Neck Pain more info. Knee Pain more info. EMG more info. Epidural Injections more info. Disc Herniation more info. Minimally Invasive Spine Surgery more info. Our Locations. Choose your preferred location. An electrophysiologic study of mechanoreceptors in the sacroiliac joint and adjacent tissues. Spine ; 26 : E — The fortin finger test: An indicator of sacroiliac pain.
Am J Orthop ; 26 : — Diagram specific to sacroiliac joint pain site indicated by one-finger test. J Orthop Sci ; 13 : — 7. Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study. J Orthop Sci ; 12 : — Wyke BD. The neurology of joints: A review of general principles. Clin Rheumat Dis ; 7 : — Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relate Res ; : — Sacroiliac joint pain after lumbar fusion.
A study with anesthetic blocks. Eur Spine J ; 14 : — 8. Sacroiliac joint pain after lumbar and lumbosacral fusion: Findings using dual sacroiliac joint blocks.
Pain Med ; 12 : — Transient sacroiliac joint-related pain is a common problem following lumbar decompressive surgery without instrumentation.
Clin Neurol Neurosurg ; : 81 — 5. Referred pain location depends on the affected section of the sacroiliac joint. Eur Spine J ; 24 : — 7. Pain relief scale is more highly correlated with numerical rating scale than with visual analogue scale in chronic pain patients.
Pain Physician ; 18 : E — The report on the revised versions. April 16, The subcommittee of the clinical outcome committee of the Japanese. J Orthop Sci ; 14 : — Kanno H Murakami E. J Orthop Sci ; 12 : — 9. The sacroiliac joint in chronic low back pain. Spine ; 20 : 31 — 7. Fukui S Nosaka S. Pain patterns originating from the sacroiliac joints. J Anesth ; 16 : — 7. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil ; 81 : — 8. Pain areas by sitting originated from sacroiliac joint dysfunction are different from those from lumbar disorders.
Seikeigeka ; 65 : — 7 in Japanese. Murakami E. Sacroiliac joint Arthrodesis for severe sacroiliac joint pain. In: Murakami E , ed. The Sacroiliac Joint Pain. Japan : Nankodo ; : 72 — 81 in Japanese. Cohen SP. Sacroiliac joint pain: A comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg ; : — Treatment of sacroiliac joint dysfunction. Spinal Surg ; 24 : 6 — 11 in Japanese.
Kurosawa D Murakami E. Pelvic girdle tenderness points to differentiate the sacroiliac joint dysfunction from lumbar diseases. Seikeigeka ; 63 : — 5 in Japanese. Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis. Eur Spine J ; 16 : — 7. Borowsky CD Fagen G. Sources of sacroiliac region pain: Insights gained from a study comparing standard intra-articular injection with a technique combining intra- and peri-articular injection.
Arch Phys Med Rehabil ; 89 : — Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondyloarthropathic patients with chronic low back pain in the region of the sacroiliac joint.
Clin Exp Rheumatol ; 20 : 52 — 4. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine ; 21 : — Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil ; 79 : — Correlation of clinical characteristics with three sources of choronic low back pain.
A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures. Arch Phys Med Rehabil ; 87 : 10 — 4.
The ability of multi-site, multi-depth sacral lateral branch blocks to anesthetize the sacroiliac joint complex. Pain Med ; 10 : — Hackett GS. Neurosurgery ; 55 : — 9. Groin pain associated with lower lumbar disc herniation. Spine ; 22 : — 9. Regional correspondence between the ventral portion of the lumbar intervertebral disc and the groin mediated by a spinal reflex.
Spine ; 21 : — 9. Movement, Stability and Lumbopelvic pain , 2nd edition. Philadelphia : Churchill Livingstone Elsevier ; : Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Introduction.
Oxford Academic. Takuhiro Yamaguchi, PhD. Funding sources: No research funding sources were provided. PDF Views. Select Format Select format.
Permissions Icon Permissions. Prospective case-control study. In brief, the injection procedure required the patient to lie in a prone oblique position with the involved side down on a fluoroscopic table so that the facet of SIJ could be clearly detected.
The posterior region of SIJ is divided into four equal sections, designated as sections 0—3. Although section 0 comprises the cranial portion of the joint, this area is included as an injection target because it contains the posterior ligaments of SIJ. Sections 1 and 2 contain the interosseous ligaments and posterior sacroiliac ligament, and section 3 contains posterior ligament and a part of the long posterior sacroiliac ligament [ 1 ].
A mm gauge spinal needle was inserted into each section of the SIJ posterior ligamentous area under fluoroscopic guidance. We evaluated the effectiveness of the injection using the pain relief scale [ 17 ]. Thus, it was the aim of this study to evaluate the diagnostic value of the PSIS distraction test for the clinical detection of SIJ arthropathy and to compare it to several commonly used clinical tests.
We performed a retrospective study in a case—control design at a specialized centre for spine and pelvic surgery in Switzerland. All patients and volunteers gave informed consent to the infiltration procedure and to participate in this study, respectively. If a patient had complaints in both SIJs, each joint was analyzed separately.
Patients with pre-existing neurological or rheumatoid diseases, patients allergic to one of the substances used for SIJ-infiltration, those with severe dementia as well as pregnant patients were excluded Figure 1. Flow chart.
Flow chart showing inclusion and exclusion of patients. Forty-eight patients with symptomatic SIJ were enrolled and after exclusion of 38 patients, 46 patients with 61 symptomatic SIJ were analyzed. For the control group, 32 patients with 64 asymptomatic SIJ were enrolled and analyzed. Within a period of maximum two weeks after the primary examination described below, infiltration of the SIJ was performed in an operation room with the patient in prone position. Under fluoroscopic guidance, a Directly before and after the infiltration, patients were asked to write down the level of pain according to the Visual Analogue Scale VAS in a pain log Additional file 1.
For the new PSIS distraction test, the patients were asked whether they felt production of new or aggravation of pain when a punctual force was applied on the PSIS in medial-to-lateral direction with the patient either standing or lying prone Figure 2.
PSIS distraction test. A punctual force is applied on the PSIS in medial-to-lateral direction with the patient either standing or lying prone. The test is positive if the patient reports production of new or aggravation of pain. As this routine examination was performed before infiltration, examiners were blinded for the result of the SIJ infiltration of the patients with SIJ pathology in the case group. The investigator testing the non-symptomatic volunteers in the control group GO was not blinded.
The aim of this study was to evaluate the diagnostic value of a new clinical test for SIJ arthropathy, the PSIS distraction test, and to compare it to commonly used clinical tests. Within our population of patients with confirmed SIJ arthropathy, the PSIS distraction test was found to be of high sensitivity, specificity and therefore a very good accuracy.
This is in accordance with previously published data, even though the range of reported values for sensitivity and specificity is broad [ 6 — 9 ] and some of these studies lack control groups [ 8 ].
In a large systematic review, Szadek et al. They assumed the use of different thresholds for a positive reference standard of sufficient pain relief to be partly responsible for this [ 7 ]. Some authors reported an association [ 9 , 13 , 14 ] between patient-reported pain in the area of the posterior superior iliac spine PSIS and SIJ-generated pain. Still, a clinical test applying a force on the PSIS combining the knowledge of patient-reported pain with movement of exclusively the SIJ has not been described, so far.
The presence of pain-transducing nerve fibers in the SIJ and its adjacent ligaments is known [ 12 , 15 ]. In this context is important to know that the innervation of the sacroiliac joint is almost exclusively derived from the sacral dorsal rami [ 16 , 17 ].
The immediate anatomical vicinity of these neural structures and the PSIS could be an explanation for the good diagnostic value of the PSIS distraction test we observed. Similar to the supra- and infraorbital exits of the trigeminal nerve, the PSIS might serve as a pressure point to test the sensitivity of the sacral dorsal rami innervating the SIJ.
However, a distinctive mapping of the nociceptive areas in the SIJ to strengthen this hypothesis has not been described in the literature. Even though our study design was useful to differentiate between cases and the controls, the results need caution to some limitations. The clinical value of the PSIS distraction test was investigated on base of a case—control design.
Since the case group consisted of patients with a SIJ arthropathy confirmed by an infiltration, this might especially influence the sensitivity values.
The commonly used SIJ provocative test are known to be subject to considerable inter- and intraobserver variabilities [ 7 ].
Information on this issue for the PSIS distraction test is not given by our study. We are convinced, however, that the simplicity of the PSIS distraction test procedure makes a high inter- and intraobserver variability unlikely. The examiners were not blinded for the non-symptomatic volunteers in the control group.
This might be a potential source of bias and in this case partially explain the good specificity. In contrast, examiners were not able to predict the results of the SIJ infiltration in the group of patients with SIJ pathology. Further validation by prospective, blinded multi-investigator trials with a larger cohort is needed to confirm this assumption.
We did not differentiate on symptom duration before treatment. Pain mechanisms are different in acute, sub-acute or chronic pain and hyperalgesia in patients with a chronic pain syndrome is a possible confounding factor. As many others [ 5 , 8 , 13 , 14 ], our study used SIJ infiltration under fluoroscopic monitoring as reference test.
0コメント