Absence de fiabilité des tests cliniques et des blocs pour le diagnostic positif de l’origine sacro-iliaque d’une douleur |
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| Affiliation: | 1. Unité de rhumatologie, service de médecine interne, hôpital Général de Douala, Faculty of Health and Science, University of Buea, BP 4856, Douala, Cameroun;2. Laboratoire d’investigation clinique (LIC) EA4393, service de rhumatologie, hôpital Henri-Mondor, AP–HP, université Paris Est Créteil, 94010 Créteil, France;1. Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium;2. Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium;3. Department of Radiology, University of Alberta Hospital, 8440-112 Street, Edmonton T6G 2B7, Alberta, Canada;1. Unité rachis 1, hôpital Tripode, CHU de Bordeaux, place Amélie Raba Léon, 33076 Bordeaux, France;2. Service d’orthopédie, CHU de Charles Nicolle, boulevard 9 avril, 1006 Tunis, Tunisie;1. Service de néphrologie, hôpital européen Georges-Pompidou, Assistance publique–Hôpitaux de Paris, 75015 Paris, France;2. Service de médecine interne, hôpital de la Pitié-Salpêtrière, Assistance publique–Hôpitaux de Paris, 75013 Paris, France;3. Service de rhumatologie, hôpital Lariboisière, pôle appareil locomoteur, AP–HP, 75010 Paris, France;4. Université Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France;5. Université Paris Descartes, Sorbonne Paris Cité, 75205 Paris, France;6. Université Pierre-et-Marie-Curie, 75012 Paris, France;1. Unité médicale sports et pathologies, centre hospitalier universitaire Grenoble Alpes, 38042 Grenoble cedex, France;2. Laboratoire HP2, Inserm U 1042, université Grenoble Alpes, 38042 Grenoble cedex, France;3. Service de rhumatologie, centre hospitalier universitaire Grenoble Alpes, 38042 Grenoble cedex, France;4. CNRS, TIMC-IMAG, Grenoble INP*, université Grenoble Alpes, 38042 Grenoble cedex, France |
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| Abstract: | Mapping studies of pain elicited by injections into the sacroiliac joints (SIJs) suggest that sacroiliac joint syndrome (SIJS) may manifest as low back pain, sciatica, or trochanteric pain. Neither patient-reported symptoms nor provocative SIJ maneuvers are sensitive or specific for SIJS when SIJ block is used as the diagnostic gold standard. This has led to increasing diagnostic use of SIJ block, a procedure in which an anesthetic is injected into the joint under arthrographic guidance. However, several arguments cast doubt on the validity of SIJ block as a diagnostic gold standard. Thus, the effects of two consecutive blocks are identical in only 60% of cases, and the anesthetic diffuses out of the joint in 61% of cases, often coming into contact with the sheaths of the adjacent nerve trunks or roots, including the lumbosacral trunk (which may contribute to pain in the groin or thigh) and the L5 and S1 nerve roots. These data partly explain the limited specificity of SIJ block for the diagnosis of SIJS and the discordance between the pain elicited by the arthrography injection and the response to the block. The limitations of provocative maneuvers and SIJ blocks may stem in part from a contribution of extraarticular ligaments to the genesis of pain believed to originate within the SIJs. These ligaments include the expansion of the iliolumbar ligaments, the dorsal and ventral sacroiliac ligaments, the sacrospinous ligaments, and the sacrotuberous ligaments (sacroiliac joint lato-sensu). They play a role in locking or in allowing motion of the SIJs. Glucocorticoids may diffuse better than anesthetics within these ligaments. Furthermore, joint fusion may result in ligament unloading. |
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