Sacroiliac joint pain

Pain in the sacroiliac joint often occurs when lifting the weight in an uncomfortable position, with tension in the joint, supporting ligaments and soft tissues. Sacroiliac joint (joint is also susceptible to the development of arthritis in various diseases that damage articular cartilage.Osteoarthritis is a common form of arthritis that leads to pain in the sacroiliac joint: rheumatoid and post-traumatic kartritis is also a frequent cause of pain.Smaller causes of ankylosing spondylitis, infections and Lyme disease.Collagenous diseases are more polyarthropathies than monoarthropathies limited to the sacroiliac joint, although the pain from the cross of the iliac joint in ankylosing spondylitis responds extremely well to intraarticular injections described below.Sometimes, patients experience iatrogenic dysfunction of the sacroiliac joint caused by traumatic bone graft removal.

[1], [2], [3]

Symptoms of pain in the sacroiliac joint

Most patients with pain in the sacroiliac joint complain of pain around the joint and in the upper part of the leg that radiates to the buttocks and back of the foot; pain never spreads below the knee. Movement increases pain, while peace and warmth bring relief. The pain is constant, it can disturb sleep. The affected sacroiliac joint is painful on palpation. Patients often spare an affected leg and lean into a healthy side. Often there is a spasm of the lumbar axial musculature that limits movement in the lumbar region in the straightened state, and improves the necessary relaxation of the femur biceps in the sitting position. In patients with pain from the sacroiliac joint, the pelvic swing test is positive. For this test, the investigator puts his hands on the crests of the iliac bones and thumbs on the anterior superior iliac spine and then forces the pelvic wings to the middle line with effort. A positive test is characterized by the appearance of pain in the area of the sacroiliac joint.

Clinical features of pain in the sacroiliac joint

Lesions of the sacroiliac joint from other injuries of the lumbar spine can be distinguished by asking the patient to lean forward in the sitting position. Patients with sacroiliac pain do this relatively easily due to relaxation of the biceps femoris at this position. In contrast, patients with lumbar vertebral pain experience an increase in symptoms when they tilt forward in the sitting position.

The injection described is quite effective in treating pain in the sacroiliac joint. Existing simultaneous burtsch and tendinitis can increase pain in the sacroiliac joint, which requires additional treatment with more local injections of local anesthetics and methylprednisilone.

Injection into the sacroiliac joint is performed in the prone position, the skin over the joint is treated with an antiseptic solution. A sterile syringe with 4 ml of 0.25% preservative-free bupivacaine and 40 mg of methylprednisolone is connected to the needle in a sterile manner. Find the posterior upper tip of the ilium. At this point, gently move the needle through the skin and subcutaneous tissue at an angle of 45 degrees in the direction of the affected joint. When ingested in the bone, the needle is removed into the subcutaneous tissues and again directed higher and slightly laterally. After penetrating the joint, carefully insert the contents of the syringe. There should be little injection resistance. If there is significant resistance, the needle is probably in the ligament and should be moved slightly into the articular region until the injection comes without significant resistance. Then the needle is removed, a sterile dressing and cold are applied to the injection site.

Physiotherapy, including thermal procedures and light exercises, should begin several days after the injection. Excessive physical exertion should be avoided, as they will exacerbate symptoms.

[4], [5], [6], [7]

Examination

X-ray examination is shown to all patients with pain in the sacroiliac joint. Since the sacrum is susceptible to traumatic fractures, the development of both primary and secondary tumors, the MRI of the distal lumbar region and the sacrum is indicated if the cause of the pain is not clear. Such patients can perform radionuclide bone examination (scintigraphy) to exclude tumors, incomplete fractures, which can be missed with conventional radiography. Based on clinical manifestations, additional tests can be performed, which include a general blood test, ESR, the determination of HLA B-27 antigen, antinuclear antibodies and blood biochemistry

[8], [9]

Differential diagnosis

Pain originating from the sacroiliac joint can be mistaken for myogenic pain, lumbar bursitis, inflammatory arthritis and lesions of the lumbar spine, roots, plexus and nerves.

[10], [11], [12], [13], [14], [15]

Treatment of pain in the sacroiliac joint

The initial treatment of pain and impaired function in the sacroiliac joint includes a combination of NSAIDs (eg, diclofenac or lornoxicam) and physiotherapy. Local application of heat and cold may also be beneficial. Patients who do not respond to this treatment are shown as the next step - the injection of local anesthetics and steroids.

Complications and Diagnostic Errors

The injection technique is safe with a good knowledge of anatomy. For example, if the needle is inserted laterally, it can damage the sciatic nerve. The main complication of intra-articular injection is an infection that, with strict adherence to aseptic rules and universal precautions, is extremely rare. The appearance of ecchymoses and the formation of hematomas can be reduced by squeezing the injection site immediately after it is carried out. Approximately 25% of patients complain of transient pain enhancement after intra-articular injection, they should be warned about this.

[16], [17], [18]