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Thursday, December 19, 2013

Patient Education Article: Sacroiliac Joint Dysfunction - Part II

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                                     Sacroiliac Joint Dysfunction - Part II




How do Spine Specialists make the diagnosis of Sacro-iliac Joint Dysfunction?


Spine specialists use the information from the patient history, physical examination, and special tests to make this diagnosis:


The Image is an Interactive Image. Move your mouse cursor over the Image and see the Interactive Tags come to life. Each tag displays text to explain a specific part of the Image.


1.     History
In severe and acute cases of sacriliitis, a patient will come to the doctor with fevers and severe pain in the low back/buttock area. They will often have a strong limp, and very little mobility of the hip. These patients may have a recent history of infection.
With the more chronic type of sacroiliac joint dysfunction, the patient will complain of nagging pain in the low back/buttock area and have a difficult time with stair climbing or standing. Some of these patients will have a history of trauma to the pelvis, a type of arthritis, or previous pregnancy.
 
 
2.     Physical Examination
Here are some physical examination techniques the doctor might use to help make a diagnosis:

o   Looking at the spine and pelvis to look for areas of swelling, redness or asymmetry (inspection)
o   Measure the length of each leg
o   Look at the height of the top of each hip bone (iliac crest)
o   Touch and pressure over the sacroiliac joint (palpation)
o   Gaenslen’s test
o   FABERE’s test
o   Patrick’s test
o   Pelvic Rock test
 
3. Imaging
a. X-Ray
X-Rays will show the sacroiliac joints. However, they often will not show a problem with the joint until a sacroiliac joint dysfunction or sacroiliitis is very advanced. It can take 10 years or more for that to be the case.
This Color X-Ray Image shows the Sacroiliac Joints in white. They are located between the Pelvis (Hip Bone) and the Sacrum (Tail Bone).
 
b. Cat Scan

CT-Scans can show the anatomy of the sacroiliac joint very clearly and with better quality than an X-Ray. However, similar to X-Rays it may not show a problem until it is advanced. The CT scan also does not show inflammation in the joint.

This Image is a Color CT Scan showing the Sacroiliac Joints
 
 
c. MRI Scan

MRI scans can show swelling and inflammation in the joint when special MRI images are taken. These are called STIR (Short Tau Inversion Recovery) images and those taken with intravenous contrast (Gadolinium). Both can show inflammation in the Sacroiliac Joint.

d. Nuclear Bone Scan

A nuclear bone scan can show severe inflammation in the form of activity in the joint. However, bone scans are usually not taken for sacroiliac joint dysfunction.

e. Diagnostic Injection

To diagnose a sacroiliac joint dysfunction or sacroiliitis, a doctor can inject the joint with the help of an X-Ray machine. Often a local anesthetic combined with an anti-inflammatory medication such as a steroid is injected. The patient is then evaluated for pain relief.

f. Laboratory Tests

Sometimes doctors will use lab tests to find a cause of sacroiliitis. Here are some possible examples:

-   Complete Blood Count with differential (CBC with Diff):
 This is a blood test which looks for elevated White Blood Cells and other more specialized cells (i.e. Neutrophils) which can be elevated in infection.
- Sedimentation Rate (Sed. Rate):
This blood test looks for severe inflammation.
- C-Reactive Protein (CRP):
This test also looks for severe inflammation.


How is Sacroiliac Joint Disease Treated?

1.     Non-Surgical Treatments

a.     Alternative Health Care
Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition.

b.     Nutrition and Weight Loss
Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

c.      Chiropractic Care
Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

d.     Spine Exercises
Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.
 
e.     Physical Therapy (PT)
PT has many modalities to offer for this condition. They can range from Manual Therapy to Exercises and Ultrasound Treatments. Mobilizing the joint and strengthening the muscles around the joint are frequent ways Physical Therapists will treat sacroiliac joint inflammation. Joint mobilization techniques can be manipulation, stretching and exercises.
 
f.       Self Help Tools
Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. A specific Sacroiliac Belt is also available.
 
g.     Spine Medications

          i.      NSAIDS (Non-Steroidal Antiinflammatory Medications)

         ii.      Steroids

         iii.      Pain Killers

        iv.      Muscle Relaxants

        v.      Antidepressants

       vi.      Topical Medications
 
 
 
h. Injections
 
Here are some commonly offered injections for chronic Sacroilieitis:
 
o   Sacroiliac joint injection

o   Sacroiliac Joint Radiofrequency Ablation
 
 
2. Surgical Treatments 
 
 
In very severe and chronic cases of a sacroiliac joint dysfunction
or  sacroiliitis, surgery can be performed. The surgery relies on
permanently immobilizing the joint. There are sacroliliac joint fusion
techniques available:
 
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General Disclaimer


Medical Media Images does NOT dispense medical or legal advice. Our images, text and any content cannot be used for diagnosis or treatment of a medical condition. All Images and content are for information purposes only. You must consult with your physician if you need medical advice. Medical Media Images is not a substitute for medical advice. 


 
 


 
 
 
 
 

 
 
 

 
 

 
 
 
 
 

 





 








 
 
 
 
 
 
 
 
 
 





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