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Back Pain: Sacro Iliac joint problem

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#1 Mon, 08/24/2015 - 13:08
Jayantilal J. C...

Back Pain: Sacro Iliac joint problem

How do you diagnose Sacro Iliac joint problem causing pain or sasy ankylosing spondylosis, how can distinguish clinically both?
Wed, 08/26/2015 - 14:06
Hamilton Hall
Hamilton Hall's picture

re Back Pain: Sacro Iliac joint problem

Sacroiliac pain has a pattern all its own. It is buttock dominant, centered in the mid to lower section. It is constant, although the amount of pain varies much more than the typical back pattern and can go from almost absent to severe in the course of the day. The pain is least in the morning and increases during the day. It is aggravated by twisting (rolling over in bed is a common cause of pain), by walking or prolonged standing. When severe, the pain can radiate down the back of the thigh to the knee. SI pain is more common in women and is frequent during pregnancy. It can be relieved by the use of a pelvic belt. A positive response is a good diagnostic test. The physical examination includes tests that stress the SI joint. I suggest that the examiner select four (anterior gapping of the iliac crests, lateral compression, posterior pressure on the sacrum and the FABER manoeuver are fairly standard) and three of the should reproduce the patient’s typical buttock dominant pain. The diagnosis of ankylosing spondylitis is the diagnosis of Pattern 1 PEN or more commonly Pattern 2 in a young person in their 20s or 30s (the sex difference with males more likely to have the disease is no longer widely accepted) with a history of prolonged morning back stiffness. The diagnosis is made on the lack of sustained improvement with mechanical therapy and a significant temporary improvement with NSAIDs. Early in the course of the disease the diagnosis can be difficult and relates more to the recurrent clinical course and lack of anticipated response than to any single presenting symptom. I have added the question, “If you are under 45 do you have morning back stiffness lasting more than 30 minutes?” to my standard eight questions. Now there are nine.
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