PELVIS AND SACROILIAC JOINT

CHAPTER NINE PELVIS AND SACROILIAC JOINT





INTRODUCTION


The pelvis is a uniquely devised mechanism designed to transfer the body weight from the single weight-bearing axis of the trunk to the bipolar weight bearing of the lower extremities. The spine attaches to the pelvis by a single connection to the sacrum. Weight transfers through the bony ring of the pelvis from the spinal column to the two lower extremities. Enclosed within the pelvis are the bladder, the female genitalia, the rectum, and the great vessels and nerves that extend to the lower extremities.


Narrow, closely fitted, irregularly shaped, and cartilage-covered surfaces of the posterior and internal ilium and the lateral border of the sacrum form the sacroiliac articulation. The lumbosacral trunk lies anteriorly in direct relationship to the sacroiliac articulation. An inflammatory neuritis is a common accompaniment of sacroiliac arthritis. The anterior ligaments are thin and easily distended by intraarticular swelling.


The upper two thirds of the joint are covered posteriorly by the posterior end of the ilium. The lower third of the joint is covered by the sacroiliac ligaments but can often be palpated in thin individuals.


The conditions that affect the sacroiliac joints are those that involve any joint. The sacroiliac articulation is a favored site for tuberculous infection and is often the starting point for ankylosing spondylitis. Degenerative arthritic changes are often significant at this joint.





TABLE 9-2 PELVIS AND SACROILIAC JOINT CROSS-REFERENCE TABLE BY SYNDROME OR TISSUE





















Fracture Iliac compression test
Lumbosacral syndrome


Pyogenic sacroiliitis Knee-to-shoulder test
Sacroiliac disease














Sprain










Subluxation









The stability of the sacroiliac joint lies in the nature of its articular surfaces and ligaments. Cardinal in this role are the dense, interosseous ligaments lying dorsal to the joint and the ventral sacroiliac ligament covering its anterior aspect.


In ankylosing spondylitis, the patient complains of spinal pain and stiffness. The sacroiliac joints are affected initially; increasing loss of spinal mobility can lead to loss of the lumbar lordosis.


A common tender fatty nodule in the sacroiliac area is sometimes called the episacroiliac lipoma or back mouse. In this instance, fatty tissue herniates through the normal deep fascia and become edematous and a source of pain. Clinically, the patient complains of pain in the tender nodules that are palpable and often bilateral. The mass is usually palpable as a mobile soft tumor that slips beneath the examining finger. Such a lipoma mass must be differentiated from the peripelvic serosanguineous cyst.





ESSENTIAL MUSCLE FUNCTION ASSESSMENT


The gluteal and erector muscles aid in stabilizing the spine and provide extension. To evaluate functional strength in spinal extension, the examiner places the patient in a prone position. The patient raises one arm out straight in front and simultaneously lifts the leg on the opposite side out straight. The patient holds this position for 5 to 10 seconds, and the examiner notes any fatigue or inability to gain a healthy contraction, especially on the side of the leg lift. This side activates the hip and spinal extensor mass. The patient repeats the exercise on the opposite side, and the examiner compares the observations.






ANTERIOR INNOMINATE TEST



ALSO KNOWN AS MAZION PELVIC MANEUVER



Assessment for Unilateral Forward Displacement of the Ilia on the Sacrum



Comment


Many cases of acute low back pain that are not correctly identified evolve into a chronic spinal problem with significant disability at the muscular level (Table 9-4). Muscular fixation alone can be the cause of spinal joint dysfunction.


TABLE 9-4 LUMBOPELVIC SYNDROMES





















Diagnosis Site of Complaint
Quadratus lumborum syndrome Gluteal region, anterior iliac spine, greater trochanter of femur
Gluteus maximus or medius syndrome Sacral and gluteal region, lateral hip
Gluteus minimus syndrome Lateral hip, thigh, and calf
Chronic lumbar strain (spinal erector muscles) Laterally to ribs, caudally toward lumbosacral junction
Piriformis syndrome Sacroiliac region; posterior hip, thigh, calf; possibly sole of foot

Adapted from Brier SR: Primary care orthopedics, St Louis, 1999, Mosby.









Jun 5, 2016 | Posted by in ORTHOPEDIC | Comments Off on PELVIS AND SACROILIAC JOINT

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