30/01/2021
SI JOINT DYSFUNCTION
/Diagnosis , Rehabilitation /
SI joint is an L-shaped articulation between sacrum and ilium
° Anteriorly: synovial joint
° Posteriorly: syndesmosi
• SI joint dysfunction is uncommon and over-diagnosed
• Etiology is idiopathic; associated with following risk factors:
° Fall
° Leg-length discrepancy
° Prior lumbar fusion
° Pregnancy
Symptoms :
• Low back pain, typically below L5
° Infero-lateral to sacral sulcus
• Gluteal pain, typically below L5 extending to gluteal fold.
• Variations in pain referral; lower extremity pain (including foot)—
excluding other etiologies
° Worse with prolonged sitting, standing, ascending stairs, running (large strides), extreme postures
Physical Exam :
—thorough exam of low back, hips, pelvis, to rule out
other diagnoses.
• Inspection: Increased lumbar lordosis. Evaluate posterior superior
iliac spine, anterior superior iliac spine, gluteal folds, p***c tubercules, ischial tuberosities, medial malleoli (to assess pelvic symmetry); muscle atrophy in gluteal muscles, distal extremities.
• Palpation: tenderness to affected SI joint
• ROM: dependent on degree of pain, can range from limited to full
PROM
• Reflex: Normal
• Strength: Normal
• Sensation: Normal
• Measure leg-length
• Provocative Maneuvers:
° Gaenslen Test—Patient supine; laying close to edge of table
▪️ Knee is flexed
▪️ Contralateral leg (proximal to edge of table) is dropped off
table causing hyperextension of hip
▪️ Pain is reproduced in SI joint dysfunction
° Sacral sulcus tenderness
▪️ Apply pressrure to gluteal region
▪️ Reproduction of pain medial to posterior superior iliac spine
is suggestive of SI joint disfunction
▪️ High rate of false positives (seen in axial pain, radicular
pain, sacral fractures, facet syndrome, piriformis syndrome)
° Iliac Compression Test
▪️ Patient in lateral decubitus position
▪️ Downward force applied to iliac crest
▪️ Pain is reproduced in SI joint dysfunction
° Patrick Test (FABER)—Patient supine, knee is fl exed on
affected side and lateral malleolus is placed over patella of
opposite leg. Downward pressure applied to fl exed knee and
opposite anterior superior iliac spine
▪️ Contralateral pain in hip/groin is reproduced in SI joint dysfunction [8]
Imaging :
• X-ray
° Ferguson views, AP views—to rule out seronegative arthropathies, which can present with sacroiliac erosions
• Bone Scan, CT
° Bone changes due to fracture, infection, tumor, arthritis
• MRI
° As above; soft tissue disease, marrow changes associated with
sacroilitis
• Fluoroscopy
° Diagnostic and therapeutic SI injection—“Gold Standard”
Treatment :
• Relative rest
• Avoid provocative movements
• Hot/cold packs, topical analgesics
• Injections—diagnostic and therapeutic
Rehabilitation Program :
• Modalities: Ice, massage, heat, electrical stimulation
• Stretching of iliotibial band, hamstrings, external rotators, hip
fl exors.
• Strengthening of hip girdle and core muscles
° Gluteus maximus, gluteus medius, erector spinae, latissimus dorsi,
biceps femoris, psoas, piriformis, oblique/transversus abdomius.
• Postural education exercises
• SI joints mobilization techniques
• Hip ROM
