Abstracts: AAOMPT Conference, 2002

Abstract

Background/Purpose: The purpose of this case report is to describe the clinical management of a patient with sacroiliac joint dysfunction (SIJD) and a concomitant asymmetrical hip-joint rotation range of motion. The patient was a 53-year-old male whose chief complaint was right low back pain (LBP) that interfered with work and leisure activities. Physical therapy consisted of manual therapy, stretching, and postural education to address SIJ and hip motion abnormalities. At the conclusion of 6 visits, the hip-joint rotation range of motion was more symmetrical. The patient reported self-correction of unilateral standing and sitting postures. He returned to full-time work and to playing golf, and he rated pain at 0-1/10. This patient's asymmetrical hip-joint rotation range of motion may have been associated with SIJD, either as a result of trauma or subsequent habitual postural adjustments. Clinician awareness of the possible relationship between SIJD and asymmetrical hip joint rotation range of motion is recommended.     

Patellofemoral pain and asymmetrical hip rotation

BACKGROUND AND PURPOSE: Patellofemoral joint problems are the most common overuse injury of the lower extremity, and altered femoral or hip rotation may play a role in patellofemoral pain. The purpose of this case report is to describe the evaluation of and intervention for a patient with asymmetrical hip rotation and patellofemoral pain. CASE DESCRIPTION: The patient was a 15-year-old girl with an 8-month history of anterior right knee pain, without known trauma or injury. Prior to intervention, her score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 24%. Right hip medial (internal) rotation was less than left hip medial rotation, and manual muscle testing showed weakness of the right hip internal rotator and abductor muscles. The intervention was aimed at increasing right hip medial rotation, improving right hip muscle strength (eg, the muscle force exerted by a muscle or a group of muscles to overcome a resistance), and eliminating anterior right knee pain. OUTCOMES: After 6 visits (14 days), passive left and right hip medial rotations were symmetrical, and her right hip internal rotator and abductor muscle grades were Good plus. Her WOMAC score was 0%. DISCUSSION: The patient had right patellofemoral pain and an uncommon pattern of asymmetrical hip rotation, with diminished hip medial rotation and excessive hip lateral (external) rotation on the right side. The patient's outcomes suggest that femoral or hip joint asymmetry may be related to patellofemoral joint pain.     

CT导引下的骶髂关节造影及其临床意义初探

目的探讨ＣＴ导引下的骶髂关节造影术及其临床意义。方法对５例骶髂关节病变患者和１５例腰腿痛的志愿者进行ＣＴ导引下的骶髂关节造影,造影后行ＣＴ扫描、Ｘ线拍片并填写疼痛图。结果骶髂关节ＣＴ扫描显影良好,Ｘ线片影像欠清晰。２例有骶髂关节病变患者的ＣＴ扫描发现有造影剂外溢及隐窝。本组共１４例感造影后穿刺侧臀部及大腿后上方酸痛,５例骶髂关节病变患者诉造影术引发的疼痛与术前疼痛部位相同。结论ＣＴ导引下的骶髂关节造影术与传统的造影方法相比,即避免了过多接触Ｘ线照射引起的伤害,又提高了工作效率,为临床诊断和开展相关研究提供了有意义的影像学信息。     

Sacroiliac joint dysfunction: a case study

Pain is a widespread issue in the United States. Nine of 10 Americans regularly suffer from pain, and nearly every person will experience low back pain at one point in their lives. Undertreated or unrelieved pain costs more than $60 billion a year from decreased productivity, lost income, and medical expenses. The ability to diagnose and provide appropriate medical treatment is imperative. This case study examines a 23-year-old Active Duty woman who is preparing to be involuntarily released from military duty for an easily correctable medical condition. She has complained of chronic low back pain that radiates into her hip and down her leg since experiencing a work-related injury. She has been seen by numerous providers for the previous 11 months before being referred to the chronic pain clinic. Upon the first appointment to the chronic pain clinic, she has been diagnosed with sacroiliac joint dysfunction. This case study will demonstrate the importance of a quality lower back pain assessment.     

A Case Report of Infectious Sacroiliitis in an Adult Presenting to the Emergency Department with Inability to Walk

Background

Infectious sacroiliitis (ISI) is an uncommon cause of back and hip pain in which the sacroiliac joint, either unilateral or bilateral, is inflamed from an infectious source. Historically, this has been an easily missed diagnosis due to nonspecific presenting symptoms along with subtle nondistinguishable laboratory abnormalities.

Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint

This case report describes the clinical reasoning and management of the sacroiliac joint, utilising the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). A patient with a 2 year history of buttock and thigh pain demonstrates a directional preference for repeated anterior SIJ rotation. The MDT approach is discussed and is an ideal method for emphasising the patients involvement in managing their own back problem.     

Diagnostic Tests for Mechanical Dysfunction of the Sacroiliac Joints

Abstract

Despite almost a century of management of mechanical dysfunction of the sacroiliac joints, no testing procedures have been satisfactorily validated for diagnosis. This paper presents tests that proved to be the most reliable for the management of 57 patients referred by their GPs for treatment of back and leg pain. The patients all regained normal pain-free function after manipulation of the sacroiliac joint(s) followed by a program of modified living and progressively increased walking. The tests include a version of Gillet's test (alternate hip and knee flexion in support standing) revised by the author, passive hip rotations in supine with 90 degrees of hip and knee flexion, and palpation of the superior ligament of the symphysis pubis. This paper proposes that when performed as described, these four tests are worth validating for the diagnosis of sacroiliac joint dysfunction.     

Gender differences in pattern of hip and lumbopelvic rotation in people with low back pain

BACKGROUND: Findings from previous studies suggest gender may affect the pattern of hip and lumbopelvic motion during a multi-segmental movement. To date, no studies have examined movement patterns and low back pain symptom behavior during hip lateral rotation. METHODS: Forty-six people (27 males and 19 females) with low back pain were examined. Three-dimensional kinematic data and low back pain symptoms were recorded during active hip lateral rotation. Percent of maximum lumbopelvic rotation was calculated for each 10% increment of maximum active hip lateral rotation. FINDINGS: Men exhibited a greater percent of maximum lumbopelvic rotation (mean 49.3, SD 13.3) during the first 60% of hip lateral rotation than women (mean 36.2, SD 16.4) (P < 0.01). Nineteen (70.4%) of the men and seven (36.8%) of the women had pain with the hip lateral rotation test (P = 0.02). INTERPRETATION: Men exhibited more lumbopelvic rotation in the early part of hip lateral rotation than women, and hip lateral rotation was more likely to be associated with symptoms in men than women. Greater lumbopelvic motion, earlier in hip lateral rotation, may make men more vulnerable to low back pain associated with hip lateral rotation. Factors that contribute to these gender differences should be investigated further.     

Diagnosis of intermittent vascular claudication in a patient with a diagnosis of sciatica.

BACKGROUND AND PURPOSE: The purpose of this case report is to illustrate the importance of medical screening to rule out medical problems that may mimic musculoskeletal symptoms. CASE DESCRIPTION: This case report describes a woman who was referred with a diagnosis of sciatica but who had signs and symptoms consistent with vascular stenosis. The patient complained of bilateral lower-extremity weakness with her pain intensity at a minimal level in the region of the left sacroiliac joint and left buttock. She also reported numbness in her left leg after walking, sensations of cold and then heat during walking, and cramps in her right calf muscle. She did not report any leg pain. A medical screening questionnaire revealed an extensive family history of heart disease. Examination of the lumbar spine and nervous system was negative. A diminished dorsalis pedis pulse was noted on the left side. Stationary cycling in lumbar flexion reproduced the patient's complaints of lower-extremity weakness and temporarily abolished her dorsalis pedis pulse on the left side. OUTCOMES: She was referred back to her physician with a request to rule out vascular disease. The patient was subsequently diagnosed, by a vascular specialist, with a "high-grade circumferential stenosis of the distal-most aorta at its bifurcation." DISCUSSION: This case report points out the importance of a thorough history, a medical screening questionnaire, and a comprehensive examination during the evaluation process to rule out medical problems that might mimic musculoskeletal symptoms.     

Physical therapy management of osteitis pubis in a 10-year-old cricket fast bowler

This case report describes a 10-year-old boy who presented with radiating pain (Visual Analog Scale score of 7.2 cm) down his left groin and was eventually diagnosed to have osteitis pubis. History revealed that he was exceeding the workload guidelines of bowling for a fast bowler. Examination findings were left sacro-iliac joint dysfunction, reduced left internal rotation of the hip, tightness of bilateral hip flexors and poor motor control of the lumbo-pelvic muscles. Physical therapy was aimed at correcting the sacro-iliac joint dysfunction, increasing the hip range of motion and muscle length along with exercises aimed at improving the lumbopelvic stability. The patient had complete resolution of pain by the ninth week and returned to fast bowling without any discomfort.     

Cox decompression chiropractic manipulation of a patient with postsurgical lumbar fusion: a case report

OBJECTIVE: The purpose of this case report is to describe a patient with an L5/S1 posterior surgical fusion who presented to a chiropractic clinic with subsequent low back and leg pain and was treated with Cox decompression manipulation. CLINICAL FEATURES: A 55-year-old male postal clerk presented to a private chiropractic practice with complaints of pain and spasms in his low back radiating down the right buttock and leg. His pain was a 5 of 10, and Oswestry Disability Index score was 18%. The patient reported a previous surgical fusion at L5/S1 for a grade 2 spondylolytic spondylolisthesis. Radiographs revealed surgical hardware extending through the pedicles of L5 and S1, fusing the posterior arches. INTERVENTION AND OUTCOME: Treatment consisted of ultrasound, electric stimulation, and Cox decompression manipulation (flexion distraction) to the low back. After 13 treatments, the patient had a complete resolution of his symptoms with a pain score of 0 of 10 and an Oswestry score of 2%. A 2-year follow-up revealed continued resolution of the patient's symptoms. CONCLUSIONS: Cox chiropractic decompression manipulation may be an option for patients with back pain subsequent to spinal fusion. More research is needed to verify these results.     

Percutaneous Sacroplasty and Sacroiliac Joint Cementation under Fluoroscopic Guidance for Lower Back Pain Related to Sacral Metastatic Tumors with Sacroiliac Joint Invasion

Abstract: Cancer patients with bone metastases are at risk of a variety of skeletal events, including vertebral compression and pathologic fractures. Approximately 30% to 40% of patients with advanced lung cancer will develop bone metastases in the course of their disease, resulting in a significant negative impact on both morbidity and survival. Skeletal complications of bone metastases include pain, pathologic fractures, spinal cord compression, and hypercalcemia. The spine is the most frequent site of skeletal metastases. We present a 48‐year‐old female with intractable and incapacitating low back pain because of metastatic bone tumor in the left lateral side of S1 and S2 with left sacroiliac invasion. Imaging identified a metastatic invasion of the sacrum. Percutaneous sacroplasty, a safe and effective procedure for sacral‐insufficient fractures, was performed under fluoroscopy guidance. However, the expected pain relief was not achieved. At 1 month, the patient remained invalided by severe back pain, which was localized to the left sacroiliac joint. In a second procedure, the sacroiliac joint was cemented. Pain relief was complete, immediate, and sustained until the patient's death related to the underlying oncologic disease. No complications were observed. Few reports exist about the treatment of sacral metastatic tumors with percutaneous sacroplasty. Further, no previous reports about sacroiliac joint cementation for joint stabilization have been found. In the present case, sacroiliac joint cementation successfully resolved residual pain that remained despite percutaneous sacroplasty treatment of the pathologic sacral fracture.     

Impairment-based examination and disability management of an elderly woman with sacroiliac region pain

BACKGROUND AND PURPOSE: The purpose of this case report is to describe the use of a cluster of sacroiliac tests in conjunction with an impairment-based model of examination, diagnosis, and management of sacroiliac region pain. CASE DESCRIPTION: The patient was a 74-year-old woman with an 18-month history of low back, left buttock, and groin pain following a misstep. The initial symptoms were intermittent. The symptoms became constant and limited her walking tolerance to 5 minutes, which affected her ability to care for her grandchildren. She was examined using a cluster of sacroiliac tests that examined: (1) innominate active mobility, (2) innominate positional symmetry, and (3) sacroiliac ligament tenderness. OUTCOMES: Following 4 treatments for identified impairments, the patient had unlimited walking tolerance and she resumed an active caregiving role for her grandchildren. DISCUSSION: This case illustrates the use of an impairment-based model for examination and management of an elderly patient with what appeared to be sacroiliac joint dysfunction.     

Lateral compartment syndrome of the lower extremity in a recreational athlete: a case report

There are a limited number of reported cases of acute-onset isolated lateral compartment syndrome. We report a case of a 28-year-old recreational athlete who was erroneously diagnosed as having a muscle strain of his right lower extremity and discharged home. The patient over the course of the next day developed increasing leg pain and returned to the same emergency department where measurement of the peroneal compartment was 122 mm Hg. The patient had an emergent fasciotomy of the peroneal compartment of the right leg. The remainder of his hospital course was unremarkable. Although not commonly encountered, lateral compartment syndrome is important to consider in all patients who present with increasing pain out of proportion to injury and a tense swollen compartment after physical activity.     

Sacroiliac dysfunction in dancers with low back pain

SUMMARY. Low back pain is a common occurrence in dancers. Studies have shown its prevalence to be around 12% of all dance type of injuries. It is commonly thought by health professionals who specialize in dance medicine that sacroiliac (SI) dysfunction is one of the more common causes of low back pain in dancers. The aetiology of SI dysfunction in dancers is related to both the biomechanics of the SI joint and the physiological demands placed on the SI joint from the dynamics of dance. Injury to the SI joint can be due to a combination of a single traumatic incident, from overuse factors involving repetitive microtrauma or from emotional stress. Clinical manifestations could be pain in the back, buttock, hip and leg, and limitation of movement specific to dance. Diagnosis is based upon the deviation from normal of both the static and kinetic functions of the low back and pelvis in its relationship to the biomechanics of dance. Treatment is aimed at relieving pain, restoring the function of the SI joint and returning the dancer to full function. Copyright 1997 Harcourt Publishers Ltd.     

Sacroiliac dysfunction in construction workers

BACKGROUND: In the literature of manual medicine the sacroiliac joint is widely accepted as a potential source of low back pain. On the other hand, some investigations have detected sacroiliac joint dysfunction without concomitant low back pain. The prevalence of sacroiliac dysfunction in the population has been noted in the medical literature to be between 19.3% and 47.9%. However, the prevalence of sacroiliac dysfunction in the general population and for construction workers is unknown. OBJECTIVE: This article presents results from the Hamburg Construction Workers Study in respect to sacroiliac diagnostics. The prevalence of and connection between sacroiliac dysfunction and low back pain are particularly interesting. DESIGN AND PARTICIPANTS: The sacroiliac joint diagnostics were studied in a cross-section investigation of a cohort of 480 male construction workers. Manual examination is the standard in the diagnostics of sacroiliac joint conditions at present. The assessment of sacroiliac joint function by standing flexion test, the spine test, the iliac compression test, and the iliac springing test was operationalized as two categories: sacroiliac dysfunction I and II. RESULTS: A prevalence of 29.0% was found for dysfunction I and 6.3% for dysfunction II, whereas a prevalence of 7.9% was found for the coprevalence of low back pain and sacroiliac dysfunction on the day of examination. This study demonstrated no statistical associations between low back pain and sacroiliac joint dysfunction. CONCLUSIONS: The reason why symptomatic and asymptomatic sacroiliac dysfunctions exist has not yet been sufficiently explained. The identification of pain-provoking factors should be the aim of subsequent investigations. A further study with a prospective design will be necessary to answer the questions that remain.     

Incidence of sacroiliac joint dysfunction and low back pain in fit college students

The incidence of low back pain and sacroiliac joint dysfunction and their relationship was studied in a sample of physically fit college students. An incidence of 26.5% was found for low back pain, while an incidence of 19.3% was found for sacroiliac joint dysfunction. This study found no significant relationship between sacroiliac joint dysfunction and low back pain.     

A possible cervical cause of low back pain: pelvic distortion

Objective: to discuss the diagnosis and treatment of pelvic distortion related to cervical spine dysfunction in a patient with low back pain, as well as presenting a theoretical etiology.Clinical features: pelvic distortion is a disorder in which the ilia become counter-rotated on the sacrum. Our clinical experience suggests that it can arise from dysfunction in the cervical spine. It can produce low back pain, as occurred in the presented case. The sacroiliac (SI) joint is often determined to be the primary pain generator, although there may or may not be joint dysfunction detected in this joint. In the presented case the primary pain generator was initially felt to be the T12–L1 joint, as well as trigger points in the iliocostalis muscle. When the pain returned, and normal findings were noted in these structures, the patient was examined for the presence of pelvic distortion. This was found, as was painful joint dysfunction in the cervical spine. It was suspected that the pelvic distortion may have occurred secondary to cervical joint dysfunction.Intervention and outcome: treatment that was limited to manipulative therapy to the cervical spine successfully relieved the low back pain in this case.Conclusion: pelvic distortion secondary to cervical joint dysfunction may be a common cause of low back pain. Further research is needed to identify the prevalence, etiology, mechanism and ideal treatment of pelvic distortion.     

Clinical decision making in a patient with secondary hip-spine syndrome

The prevalence of lumbar and hip pathology is on the rise; however, treatment outcomes have not improved, highlighting the difficulty in identifying and treating the correct impairments. The purpose of this case report is to describe the clinical decision making in the examination and treatment of an individual with secondary hip-spine syndrome. Our case study was a 62-year-old male with low back pain with concomitant right hip pain. His Oswestry Disability Index (ODI) was 18%, back numeric pain rating scale (NPRS) was 4/10, fear avoidance beliefs questionnaire (FABQ) work subscale was 0, FABQ physical activity subscale was 18, and patient specific functional scale (PSFS) was 7.33. Physical examination revealed findings consistent with secondary hip-spine syndrome. He was treated for four visits with joint mobilization/manipulation and strengthening exercises directed at the hip. At discharge, all standardized outcome measures achieved full resolution. Clinical decision making in the presence of lumbopelvic-hip pain is often difficult. Previous literature has shown that some patients with lumbopelvic-hip pain respond favorably to manual therapy and exercise targeting regions adjacent to the lumbar spine. The findings of this case report suggest that individuals with a primary complaint of LBP with hip impairments may benefit from interventions to reduce hip impairments.