
inner muscle group anterior-posterior superficial group
Stability at the SI joint
Determined by three factors
Motor control
Form closure: close packed position
intrinsic factors joint shape, friction of the joint surfaces, and integrity of the
ligaments
Force closure: loose packed position
extrinsic factors muscles and neurological control (forces applied to the joint)
Neutral pelvis
Get into the “neutral pelvis” position?
Hold the “neutral pelvis” statically
while moving distal joints dynamically?
Hold the “neutral pelvis” when moving it dynamically?
Pregnancy
Psychosocial issues
PHYSICAL EXAMINATION
Assessment of musculoskeletal and neurologic test
(low back, hips, and pelvis)
exclude other common diagnoses
Gait
ROM, Leg length
Muscle atrophy : gluteal, lower extremities
Palpation of the bony structure, subcutaneous tissues, muscles, and
ligaments
Neurologic exam
PELVIC ASYMMETRY
ASIS , iliac crest, PSIS, gluteal folds, ischial tuberosities
ASIS and PSIS are higher than other side
upslip of the ilium on sacrum,
short leg on opposite side or muscle spasm
Sacroiliac joints :
-slightly medially and distal to the PSIS
-knee flexed to 90° and hip is passively
medial rotated
ACTIVE MOVEMENT
● SI joints do not have muscles directly control
● Stress SI joints by contraction of muscles other joints
SPECIAL TEST FOR SI JOINT
Sitting or standing
Use one finger to localize pain
Positive : twice identifies the painful
region (within 1 cm of inferomedial to
the PSIS)
SEATED FLEXION TEST
Sitting position
Places thumbs under each PSIS
Patient bends forward
Observe each PSIS and their
movement
Sensitivity : 8 % Specificity : 93 %
PROVOCATION TEST
X-rays, CT, MRI, and bone scan do not provide used for the diagnosis
Intraarticular Injection : Gold standard for diagnosis of intraarticular SIJ pain
70-80% (>75%) relief of pain is diagnostic
PLAIN RADIOGRAPH
Fluoroscopic guidance
with the use of contrast media is recommended
Complication
Pain
Local bleeding
Side effect of steroid
Complete Diagnosis of pain of SI joint
International Association Society for the Study of Pan (IASP)
3 diagnostic criteria
Postural education
MEDICATION
Acetaminophen
NSAIDs
Muscle relaxants
Improving strength
Prevent deconditioning
EXERCISE
Lumbar core muscle strength
Hip girdle flexibility
Correction of gait abnormalities
MANIPULATIVE THERAPY
Pain and muscle spasms
Not change joint alignment significantly
Approximately only 2 degrees of rotation
and 0.77 mm of translation manipulation
Complications
Pain
Bleeding
Infection
Paralysis
SURGERY
Indication