Sacroiliac joint subluxation
Sacroiliac joint sprain and strain refers to the sacroiliac joint due to the influence of external force and postural stress, causing damage to the ligaments around the pelvis or loss of stability and dislocation, resulting in the destruction of the weight-bearing mechanism of the pelvis and the occurrence of lumbosacral and lower limb pain and reduced ability to work and live.
I. Diagnosis basis
1.Menstrual women tend to have chronic onset and may have no history of lumbar trauma; young men tend to have acute onset and history of lumbar trauma.
2, manifested as lumbosacral pain (a small number of patients can also appear coccygeal pain) and one or both sides of the lower limbs pain, the patient standing more to the healthy limb weight-bearing, sitting with the healthy side of the hip to touch the chair; severe cases even supine can not straighten the lower limbs, like to flex the affected limb lying supine or to the healthy side.
3.Patients with acute injury have a tilted pelvis, scoliosis, a special posture of “crooked hip and limp”, and cannot straighten the chest and waist; due to the asymmetry of the hip bones on both sides, the three-dimensional space position of the acetabulum moves up or down, and the appearance of the two lower limbs is not equal; the bony signs of the posterior superior iliac spine and posterior inferior iliac spine on both sides are asymmetrical, and there is pressure pain and percussion pain. In patients with chronic strain injury, the “crooked hip limp” may not be obvious because of the compensated spinal posture, but the above-mentioned signs can still be found in the physical examination.
4.Pelvic orthopantomogram is the basic imaging basis for diagnosing this disease, mainly showing: staggered asymmetry of hip width and closed hole width; step-like changes on both sides of the pubic symphysis and asymmetry of pubic bone diameter; posterior superior iliac spine on both sides is not at the same level, posterior superior iliac spine is superior in extension subluxation, and posterior superior iliac spine is inferior in flexion subluxation; chronic patients can see increased bone density on the iliac side of the affected sacroiliac joint, which used to be It is called dense iliac osteitis.
5.If synovitis of sacroiliac joint is suspected, sacroiliac joint axial film can be taken further; if the sacroiliac joint is suspected to be a local manifestation of ankylosing spondylitis, further differentiation can be made by testing.
Second, the classification of evidence
1.Modern medical classification
2.Sacroiliac joint subluxation: sudden onset, history of trauma before onset, severe pain, pain intensifies when changing position or coughing or sneezing, lower limb on the affected side is semi-flexed, active or passive extension and flexion are obviously limited and severe pain, lumbosacral buckling pain; positive “4” test, bedside test and pelvic squeeze test on the affected side. According to the direction of sacroiliac joint movement during subluxation, it can be divided into flexion subluxation and extension subluxation.
3.Sacroiliac joint flexion subluxation: the posterior superior iliac spine on the affected side is shifted down and bulged, and the lower limb is pseudo-shortened.
4.Extension subluxation of sacroiliac joint: the posterior superior iliac spine on the affected side is shifted upward, convex, and the lower limb is pseudo-lengthened.
5.Sacroiliac joint ligament sprain: sudden onset, history of trauma before onset, moderate pain, pain increases when position changes, no snap pain in lumbosacral region; positive “4” test, bedside test and pelvic squeeze test on the affected side, but symmetry of bony structures of both sides of the pelvis, pressure pain at the attachment of sacroiliac joint ligaments such as the second middle sacral spine and iliac crest.
6.Sacroiliac joint strain: chronic or insidious onset, patients feel weakness with hidden pain in the lower back and buttocks, but the symptoms in the distal part of the lower limbs are not obvious, manifesting as soreness, tenderness, numbness, coldness and other sensations; some patients show stubborn pain and tenderness in the sacrococcygeal area and excessive movement of the extracted and extended sacroiliac joints; pelvic X-ray plain film shows the so-called “dense iliac osteitis The pelvic X-ray shows the signs of so-called “dense iliopsoas”.
Chinese medicine identification and classification
1.Qi stagnation and blood stasis, bone misalignment and tendon knot: history of trauma, severe pain, restlessness, movement disorder, refusal to press the injured area, local swelling, dark tongue or petechiae, tight pulse.
2. Liver and kidney deficiency, tendon relaxation and bone error: soreness and weakness of the waist and knees, coldness and weakness of the lower extremities, inability to walk and sit for a long time, painful areas like to press, pain is aggravated after exertion, urine is closed and not fixed, frequent. The tongue is light and the pulse is sunken.
IV. Treatment plan
1.Treatment: orthopedic repositioning, restoration of pelvic bearing function, rectification techniques.
2.Sacroiliac joint flexion subluxation: modified oblique trigger method (posterior superior iliac spine) or short lever fine-tuning technique (lower end of sacrum, posterior superior iliac spine) is appropriate for rectification.
3.Extension subluxation of sacroiliac joint: the modified oblique toggle method (sciatic tuberosity) or short lever fine-tuning manipulation (upper end of sacrum, sciatic tuberosity) is appropriate for rectification. The sign of successful revision is significant pain relief and restoration of symmetry of the bony structure of the pelvis. The lumbar activities return to normal, the clinical signs disappear and the weight-bearing function of the affected limb is restored.
4.Sacroiliac joint ligament sprain: stretch the sprained sacroiliac ligament and iliolumbar ligament by modified oblique trigger method (posterior superior iliac spine) and sacroiliac joint extraction and extension method, and then operate locally in the injured ligament by rubbing method, and the degree of heat penetration. The sign of effective manual treatment is the disappearance of lumbosacral pressure pain and relief of lumbosacral motor pain.
5.Sacroiliac joint strain injury: to rectify the sacroiliac joint with short lever fine-tuning technique (lower end of sacrum and posterior superior iliac spine or upper end of sacrum and sciatic tuberosity), together with sacroiliac joint extraction and extension method, and then to operate locally with rubbing method on the joint, and the degree of heat penetration. The sign of effective manual treatment is the disappearance of pressure pain in lumbosacral area, relief of lumbosacral motor pain and recovery of weight-bearing function of the affected limb.
6.Qi stagnation and blood stasis, bone misalignment and tendon knot evidence: after massage treatment, it is advisable to apply ointment such as tricolor ointment to promote healing by activating blood circulation and removing blood stasis and relieving swelling and pain.
7, liver and kidney deficiency, tendons and bones wrong evidence: in the manipulation treatment at the same time can be combined with the guide exercise, external strong tendons and bones, internal real liver and kidney.
Five, other treatments
1.Acupuncture and moxibustion: use acupoints such as A-Yi, Kidney Yu, Large Intestine Yu, Sub-S, Lower Jiao Yu, Huan-Yuan, Yin-Men and Wei-Zhong.
2.Wet and hot compresses of Chinese medicine: suitable for patients with sacroiliac joint ligament sprain and sacroiliac joint strain.
3.Guided exercise: knee flexion and hip flexion stirrup work, snake walking work, applicable to patients with sacroiliac joint strain injury.
Sixth, the management of complications
1.Lumbar degeneration: Patients with sacroiliac joint strain injury are often combined with serious lumbar degeneration such as lumbar disc herniation and lumbar spondylolisthesis because of the imbalance of dynamic and static force of the spine, and should actively treat lumbar spine diseases while treating sacroiliac joint diseases.
2, joint problems at the same time using vibration method operation on the lower abdomen, rubbing eight s and other operations to lift the parasympathetic nerve disturbed state, restore normal urinary function.
3, sacroiliac joint osteoarthritis: Sacroiliac joint strain patients can cause synovitis or osteoarthritis due to long-term joint mechanics imbalance and excessive concentrated load on local articular cartilage, even if the sacroiliac joint surface restores normal spatial relationship, pain will still occur when the lower limb is weight bearing. It can be treated with local herbal hot compress and physiotherapy at the same time of manipulation; for those with synovial inflammation, sacroiliac joint closure can be used.
Seven, precautions
1.Sacroiliac joint should be avoided to walk continuously for several days after manipulation, especially going up and down stairs, so as not to increase the load of sacroiliac joint and cause re-displacement.
2.The ligaments and muscles around the sacroiliac joint are very developed, and there is great resistance to rectification, so the manipulation should not be rough, so as not to cause medically originated injury, and those who have difficulty in rectification by manipulation should be promptly referred or asked to a higher-level physician.
Eight, efficacy assessment
1, cure: clinical symptoms, signs disappeared, no obstacle to the lumbar and lower limb activities.
2.Improved: clinical symptoms improved, signs reduced, no obstacle to lumbar and lower limb activities.
3.Invalid: No change in clinical symptoms and signs, and the activities of the waist and lower limbs are still obstructed.