Disease of the sacroiliac joints: osteoarthritis, inflammation, dysfunction of the joint
The sacroiliac joint: anatomy and diseases of the joints
In order to understand what sacroiliac joint (KPS), and to understand why it is prone to osteoarthritis and other diseases, will give the minimum necessary explanation of the anatomy and biomechanics ileosacral joint.
Also will consider opportunities for the diagnosis and treatment of diseases of this region.
Anatomic help — just about the complex
First of all you must understand what a brief is sometimes called a joint, so is not – there is no sliding of one surface on another, providing some freedom and range of motion.
On the contrary, the function of the paired poluustav between the sacral bone and iliac divisions of the pelvic bones is the preservation of the extremely close distance between them. Leaving, however, some freedom to be remote from each other at extremely small distance in such a natural physiological situation such as childbirth. More than in any other position, the weakening of the connection between the spine (sacrum) and «ring-funnel» of the pelvic bones is unacceptable.
That is exactly poluustav, the presence of all the aforesaid planar, truly articular surfaces, over each of which there is a true joint capsule.
In addition to the very short and very taut joint bags strength of the sacral iliac articulation provide two rows (one on each side) powerful Sacro-iliac ligaments, essentially inextensible, and skeletal muscle, strengthen further amphiarthrosis.
So, thanks to almost the solidity of these two joints the internal surface of the sacrum the «wedge» back fastening
between the pelvic bones, without any visible transition becomes an extension of their wide flat interior surfaces.
And the whole structure of the region more and more resembles a bucket – like pelvis attached to the handle-spine «welding-brazing» in the area of the sacrum. It provides a secure and durable support for the skeleton and also serves as a container for internal organs, not letting neither of them moving relative to each other.
What diseases affected joint and why?
Podiatrist Dikul: «the Penny product is No. 1 to restore the normal blood supply to the joints. Back and joints will be like in 18 years, enough time in the day to smear… Read more
In accordance with the anatomical features ileosacral articulation (often both) can be subject to the same diseases and conditions that a real joint:
- injury (torn ligaments with fractures of the involved bone or during a difficult birth);
- anomalies of structure (innate nature);
- degeneration of cartilage (due to osteoarthritis);
- infectious lesions (tuberculosis, brucellosis caused by pyogenic flora);
- inflammatory diseases (psoriatic arthritis, ankylosing spondylitis, Behcet’s disease, Reiter’s, Whipple’s, juvenile rheumatoid arthritis, or due to intestinal and resembling pathology);
- the conditions caused by changes in hormonal background of the organism (pregnancy, menopause, during menopause) or metabolic disorders (type alkaptonuria);
- the disease is not fully elucidated etiology and pathogenesis (Paget’s disease, Gaucher condensing osteitis of the Ilium).
Common diseases that affect the sacral iliac joint, are:
- dysfunction of the joint;
- the development of systemic diseases (psoriasis, Reiter’s syndrome, ankylosing spondylitis).
The General nature of the clinic and specific symptoms
The symptoms of the most common diseases that affect the sacral iliac joint.
Osteoarthritis – pathology, manifested by degeneration of cartilage tissue that causes a change in the shape of the sacral iliac joints and reduction in the already limited mobility of the formations. The disease is characterized by pain in poluustav and sacrum, becoming more intense with heavy use and prolonged stay in the same position (sitting, standing) or walk. The intensity of pain in the supine position is reduced, at night they do not bother, and in the morning the patient feels rested.
Other manifestations characteristic of the joints with a greater degree of mobility, in the form of clicking and crunching if this condition is not observed.
How does sacroiliitis
Inflammation of the sacral iliac joints which is called sacroiliitis – the development of KPS with arthritis pain manifestations of various degrees of intensity and with a large arena for their distribution. It includes the whole lower back, entire sacrum, pain radiating not only in the buttocks area, but also thighs and legs.
The intensity of the sensation increases with pressure on the region of the articulation (or both), while the lateral abduction or rotation of the hip, when walking, squatting and attitude, and, on the contrary, weakens the position without tension, particularly given to the body and bent legs.
Very typical of sacroiliitis «duck walk» with the walk vperevalochku.
Inflammation triggered by the infection (specific or vulgar), is usually unilateral in nature, in rheumatic or similar nature of the disease is reversible.
In addition to infection rise to a disease may be the failure in the activities of the immune system (autoimmune etiology) and upset metabolism. In the first embodiment, the condition is characterized by «morning stiffness» pain in the night and early morning time, decreased mobility of lumbar segment of the spine.
Dysfunction of the joint
Another very common disease of the sacroiliac joints – it dysfunction, usually occurs in persons of middle age or in times of pregnancy. In the second case, the pathology due to hormonal effects on connective tissue poluustav themselves and their ligamentous apparatus, with increasing flexibility of ligaments.
Among persons age described this dysfunction in different variants up to 53% of all diseases with pain in the lower back.
The pain manifestations in such cases is the different degree of intensity and the dependence on the time of day the pain is maximum in the first half of the day with a decrease by night. Localization of them is the area of the sacrum with possible radiating to the region of the hip or in the thigh or groin.
Less significant share in the structure of morbidity are infectious arthritis etiology and damage due to fractures of the pelvis with ruptured ligaments and joint capsules due to the following factors:
- Of the accident;
- excessive power loads;
- falls from considerable heights;
- due to the violation of the normal course of childbirth.
Pain symptoms injuries have a very great power with an even greater increase of pain during normal movement and in changing posture.
Diagnosis and medical history
To determine the severity of dysfunction of the sacroiliac joints developed and applied a number of sample tests, in addition to the flexion test including test on:
Eligible also test Mandela and Patika.
Of instrumental methods of diagnosis of diseases of the sacroiliac joint techniques are applied:
The application of these results allows us to identify not only the x-ray (MRI, CT) signs of rupture of the joint capsule, or fracture of the pelvic bones, because they give a clear picture of the deformation of the joint zone or offset one half of the pelvis relative to the other, but also changes that are specific to a particular type of pathology of poluustav.
The infectious process demonstrates extension of the joint cavity, the pattern of resorption in the form of a slight decline in density of all involved bone near the joint.
When inflammation caused by tuberculosis, MRI shows areas of destruction zones of adjacent bones with loss of definition of the contours of the joint, or a picture perfect imperforate of the joint space.
For degeneration (in addition narrowing of the joint space) characterized by the presence of sealing tissue of the articular surfaces and growths-osteophytes.
Research in autoimmune sacroiliitis (in addition to periarticular changes in version osteopenia and osteoporosis) identifies different degrees of sclerosis of the articular cartilage. The position of the joint space depends on the duration of the process: at the beginning of the disease it is expanded at a late stage narrowed or the same will be the pattern of ankylosis (complete fusion of the components of the joint surfaces).
On the cause and degree of activity of inflammatory process allow us to judge the data of laboratory parameters:
- Oak (common blood test);
- OAM (urinalysis);
- biochemical examination of blood;
- punctate joint fluid.
In favor of the infectious nature of inflammation says leukocytosis and accelerated erythrocyte sedimentation rate test cows, in favor of rheumatoid – detection of rheumatoid factor. The pus obtained by puncture of the joint, discovers the germs, the causative agents of pathology, to establish the ankylosing spondylitis allows the identification of HLA-B27.
Diagnostic blockade with the use of anesthetics equally contribute to the recognition of inflammation of the sacral iliac joints and its differentiation from similar diseases.
Osteoarthritis ileosacral articulation
It is a chronic long-term illness current, waves turning into aggravation.
Osteoarthritis of the lumbar sacral spine develops by the same laws, which is the same process in other joints, characterized by the same signs: pain, restriction of mobility, impairment of function of nearby organs.
Exacerbation of pain syndrome occurs due to episodes of hypothermia or due to over-voltage structures that form the articulation or the spine in General. In the area covered by pain, are not only themselves ileosacral joint, and sacrum fully, there is also pain upon palpation of the lumbar segment of the spine and in the area of the pelvis.
The intensity of the syndrome increases with increasing physical activity (including brisk walking) or while maintaining the same body position for a long time, and, conversely, decreases in the supine position, so the forced restriction of freedom of movement promotes well-being.
Night pain is not typical for the disease, as well as the crunch and «snaps» typical of arthrosis of other joints.
Chronic course of disease leads to the degeneration of cartilage tissue and the increase in disorder of the function of amphiarthrosis until the sharp restriction of mobility of the bones relative to each other, which can not affect the gait and posture of the patient.
Diagnosis of sacroiliac osteoarthritis is based on:
- the study of the history of the disease;
- the examination of the patient with carrying out anthropometric measurements (including determining the length of both lower extremities, assessment of gait, biomechanics of movement, tone and strength of muscle, range of motion in the lumbar);
- palpation studies of the spine and sacral areas;
- conduct necessary laboratory and instrumental investigations: blood tests, radiography (computed tomography) in the study area allowing to differentiate the disease from sacroiliitis, osteomyelitis, trauma and cancer process.
For women you have to go through a pelvic examination.
Treatment of osteoarthritis sacroiliac joint involves the application of the whole complex of anti-inflammatory measures and measures of rehabilitation, including the use of:
- physiotherapy and massage;
- orthopedic regime.
Medications carried out by both oral and parenteral way, includes the entire Arsenal of tools available, from NSAIDs to opioids.
Severe pain most effective drug blockade using Hydrocortisone, Lidocaine, Diprospan, Kenalog.
To reduce the intensity of pain symptoms, edema and inflammation in the joint and improve muscle tone and increase of motion of the spine applies methods of physiotherapy, including:
- laser therapy;
- magnetotherapy treatment;
- the use of sulfur and radon baths.
In the absence of contraindications a serious tool in medicine is the use of manual therapy and massage that improves blood circulation and trophism, helps to restore the structure of cartilage tissue.
Treatment of osteoarthritis involves the execution of movements in harmony with their natural biodynamics. Following the same prescribed orthopedic mode in the period of exacerbation of the disease requires the need to curb the movements with a reasonable limitation of the degree of mobility in the sacroiliac region while simultaneously creating support for the spine.
This is achieved by wearing a special bandage for fixation of the lumbar, can relieve lumbar-sacral segment of the back, especially in time of pregnancy.
The same features inherent in semi-rigid lumbar corset (to reduce pain symptoms, relieve spasms in the muscles of the gluteal area and back), if recommended by the orthopedist, who picks up the tool individually and prevents it from wearing following the elimination of the need for it.
In periods of exacerbations of osteoarthritis to limit walks and to avoid the long seat.
As a result: consequences and prevention
In the absence of measures for the treatment of diseases of the sacroiliac joint can cause serious injury, which can lead, ultimately, to reduce the mobility of the spine, in severe cases, the patient chained to a wheelchair.
To avoid trouble you must comply with the mobile lifestyle, monitoring body weight, preventing the development of chronic infection and timely treatment of acute. If you encounter problems in this region of the skeleton need for immediate recourse to a specialist (neurologist, therapist, M. D. or chiropractor).
Despite the apparent impotence of physicians in addressing issues related to the spine, modern methods of treatment allow effective help today millions of people all over the world.