Sacroiliac Joint Dysfunction

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Sacroiliac Joint Dysfunction

Sacroiliac Joint Dysfunction (SIJD) is a condition characterized by a disruption in the normal functioning of the sacroiliac (SI) joints. This dysfunction can manifest as either excessive movement (hypermobility), reduced movement (hypomobility), or misalignment of the joints.

Causes

SIJD can arise from a variety of factors, including:

• Sprain injury to the sacroiliac joint.
• Prolonged incorrect posture.
• Incorrect lifting technique.
• Ligamentous instability due to previous or repeated trauma.
• Ligamentous instability due to hormonal factors in pregnancy.

Diagnosis

Pain associated with SIJD is typically localized over the SI joint. It may radiate to the buttock, upper lateral thigh, and in some cases, the low lumbar region, posterior thigh, and groin. The exact pattern of pain referral can vary.

Diagnosing SIJD involves a comprehensive approach:

• Patient History: Analyzing the onset, duration, and nature of symptoms.
• Physical Examination: Evaluating joint function and detecting pain patterns.
• Special Tests: Utilizing tests like the sacroiliac compression test, Gillet’s test, and Trendelenburg test to assess joint integrity and pain.

The reliability and validity of tests for SIJD have been inconsistent. Some studies have reported low sensitivity and specificity, while others suggest reasonable to good reliability and validity. Recent research indicates that combining findings from multiple sacroiliac pain provocation tests can enhance diagnostic accuracy, with one study showing a combined sensitivity of 91% and specificity of 78%.

Hormonal and physical changes during late pregnancy and the postpartum period can increase susceptibility. The classic presentation is that of a woman in the final trimester of pregnancy or in the postpartum phase. However, many now consider it more widespread in the general population.

Rheumatoid arthritis and ankylosing spondylitis have a notable affinity for the SI joint. Rheumatoid arthritis is more common in females, whereas ankylosing spondylitis, which often involves the SI joints early on, primarily affects males. Osteoarthritis, affecting both genders, should also be considered, particularly in older adults.

• Pain is most commonly experienced just medial or distal to the posterior superior iliac spine (PSIS).
• Pain may also be felt in the buttock, lower back, posterior thigh, or groin.
• Pain is often described as sharp or stabbing but can also present as a dull ache.
• Pain is typically brought on or aggravated by rising from a seated position, prolonged sitting, or climbing stairs.

• Tenderness may be present over the SI joint posteriorly.
• Functional assessment of the SI joint may reveal restricted or aberrant motion, as indicated by tests such as Gillet’s test.
• A combination of positive sacroiliac joint special tests can help confirm the diagnosis of SI joint dysfunction. These tests include:
  • Sacroiliac Compression Test
  • Sacroiliac Distraction Test
  • Gaenslen’s Test
  • Sacral Thrust Test
  • Thigh Thrust Test
  • Yeoman’s Test

If inflammatory arthropathy, such as rheumatoid arthritis or ankylosing spondylitis, is suspected, plain radiography, MRI, or CT scans may be necessary to investigate further.

Red flags for patients presenting with low back pain and lower extremity symptoms include:

• Gradual onset or worsening of radiculopathy signs and symptoms
• History of significant trauma.
• Bilateral lower extremity symptoms.
• Pronounced neurological impairment.
• Bladder or bowel dysfunction.
• Saddle anesthesia.
• Severe tenderness on palpation or severe pain during any examination procedure.
• Unexplained weight loss.
• Fever

If any of these red flags are identified during history taking or clinical examination, prompt referral for urgent medical evaluation and further investigation is essential.

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