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Updated: Jun 24 2021

Sacroiliitis

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https://upload.orthobullets.com/topic/2040/images/sacroiliatis.jpg
  • summary
    • Sacroiliitis is an inflammatory condition of the sacroiliac joint that can cause persistent low back and posterior pelvic pain.
    • Diagnosis is made with MRI studies with contrast showing fluid/inflammation at the SI joint and possible abscess.
    • Treatment is usually nonoperative with NSAIDs and rest, with IV antibiotics reserved for infections. Surgical debridement is indicated in the presence of an abscess. 
  • Epidemiology
    • Demographics
      • most commonly presents in teen to middle-aged individuals
        • males > females
    • Associated conditions
      • commonly part of ankylosing spodyliitis or Reiter's syndrome
  • Etiology
    • Pathophysiology
      • can stem from traumatic event or infection
      • pregnancy may lead to increased incidence in some females
      • often stems from chronic inflammation of SI joints
      • can lead to fibrosis and ossification within SI joint
    • Associated conditions
      • ankylosing spodyliitis
        • associated with HLA-B27
        • 1-2% of all individuals will have HLA-B27
      • Reiter's syndrome
        • oligoarticular arthritis, conjunctivitis and urethritis
      • joint arthritis
  • Presentation
    • Symptoms
      • pain with prolonged standing
      • difficulty climbing stairs
      • generalized low back pain
      • weakness from hip musculature on affected side
      • morning stiffness
    • Physical exam
      • FABER test
        • pain with flexion, abduction, and external rotation of hip
      • ankylosing spondylitis associated with
        • spinal flexion deformities
        • starting in T and L spines
  • Imaging
    • Radiographs
      • may show some erosive changes in the bone, but it’s not specific
      • may show calcifications or sclerosis within SI joint
    • MRI is study of choice
      • use gadolinium
      • T2’s show fluid/inflammation at the SI joint and maybe an abscess
  • Studies
    • Labs
      • WBC
        • usually normal
        • can be elevated with infection
      • ESR/CRP
        • usually elevated
      • blood cultures
        • are positive in 50%
      • HLA-B27
        • check for rheumatoid factor (should be negative for true Ankylosing spondylitis)
  • Treatment
    • Depends on cause
      • infection
        • IV antibiotics
          • until symptoms and the CRP resolve
          • then put on orals antibiotic
        • surgery
          • may be necessary if this fails or if there is a large abscess
      • trauma or overuse
        • rest, activity modification, NSAIDS, corticosteroid injections
          • indications
            • most resolve with soft tissue rest and activity modification
      • pregnancy
        • observation
          • typically resolves after childbirth
      • part of larger spondylopathy
        • aggressive PT, NSAIDs, TNF inhibitors
          • severe symptoms may require TNF inhibitors or other similar medications
  • Prognosis
    • Depends on cause but most patients will eventually resolve the episode and continue without issues
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Question
1 of 2
In scope icon N/A
QID 219803 (Type "219803" in App Search)
A 52-year-old recreational surfer presents with shoulder pain and weakness after being hit forcefully by a wave while trying to recover his board with his arm in hyperabduction and external rotation. On examination, he has a positive bear hug test, active internal rotation to neutral on the affected side, and passive external rotation of 100 degrees compared to 70 degrees on the unaffected side. He comes to the clinic with an MRI, a representative image of which is shown in Figure A. You are planning to book him for a rotator cuff repair with a suprapectoral arthroscopic biceps tenodesis. Injury to which of the following structures most likely contributed to the findings shown in Figure A?
  • A

Coracoacromial (CA) ligament and superior glenohumeral ligament (SGHL)

4%

25/626

Coracoacromial (CA) ligament and middle glenohumeral ligament (MGHL)

3%

17/626

Coracohumeral ligament (CHL) and inferior glenohumeral ligament (IGHL)

23%

142/626

Coracohumeral ligament (CHL) and middle glenohumeral ligament (MGHL)

41%

258/626

Coracohumeral ligament (CHL) and superior glenohumeral ligament (SGHL)

27%

172/626

  • A

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Spine | Sacroiliitis
  • Spine
  • - Sacroiliitis
10:13 min
4/4/2022
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