Sacrum and sacroiliac joint
Five sacral vertebrae grow together in an adult into a single bone - the sacrum. Fusion of the sacral vertebrae occurs relatively late: at the age of 18-25. After 15 years, the fusion of the three lower vertebrae begins, and by 25 - the two upper sacral vertebrae. The sacrum in men is longer, narrower, and more curved than in women.
In the case of incomplete fusion of the sacral vertebrae with congenital developmental anomalies - spina bifida, sacralization, or lumbarization, splitting of the vertebral arch with the formation of meningocele or meningomyelocele can be detected. The lateral surfaces of the sacrum have ear-shaped articular surfaces (ear-shaped joints), with the help of which the sacrum articulates with the surfaces of the iliac bones of the same name.
The sacroiliac joint is a rigid formation that is often called as the sacroiliac junction.
Sacroiliitis and its causes
Sacroiliitis is inflammation of the sacroiliac joint (junction). The cause of inflammation of the sacroiliac joint with the occurrence of sacroiliitis may be prolonged positional overload of the lower limb-girdle (sedentary work, carrying heaviness, pregnancy), trauma, infection, autoimmune process.
The main complaints of the patient with sacroiliitis are a pain in the sacral region (sacrodynia) on the side of the inflammation of the sacroiliac joint (junction). The pain is aching in nature, or as with a "bruise", or in the form of constant heaviness and discomfort after exertion (walking, sitting, or dancing).
Diagnosis and symptoms of sacroiliitis
Diagnosis of sacroiliitis consists of examining the patient by a doctor, studying his history of the onset of the disease (anamnesis), assessing biomechanical changes (gait, muscle tone, and strength, range of motion in the joints of the lower shoulder girdle).
Locally, with sacroiliitis, the patient may have a symptom of pain (sacrodynia). Palpation on the side of the inflamed sacroiliac joint (joint) in the presence of sacroiliitis can dramatically increase the symptom of pain in the patient.
In blood tests with sacroiliitis, signs of inflammation can be detected in the form of an increase in the erythrocyte sedimentation rate (ESR). X-ray of the pelvic bones allows excluding traumatic causes of damage to the sacroiliac joint and osteomyelitis in the patient.
Computed tomography (CT) has made a great contribution to the modern diagnosis of diseases of the pelvic bones and its joints in sacroiliitis. Computed tomography of the sacral spine and pelvic bones helps to identify or rule out arthrosis of the sacroiliac joint (joint). Also, CT of the pelvic bones and the lumbosacral spine makes it possible to exclude the patient's oncological cause of damage to the pelvic bones or vertebral bodies.
Sacroiliitis treatment includes if possible, complete, or partial limitation of excessive physical exertion on the sacroiliac joint (joint). For unloading in pregnant women, for example, a special bandage can be used, which creates unloading of the lumbosacral region. It is desirable to restrict the patient to prolonged sitting or walking.
Medical treatment of sacroiliitis is prescribed depending on the severity of a particular symptom in a patient. These can be non-steroidal anti-inflammatory drugs (NSAIDs) for external and internal use, analgesics, glucocorticoids.
In case of severity of pain symptom (sacrodynia) in a patient with sacroiliitis, blockages (with lidocaine, hydrocortisone, diprospan, kenalog, etc.) can be performed.
Additionally, in the treatment of sacroiliitis, physiotherapy is prescribed on the side of inflammation of the sacroiliac joint (junction).
Depending on the severity of the symptoms of sacroiliitis in the patient, the following therapeutic actions are possible:
- drug therapy (NSAIDs, analgesics, hormones)
- therapeutic injections - injection of drugs into the cavity of the sacroiliac joint (joint), spinal canal, trigger points in the muscles
- manual therapy (muscle, articular and radicular technique)
- physiotherapy (UHF, TENS, etc.)
- surgical treatment
Wearing a semi-rigid lumbosacral brace helps to limit the amount of movement in the sacroiliac joint (articulation). This helps to reduce the symptom of pain in the area of inflammation of the sacroiliac joint (articulation) in sacroiliitis and relieve excessive protective tension and spasm of the muscles of the back and buttock area.
In this brace, the patient can move independently at home and on the street, sit in the car, and at the workplace. The need to wear a corset disappears as soon as the pain in the sacrum passes.
There are several types of lumbosacral semi-rigid braces and bandages. All of them are selected according to the size and can be used repeatedly in case of repeated occurrence of pain in the sacrum.