CONA SIJ

what are SI joint syndromes?

SIJ sprain and sacroiliitis

what are the disorders of the SIJ and pelvis?

SI joint syndrome, piriformis syndrome and osteitis pubis

what is the definition of SI joint syndromes?

pain syndrome presenting with pain over 1 sacroiliac joint which may be accompanied by referred pain to the buttock, groin and leg

what are the causes of SI joint syndromes?

dysfunction or lesion to the joint

what percent of SIJ syndrome cases are from a one time event?

44%

what percent of SIJ syndrome cases are from repetitive injury?

20%

what percent of SIJ syndrome cases had idiopathic/spontaneous onset?

35%

whaat are is the kirkaldy-willis explanation of causes of SIJ syndrome?

minor dysfunction and sustained contraction of muscle overlying joint

can SI joint cause low back pain?

yes

is there a standard pain referral system for SI joint syndromes?

no

how is SI joint syndrome pain described?

local aching, burning or dull pain that can be sharp at times

when is there point tenderness or pain with SIJ syndrome?

with motion palpation

what is true of radiation of pain with SIJ syndromes?

no radiation of pain above L5

where are common places for referred pain with SIJ syndrome?

buttock, posterior or lateral thigh, groin or anterior pelvis

what are some common conditions of the SIJ?

sprain, sacroiliitis, infection, seronegative arthritides, degenerative joint disease, joint dysfunction

what are the seronegative arthritides of the SIJ?

ankylosing spondylitis, Reiter's, psoriatic

what are the 7 examples SIJ orthopedic tests?

Gaenslen's test

Lewin-Gaelen's test

Yeoman's

Nachlas

Pelvic Rock

Hibb's

Sign of the Buttocks

how is the distraction/compression test performed?

patient is supine. pressure is applied first in a posterior and lateral (compression) direction on ASIS simultaneously and then is applied in an anterior and medial direction of the ASIS (distraction)

how is a sacral thrust test performed?

patient is prone, examiner delivers an anteriorly directed thrust/pressure directly over the sacrum to reproduce SI pain

what is the management of SIJ syndromes?

CMT, prolotherapy, stabilization and rehabilitation exercises, changing postures and avoid prolonged activities

what is prolotherapy?

inject sclerosing agent to tighten SI ligaments

what muscles need to be stabilized/rehabilitated to manage SI syndromes?

glute medius, glute max, abdominals, QL, iliopsoas, rectus femoris and hamstrings

how does an SIJ sprain present?

sharp, stabbing pain over SIJ that may radiate down the leg or into the groin as a dull ache

what is the MOI of an SIJ sprain?

following lifting an object, straightening up from stooped position, or repeated stoop/stand, patient with ligamentous laxity

what is the examination for SIJ sprain?

any procedure or activity that induces SIJ extension, compression, or distraction may be provocative. tenderness to direct palpation

what is the management of SIJ sprains?

SIJ belt, cautious CMT, ice, core stabilization

what is sacroiliitis?

inflammation of the SIJ

what is piriformis syndrome?

buttock pain with or without sciatic nerve pain secondary to injury or contracture of the piriformis muscle

what may piriformis syndrome mimic?

radiculopathy

what are the possible pain patterns of piriformis syndrome?

groin, posterior thigh into calf and ankle and foot

what can exacerbate piriformis syndrome pain?

activity, bowel movement, prolonged sitting, or rise from seated position

what is the origin of the piriformis?

anterior surface of the lateral sacrum and sacrotuberous ligament

what is the insertion of pirifromis?

greater trochanter

where does the sciatic nerve pass in regards to the pirifromis muscle?

below piriformis or through muscle or divided through and above/below

what are the causes of pirifromis syndrome?

SIJ dysfunction, trauma, prolonged sitting postures or activities requiring internal rotation of leg with flexion

what are the palpation findings of piriformis syndrome?

tenderness on muscle O and I, SIJ restriction is likely

what are the ROM findings of piriformis syndrome?

often full L/S motion and hip motion with pain on internal rotation and flexion

what passive ROM will exacerbate pirifromis syndrome pain?

internal rotation

what orthopedic tests will be positive for pirifromis syndrome?

pirifromis test, friebergs

what are the differential diagnoses for piriformis syndrome?

disc, stenosis, facet syndrome, tumor, endometriosis

What is osteitis pubis?

inflammation of pubic symphysis

what population is osteitis pubis prevalent in?

athletes

what is the etiology of osteitis pubis?

acute trauma, genitourinary infection, pelvic surgery, pregnancy, arthritic conditions

what are the S&S of osteitis pubis?

ache or tenderness on palpation, pain with passive abduction or resisted adduction

what are the imaging characteristics of osteitis pubis?

characterized by sclerosis and bony changes of the pubis symphysis seen on x-ray

what is the management of osteitis pubis?

rest and time, modalities including heat and ice may provide symptomatic relief