Department of Anaesthesia, Royal Free Hospital, London, UK
The sacroiliac joint is a diarthrodial joint (synovial). It is the largest axial joint in the body and is formed by the sacrum and ileum. Its average surface area is 17.5 cm2. The anterior joint is supplied by L2–S2 ventral rami and posterior joint by L3–S3 dorsal rami. It accounts for 15–20 % of chronic low back pain. Risk factors include activities involving unilateral loading (skiing, rowing), pregnant women, increased lordosis, weight gain and leg length discrepancy.
47.1 Clinical Features
Most of the patients present with medial buttock discomfort and pain in sacral sulcus. Pain may be referred to hip, groin and abdomen. The two characteristic features are presence of groin pain and absence of pain above L5. There may be weakness of the gluteus medius muscle with tightening of the piriformis and quadratus lumborum. Nerve root signs are not positive and movements of the spine are not affected. Mostly, the pain is unilateral.
There is no single diagnostic test. Diagnosis is confirmed by eliciting pain in the sacroiliac joint.
Patrick test: the left leg is placed over the right thigh while patient is supine. Pressure is applied over the medial aspect of the left knee while the other hand holds the right hip. Test is positive with the elicitation of the pain.
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