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Monday, June 9, 2014

Patient Information: What is Sacroiliac Joint Dysfunction? Shown and Explained with Color Radiology Images!

The Sacroiliac Joint is located at the base of the spine and connects the tailbone (sacrum) to the pelvis (hip bone). At this joint, the weight of the spine is transferred from the spine to the pelvis and legs. This places a considerable force on the joint. So, the Sacroiliac Joint has to act as a small shock absorber as it passes the weight from the upper part of our body on to the legs.

What is the Sacroiliac Joint?

The sacroiliac joint has synovium (joint lining)  and cartilage just like the hip and knee joints. It also has very strong connections from the sacrum (tailbone) to the pelvis (hip bone. They consist of many strands of tough ligaments, which provide stability for the joint. However, the result is that this joint does not have much mobility. In fact, it typically only moves a fraction of an inch (millimeters). A normal degree of motion is only 2-4 degrees of rotation, and perhaps 2mm of up and down movement (translation). An exception is pregnancy where the ligaments become loser and allow the pelvis to open wider to let the baby pass through the Pelvis. With age, the sacroiliac joint stiffens and can become virtually fused together.

What is the Anatomy of the Sacroiliac Joint?

Lets take a quick look at the Anatomy of the Sacroiliac Joint so we can understand a Sacroiliac Joint Dysfunction better. Here is an X-Ray converted into Color. This Image is Interactive. Just move your mouse cursor over the Image and see Interactive Image tags come alive. Each Tag displays text to explain a part of the Image.


AP Pelvis Color X-Ray Medical Image of the Sacroiliac Joints
Color X-Ray of the Sacroiliac Joints

The next Image is a Color MRI which shows you even more detail. This Image is also Interactive.

Axial Color MRI Medical Image of the Sacroiliac Joints
Interactive Color MRI showing the Sacroiliac Joints

Now that we have seen the Anatomy, lets talk about Sacroiliac Joint Dysfunction. There are several different terms which are used to describe painful Sacroiliac Joints: Sacroiliac Joint Dysfunction, Sacroiliac Joint Syndrome, Sacroiliac Joint Strain, Sacroiliac Joint Inflammation, and Sacroiliitis. We will stick with Sacroiliac Joint Dysfunction as an umbrella term.

What is Sacroiliac Joint Dysfunction?

Sacroiliac Joint Dysfunction is a painful inflammatory condition of the sacroiliac joint. This condition is most commonly due to wear and tear and repetitive injuries to the Sacroiliac Joint. Some of the common reasons for this dysfunction are uneven leg length, pregnancy, falls, favoring one leg over the other (e.g. foot, knee or hip injury), minor repetitive trauma, major trauma (Pelvic Fracture) and the development of Arthritis.
Pregnancy is a common reason to develop Sacroiliac Joint Dysfunction. This is due to the release of certain Hormones (progesterone) during Pregnancy which relax the supporting Ligaments of the Sacroiliac Joints. While this is important to allow the baby to slowly move down into the Pelvis, it can also change the Sacroiliac Joint alignment and wear. Some patients suffer from Sacroiliac Joint Pain long after pregnancy as the abnormal wear and alignment continues.
Certain types of Arthritis can specifically affect the Sacroiliac Joint causing Joint Dysfunction due to severe inflammation. Osteoarthritis, Rheumatoid Arthritis, Gouty Arthritis and Ankylosing Spondylitis are some examples. 
In rare cases, patients can develop an infection in the Sacroiliac Joints. This can be related to an infection elsewhere in the body such as a Urinary Tract Infections and Infections of the Endocardium (Heart Sac) and others. In other patients, a low function of the Immune System (HIV, Chemotherapy, etc.) can also be a reason for a Sacroiliac Joint infection.

Now lets take a look at some Images of degenerated Sacroiliac Joints. This next Image is a Color CT Scan. The Image shows how the Joints become narrow (red arrows) which causes wear and inflammation of the bones next to the Sacroiliac Joints (white). This Image is also Interactive. Enjoy learning from the Interactive Image Tags.

Axial Color CT Scan of Degenerated Sacroiliac Joints
Interactive Color CAT Scan of Sacroiliac Joint Degeneration

The next Image are Color X-Rays which show a normal and degenerated Sacroiliac Joint side-by-side. This Image is also Interactive.

AP Pelvis Color X-Ray Images of Normal and Degenerated Sacroiliac Joints
Interactive Color X-Rays of  Normal and Degenerated Sacroiliac Joints

What are the Symptoms of Sacroiliac Joint Dysfunction?

What are the common Symptoms of Sacroiliac Joint Dysfunction? Patients usually feel pain in the lower back, buttocks and hips. This pain is often worsened with stair-climbing, standing for longer periods of time, and shifting weight on one leg.

How is Sacroiliac Joint Dysfunction Diagnosed?

The common ways to diagnose a Dysfunction of the Sacroiliac Joints is through the doctor taking a medical history, performing a physical examination and obtaining Radiology Images.

The Medical History can often point towards the Sacroiliac Joints as a source of pain. Common complaints are pain in the hip and buttocks, worsened with standing and stair-climbing. However, pain from the Hip Joints and Low Back (Lumbar Spine) can cause similar complaints.

The Doctor's Physical Exam often includes specific tests which are done to rule in or rule out the Sacroiliac Joint as a source of the patient's pain. These include checking the patients leg lengths, checking the height on each side of the Hip Bone, putting pressure over the Sacroiliac Joints and specific Sacroiliac Joint Tests (FABERE's test, Gaenslen's Test, Pelvic Rock Test, Patrick's Test).

Radiology Images such as X-Rays, CT Scans, MRI Scans and Nuclear Bone Scans can also help with the diagnosis of Sacroiliac Joint Dysfunction. However, with the exception of an Infection in the Sacroiliac Joints, Radiology Images often do not show significant changes in the Joints unless the condition is long-standing and severe.

X-Rays and CT Scans show the Anatomy of the Sacroiliac Joint. The CT Scan can show the details of the Joints the best, however it uses a much larger dose of radiation compared to X-Rays. MRI Scans are not usually performed for pain from the Sacroiliac Joints. However, they can be very useful to show severe Joint inflammation and infection. Nuclear Bone Scans do not show the specific Anatomy of the Sacroiliac Joint, but can show severe inflammation and infection. Overall, X-Rays are the most commonly performed tests. Often X-Rays of the Low Back (Lumbar Spine) and Hip Joints are also done to rule them out as a source of pain.

Injections of the Sacroiliac Joints with the help of an X-Ray machine (fluoroscope, CT) can also help with the diagnosis. These injection usually deliver a Local Anesthetic to numb up the Joint. If the patient's pain is resolved with the Injection, this may help in the diagnosis. Often a small amount of Steroid is added to the Injection to give a patient longer relief.

Sometimes doctors lab tests to rule out an infection or specific form of Arthritis.

How is  Sacroiliac Joint Dysfunction Treated?

The commonly available Treatments for Sacroiliac Joint Dysfunction range from conservative ones to surgical ones.

Examples of medications used for conservative care are Anti-Inflammatory medications (NSAIDS), Pain Killers, and Muscle Relaxants. Physical Therapy (PT), Chiropractic Care, and Acupuncture can also provide relief. PT often focuses on stabilizing exercises to limit the motion of  the Sacroiliac Joint. SI-Belts are also used as a type of support brace for Sacroiliac Joint Dysfunction. Chiropractic Care can try to "realign" the Joints.
Injections of the Sacroiliac Joints can help with both the diagnosis and short-to intermediate-term relief. Here is a Color X-Ray Image of a Sacroiliac Joint Injection. This Image is interactive.

AP Pelvis Color X-Ray of a Sacroiliac Joint Injection
Interactive Color X-Ray of a Sacroiliac Joint Injection

Another minimally invasive form of treatment of pain originating from the Sacroiliac Joint is a type of "Nerve burning" procedure, called a "Radiofrequency Ablation". This procedure tries to disrupt the small Nerves which travel to the Sacroiliac Joint with targeted heat delivered by small Needles.

In recent years, a number of surgical techniques have become available to treat severe, chronic pain from Sacroiliac Joints. These types of Surgeries rely on immobilizing (fusing) the Sacroiliac Joints to eliminate pain. Since pain from Sacroiliac Joints often relates to too much motion or abnormal motion and alignment, a fusion can provide pain relief by eliminating all motion. Small metal screws or rods are placed across a diseased Sacroiliac Joint to achieve this fusion. Sometimes, bone grafts (pieces of Cadaver or Synthetic Bone) are added to provide for a future Bone Fusion.

Here is a Color X-Ray of a Sacroiliac Joint Fusion. This specific type of fusion uses small Titanium Rods which are placed through the Sacroiliac Joint from the side of the Hip Bone (Pelvis). Each Rod has a specific coating which allows the Bone around the Joint to grow to the Rod. Typically three Rods are used to achieve maximum stability for the Fusion. Either one or both Sacroiliac Joints can be treated with this Surgery. This system is called "iFuse", which is made by SI-Bone, a San Jose, California based company.

AP Pelvis Color X-Ray of a Sacroiliac Joint Fusion
Interactive Color X-Ray of a I-Fuse Sacroiliac Joint Fusion

Patients suffering from Sacroiliac Joint Dysfunction have many more options for Treatments than even 10 years ago. Overall, the Sacroiliac Joint has gained far more recognition and attention as a source of back, leg and buttock pain. Also, new surgical options like the one above provide hope for permanent solutions to this chronic pain problem.

If you enjoyed this Blog, here are some related subjects from recent MMI Blogs:

What is Sciatica? Shown and Explained with Color X-Ray and Color MRI Images

What is a Spinal Fusion Surgery of the Low Back (Lumbar Spine)? Shown and explained with Color X-Ray Images

Spinal Stenosis of the Low Back (Lumbar Spine) shown and explained with Color MRI Images

What is a "Spondylolisthesis" of the Low Back (Lumbar Spine)? Shown and explained with Color X-Ray and Color MRI Images.

Disc Herniations of the Low Back (Lumbar Spine) shown and explained with Color MRI Images

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