User:CindyC78/Sacroiliac Joint Dysfunction

Sacroiliac Joint Dysfunction

Sacroiliac Joint Dysfunction or SI Joint Dysfunction is a condition in which the joint is locked, partially dislocated or "subluxated" (see "subluxation") in a non-anatomically correct position due to hypermobility (too much movement) or hypomobility (too little movement) within the joint. Sacroiliac Joint Dysfunction is commonly characterized by low back and gluteal pain and may be accompanied with referred groin, hip, and sciatic leg pain (see "sciatica"). The condition can affect one sacroiliac joint (left or right), or both joints. The degree of pain and disability due to the condition can vary widely, from an occasional discomfort that limits certain activities to severely debilitating. It is reported to affect between 15% and 38% of the general population, with women being affected over men, 3 or 4:1. In spite of these statistics, many patients with SI Joint Dysfunction go years without a correct diagnosis. The sacroiliac joints are often overlooked as a causative role in lower back pain.

Anatomy and Physiology of the Sacroiliac Joints
see "sacroiliac joint" for an explanation of the anatomy and physiology of the sacroiliac joint and associated ligaments.

Common Symptoms
Common symptoms include lower back pain, buttock pain, sciatic leg pain, groin pain, hip pain (for explanation of leg, groin and hip pain, see referred pain), urinary frequency, and "transient numbness, prickling, or tingling". Symptoms worsen during prolonged sitting, walking or lying, bending forward, stair climbing, and rising from a seated position. Pain is reported to increase during sexual intercourse and menstruation in women (Sims 2004, p. 11). Like with other chronic pain conditions, patients severly affected by Sacroiliac Joint Dysfunction often suffer from insomnia and depression (Issac & Devine 2008, p. 268).

Hypermobility
Sacroiliac Joint Dysfunction is sometimes referred to as "sacroiliac joint instability" or "sacroiliac joint insufficiency" due to the lack of support the once strong and taut ligaments can no longer sustain. When the joint is hypermobile or loose, it is classified as an extra-articular dysfunction because abnormal joint movement and alignment is a consequence of weakened, injured, or strained ligaments, while the joint itself is structurally normal and healthy. The joint itself will not show degenerative changes, such as arthritis, until many years of the dysfunction being allowed to continue (Lippitt AB, p.588-589). Injury to the ligaments that hold the sacroliliac joints in proper support is usually caused by a torsion or a high impact injury (such as an automobile accident) or a fall, resulting in the hypermobility. The joint which was once able stabilized by the strong ligaments becomes overly stretched or torn, allowing the joint to move beyond its normal range. This results in the ilium and sacral surfaces locking in an incongruent fashion causing pain that can be debilitating (Lippitt AB, p. 589). Hormone imbalances, particularly that associated with pregnancy and the hormone relaxin, can also cause a ligamentous laxity that results in the weakening of the sacroiliac structure. During pregnancy, relaxin serves as nature's way of allowing the female pelvis to achieve distention of the birthing canal. Pelvic joint pain in post pregnancy women is thought to be derived from the inability of the stretched out ligaments to return to normal tautness.

Hypomobility
Hypomobility (too little movement) of the sacroiliac joint is an intra-articular disorder in which the joint locks due to wearing down with age or degenerative joint disease. Hypomobolity of this kind can also occur with an inflammatory disease such as ankylosing spondylitis or rheumatoid arthritis, or an infection.

Diagnosis and Testing
The gold standard for diagnosis of sacroiliac joint dysfunction is a local anaesthetic block performed under fluoroscopy or CT-guidance. This relatively simple test is administered by injecting an anaesthetic, such as Lidocaine Hydrochloride, into the painful area of the sacroiliac joint. The diagnosis is confirmed when the patient reports relief from pain. The patient/doctor may decide to administer a corticosteroid at the same time the anaesthetic is injected into the painful sacroiliac joint for prolonged pain relief since the anaesthetic provides only temporary relief.

Controversy within Medical Community and Treatment in History
debate of movement of joint, lack of ability to diagnosis due to not showing up in imaging, role in low back pain, onset of discogenic problems.