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.
Osteoarthritis of the sacroiliac joint
Osteoarthritis of the sacroiliac joint (articulation) is a chronic dystrophic process in the sacroiliac joint (articulation), occurring against the background of its long-term inflammation with impaired mobility in it. The pain in the sacrum (sacrodinia) is of the same aching nature as in patients with sacroiliitis, in the form of constant heaviness and discomfort after exertion (walking, sitting, or dancing). It can pass on its own and re-escalate when overloaded or overcooled.
Diagnosis of osteoarthritis of the sacroiliac joint
Diagnosis of osteoarthritis of the sacroiliac joint (articulation), as well as with sacroiliitis, consists of examining the patient, studying his history (anamnesis) of the disease, assessing biomechanical changes (gait, muscle tone, and strength, volume of movement in the joints of the lower shoulder girdle).
Locally, with osteoarthritis of the sacroiliac joint, soreness is possible with palpation on the side of the inflamed articulation.
In blood tests of osteoarthritis of the sacroiliac joint (articulation), signs of inflammation can be detected in the form of an increase in the rate of erythrocyte sedimentation (ESR). Radiography of the pelvic bones allows you to exclude their traumatic injuries and osteomyelitis in the patient.
Computed tomography (CT) of the lumbosacral spine and pelvic bones helps to exclude sacroiliitis of the sacroiliac joint (articulation). Also, CT of the pelvic bones and the lumbosacral spine allows the patient to exclude the oncological nature of the lesion of the pelvic bones or vertebral bodies.
Treatment of osteoarthritis of the sacroiliac joint
Treatment of osteoarthritis of the sacroiliac joint (articulation), as well as with sacroiliitis, includes if possible, complete or partial restriction of excessive physical activity on the sacroiliac joint (articulation). For unloading in pregnant women, for example, a special bandage can be used, which creates unloading of the lumbosacral region. It is advisable to restrict the patient to sitting or walking for a long time.
Drug therapy, as well as for sacroiliitis, is prescribed depending on the severity of a particular symptom in a patient with osteoarthritis of the sacroiliac joint. These can be non-steroidal anti-inflammatory drugs (NSAIDs) of external and internal use, analgesics, glucocorticoids.
In the case of the severity of the pain symptom (sacrodinia) in the patient with arthrosis of the sacroiliac joint (articulation), blockages can be made (with lidocaine, hydrocortisone, diprospan, kenalog, etc.).
Manual therapy is mandatory (if the patient has no other contraindications), which improves regional blood circulation and restores the lost volume of movement in the affected arthrosis of the sacroiliac joint (articulation).
In addition, for arthrosis of the sacroiliac joint (articulation), physiotherapy is prescribed on the side of inflammation of the sacroiliac joint (articulation). This can be UHF, SMT, TENS and infrared radiation therapy.
Depending on the severity of the manifestations of osteoarthritis of the sacroiliac joint (articulation), the following therapeutic actions are possible in the patient:
- 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 pain in the area of inflammation of the sacroiliac joint (articulation) 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 corsets 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.