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sacroiliitis

Evaluation and Treatment of Sacroiliac Joint Dysfunction in the Primary Care Setting: A Practical Review

Teaser: 

Sydney Rucker, BS, 1 Adrienne Kelly, MD, FRCSC,2 David W. Polly, MD,3Robert J. Ferdon, MS,4 Robert A. Ravinsky, MDCM, MPH, FRCSC,5

1Medical University of South Carolina College of Medicine, Charleston, SC.
2 Orthopaedic Surgeon, Sault Area Hospital, Assistant Professor, Northern Ontario School of Medicine, Sault Ste Marie, ON.

3 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.

4 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, University of South Carolina School of Medicine, Columbia, SC.

5 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC.

CLINICAL TOOLS

Abstract: Mechanical dysfunction of the sacroiliac joint (SIJ) is an often overlooked, but a common cause of low back pain in the North American adult population. The diagnosis is primarily clinical and requires the exclusion of other potential etiologies of low back pain (LBP). A number of non-surgical treatment options are available for patients with this pathological entity. In cases of persistent, severe SIJ pain refractory to non-operative measures, SIJ fusion may be considered as a surgical intervention.
Key Words: sacroiliitis, sacroiliac dysfunction, sacroiliac joint (SIJ), low back pain (LBP), gluteal pain, SI joint fusion, percutaneous SI joint fixation.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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Pre-test CME Quiz Post-test CME Quiz
1. The SI joint is a known contributor to low back pain
2. Non-surgical treatment remains the primary management approach for SIJ dysfunction
3. Diagnostic intra-articular injections performed under image guidance are considered the gold standard for confirming SIJ-mediated pain
4. For patients with clinically debilitating mechanical SIJ dysfunction who have failed an exhaustive course of non-operative treatment, surgical options may be considered
1. SIJ dysfunction is a known contributor to low back pain, accounting for approximately 15-30% of LBP cases in the outpatient setting.
2. While imaging plays a role in excluding alternative diagnoses, no imaging modality has demonstrated reliable diagnostic utility for mechanical SIJ dysfunction although there is some utility of MRI in the setting of inflammatory sacroiliitis.
3. Patients with SIJ pain typically report symptoms consistently localized to an area within 1cm inferomedial to the posterior superior iliac spine (PSIS) that may radiate into the buttocks, groin, posterior thigh or even past the knee and into the foot.
4. Diagnosis is by physical examination which should include a variety of SIJ-specific provocation tests. Three or more positive results out of five standardized maneuvers is supported by Level 1 evidence for a Clinical Diagnostic Rule.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, sacroiliitis, sacroiliac dysfunction, sacroiliac joint, low back pain, gluteal pain, SI joint fusion, percutaneous SI joint fixation

Ankylosing Spondylitis and Spinal Fractures

Teaser: 

Andrew Kanawati, BSc, MBBS MSc (Hons) UNSW Mast Anat (UNE) FRACS (Orth),1Nicolas Dea, MD, MSc, FRCSC,2Parham Rasoulinejad, BHSc, MD, FRCSC, MSc, 3Christopher S. Bailey, MD, FRCSC, MSc,4

1 Clinical Fellow, London Health Sciences Centre Spine Program, London, ON.
2Spine Surgeon, Clinical Associate Professor of Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, BC.
3 Assistant Professor, Department of Surgery, Division of Orthopaedic Surgery, Schulick School of Medicine and Dentistry, The University of Western Ontario, London, ON.4 Orthopaedic Surgeon, Division of Orthopaedic Surgery, London Health Sciences Center, and Associate Professor, Dept. of Surgery, University of Western Ontario, London, ON.

CLINICAL TOOLS

Abstract: Ankylosing spondylitis is a seronegative spondyloarthropathy associated with HLA-B27. The main site of pathology is the enthesis (site of tendon insertion). The axial skeleton is affected primarily, with the sacroiliac joints initially involved, with the enthesopathy resulting in fibrosis, calcification and fusion of the sacroiliac joints and spine. There is a high incidence of spine fractures in patients with AS, and there is a high rate of missed fractures, therefore advanced imaging in the form of CT and/or MRI is necessary. Due to their highly unstable nature, surgical management of spine fractures in AS is preferable to non-operative care.
Key Words: Ankylosing spondylitis, spondyloarthropathy, sacroiliitis, spine fracture.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
The spine and sacroiliac joints are the primary site of pathology in AS.
The natural history of the disease causes eventual fusion and kyphosis.
Spinal fractures occur at a higher incidence in AS compared to general population.
There is a high rate of missed fractures, and secondary neurologic complications.
Advanced imaging (CT and/or MRI) is mandatory to rule out fracture, because of high false-negative results of plain radiography.
The patient’s kyphosis must be taken into account when applying full spine precautions for suspected fracture.
Patients must not be forced into extension as this may shift an initially non-displaced fractures.
Loss of flexibility and ankylosis of the spinal column results in long lever arms and behavior akin to a long bone, therefore fractures of the spine are highly unstable and usually require surgical stabilization.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, Ankylosing spondylitis, spondyloarthropathy, sacroiliitis, spine fracture
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