Osteoarthritis and sacro
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Osteoarthritis (OA) occurs most frequently in weight-bearing joints.
Among the joints that help with weight-bearing are the sacroiliac (SI) joints. The sacro-iliac joint is the joint that connects the sacrum (triangle-shaped "wedge" of bone at the base of the spine) with the pelvis. Sacro-iliac joint pain is often misdiagnosed as hip or back pain. Like all true joints, there is articular cartilage on both sides of the SI joint surfaces.
The articular surfaces have both hyaline cartilage and fibrocartilage. The sacroiliac joint also has a number of depressions and elevations which make this joint unique in structure.
The SI joints help absorb shock transmitted from the upper body to the lower body. When these joints become inflamed, they may cause pain in the lower back, buttocks, abdomen, groin or legs.
Unlike other joints, the SI joints are not particularly mobile.
The SI joint usually only moves about two to four millimeters during weight bearing and forward flexion. This motion is described as "gliding". This is quite different from the hinge motion of the knee or the ball and socket motion of the hip. The SI joint is a viscoelastic joint. Its major movement comes from giving or stretching. The SI joint's main function appears to be providing shock absorption for the spine. The SI joint may also provide locking function that helps with ambulation. The joint locks on one side as weight is transferred from one leg to the other.
One of the most common causes of SI joint problems is an injury. The injury can come from a direct fall on the buttocks, a motor vehicle accident, or even a blow to the side of your pelvis. The force from these injuries can strain the ligaments around the joint. Injury of these ligaments can lead to excessive motion which can eventually lead to degenerative arthritis. Injuries can also cause direct injury of the articular cartilage lining the joint.
Women are at risk for developing SI joint problems later in life due to childbirth. During pregnancy, hormones are released that allow the connective tissues in the body to stretch. This stretching results in changes to the SI joints, making them hypermobile. Over time, the hypermobility can lead to wear-and-tear arthritis.
SI joint problems can also occur as a result of inflammatory arthritis... the spondyloarthropathies. Among this groups are condition such as ankylosing spondylitis, psoriatic arthritis, and Reiter’s disease. These conditions must be differentiated from osteoarthritis since the treatment differs greatly.
SI joint problems have the following symptoms.
• Back pain - particularly low back pain
• Buttock pain
• Thigh pain
Various examination maneuvers designed to elicit pain of SI joint origin will be performed by the physician.
A CAT scan or MRI scan will show more detail than x-rays.
Injection of the sacroiliac joint with glucorticoid using ultrasound guidance is often indicated and provide relief.
If sacroiliac ligaments are the source of the pain, they may need ultrasound guided injection with platelet-rich plasma (PRP). PRP is an ultraconcentrate of blood with a large number of platelets. Platelets are cells that contain many growth and healing factors.
Physical therapy is also useful. Two forms of treatment may be needed. They are mobilization and stabilization. Mobilization of the joint may include exercises and manipulation by the therapist. This type of therapy is directed to loosening up the joint ligaments, allowing the joint to move in a normal fashion. Stabilization of the joint may include muscle strengthening and pelvic stabilization exercises to reduce the movement in a joint that appears to be too loose.
Stabilization can also be accomplished through use of a specific brace called the sacroiliac belt. The belt wraps around the hips to squeeze the SI joints together. This supports and stabilizes the pelvis and SI joints.
Surgery is rarely, if ever, indicated.
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