Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Sacroiliac Dysfunction (Inflammation of the Sacroiliac Joint)

Inflammation of the sacroiliac joints (the joint joining the pelvis and the spine) is not uncommon as an isolated condition among athletes who pursue winter sports. It can also be part of generalized disease, such as Bechterew’s disease. In sports, sudden violent contractions of the hamstrings or abdominal muscles with severe direct load to the buttocks or forceful straightening from a crouched position, can generate forces to the sacroiliac joints that may cause injury and pain at a later stage. The main symptom of this syndrome is pain in the region of tenderness.

Symptoms and diagnosis

There are several tests for sacroiliac joint pathology, one of which is the three-step test. During this test the examiner’s hand moves proximally to investigate first the hip and the iliopsoas muscle, then the sacroiliac joint, and finally the lumbar spine. The patient lies face down. The first step is to extend the hip joint with the knee flexed combined with pressure on the buttocks. In the second step the examiner’s hand moves to the sacrum (the lowest part of the spine), and further extension of the leg will affect the sacroiliac joint. The
third step is examining the lumbar spine with the leg in the same position, but with the examiner’s other hand fixing the lumbar junction. Discomfort or compression of the iliac rings when the patient is lying
supine also indicates a pathological problem.
– Vague symptoms include aching and stiffness in the lower part of the lumbar region. These are most pronounced in the morning and after periods of inactivity. They come and go, and long periods free from
problems are typical.
– The aching can radiate towards the back of the thigh, the hip joint, or the groin. Changes in the sacroiliac joint can, however, be painless.
– Inflammation of the sacroiliac joint can sometimes be combined with inflammation of other joints, e.g. the knee and ankle.
– A raised erythrocyte sedimentation rate occurs along with other blood changes typical of inflammatory disorders.
– An X-ray or CT scan may show osteophytes, which can be a sign of pathologic motion.

Treatment

Many different treatments have been tried, but the success rate depends on whether the diagnosis is accurate or not. Anti-inflammatory medication and occasionally steroid injections may help. Rheumatoid spondylosis (Bechterew’s disease) can also affect the sacroiliac joint causing vague and diffuse symptoms.

The doctor may:
– prescribe anti-inflammatory medication;
– prescribe physiotherapy;
– recommend a lumbar heat retainer.

Healing and complications

The symptoms are prolonged, but the condition is considerably more benign in women than in men.

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