Sacroiliac Joint

Clinically, the sacroiliac joint cannot be palpated directly due to its anatomic location. The sacrum is mechanically associated with the spine, whereas the innominate is aligned with and affected by movement of the femur. Crucial Realities

During ambulation the S1Js decrease the effort of ambulation and absorb shear forces to protect the disks and to decrease the effects of impact-loading on the femoral heads. Weight is transmitted to the sacrum via the lumbosacral junction (fifth lumbar vertebra and lumbosacral disk to the first sacral segment), distributed equally along the alae of the sacrum, and transmitted through the S1Js to the acetabulum and hence to the lower limbs. The force of the body weight tends to separate the sacrum from the ilia and tends to push the first sacral segment into flexion (nutation). Crucial Realities

The pelvis can move in all three body planes: in the sagittal plane during forward- and backward-bending, in the coronal plane during side bending (lateral flexion), and in the axial plane during twisting of the trunk. Middle transverse axis (located at the second sacral body). This is the principal axis of normal sacroiliac flexion and extension (nutation/counternutation) In osteopathic medicine, the SIJ is often described as two joints: the iliosacral and the SIJ. The term iliosacral implies the innominates moving on the sacrum; conversely, the term sacroiliac implies the sacrum moving within the innominates. Crucial Realities

Kinematics of the SI Joint Principal SI joint axis is in the transverse plane at the S2 level. The SI joint is unique in that its range of movement is extremely small and there are no muscles that directly produce active motion at this joint. In effect, SI joint movements are passive and occur in response to the loads it must transmit and the stresses it must relieve. The SI joint has two principle motions, nutation and counter nutation. Kinematics of the SI Joint

NUTATION/COUNTER NUTATION During nutation, the sacral promontory moves anteriorly and inferiorly and the coccyx moves posteriorly. During counter nutation, the sacrum moves in an opposite direction with the sacral promontory moving posteriorly and superiorly and the coccyx moving anteriorly. NUTATION/COUNTER NUTATION

Contents Introduction Examination and Treatment Techniques When Applicable Tests Examination and Treatment Techniques Subjective Examination Areas of the symptoms Opening the Anterior and Posterior Surfaces Behavior of Symptoms Special Questions Further Tests History Palpation Physical Examination Treatment Techniques Observation The Symphysis Pubis Treatment Movements

Introduction The sacroiliac joint has a diverse and extensive innervation from L2 toS4. Needs DD because of complexity of the joint It needs series of relevant findings to announce the Sacroiliac joint as source of the symptoms Most patients with pain in the sacroiliac area do not have sacroiliac disorder. The pain is usually referred from the lumbosacral spine

Subjective Examination Areas of the symptoms Behavior of Symptoms Special Questions History

Subjective Examination True involvement usually found in 2nd and 3rd decade Elderly: Prostate Tumor Jabs of Pain with certain activities

Areas of Symptoms True Sacroiliac joint strains or sprains are unlikely to produce the symptoms that crosses midline. Bilateral Sacroiliac joint in the absence of pregnancy and inflammatory disorders is referred from spine Pain in the groin Inside the leg or under the testicles in men Tenderness over the symphysis pubis Crepitus, shearing inside the joint during walking

Behavior of Symptoms Painful Weight bearing during weight transfers Disabling pain, even can’t get out of the bed In acute phase unable to distinguish from lumbar spine and hip Night pain with prolonged morning stiffness can be a red flag Patients with SIJ strain often flex their hips or flatten their back against a wall for relief The hip may felt out of place Heaviness of the whole leg

Special Questions Genitourinary Bowl and Bladder Saddle Anaesthesia

History Common in pregnancy Repeated in sports activities like cricket, football, Disturbed pelvic postural alignments

Physical Examination Observation Movements When Applicable Tests

Observation Prominence of the Posterior and Anterior Iliac Spine, greater trochanter Any change in the gluteal and abdominal musculature should be noted

Movements Sacroiliac joints should be functionally tested along with lumbar spine and hip Quality of the movements should be recorded

When Applicable Tests Neurodynamics tests SLR SLUMP Exclusion of the hip and spine also plays an integral part of the examination of the pelvis region

Examination and Treatment Techniques Opening the Anterior and Posterior Surfaces Further Tests Palpation Treatment Techniques

Opening the Anterior and Posterior Surfaces Opening Anterior Surfaces Opening Posterior Surface Direct Pressure over the Sacrum and the Ilium

Further Tests

Palpation Soft Tissue Changes Buttocks ASIS PSIS Abdominals

Treatment Techniques

The Symphysis Pubis

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