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pelvic inflammatory disease (pid):

www.anthrax-chlamydia-gon...se_pid.htm

sacroiliac joint pain and radiofrequency denervation:

Low Back Pain. . .
Consider the Sacroiliac Joint.
By Nathan H. Brandon, M.D., The Physicians - Walton Pain Center, Augusta, GA
Charles A. MacNeil, M.D., The Physicians, Marietta, GA
A patient goes to the doctor with complaints of low back, buttock, and occasional posterior thigh or groin pain. There may be a history of falling on the buttocks or initial pain with pushing a heavy object, typically, nothing memorable. Climbing stairs and riding a bicycle increase the pain, but there is a little discomfort with standing or mall walking. X-rays of the low back and pelvis are probably normal, but the severity of symptoms leads to an MRI, which is also negative. The very inquisitive physician may order a bone scan which possibly shows increased uptake in the sacroiliac joint (SI joint). The most likely finding, however, is on physical exam, when palpation of the SI joint indicates significant tenderness, while body positions that stress the SI joint cause a mimicking of the pain. With the above presentation, the sacroiliac joint should be considered as a probable gain generator.

The sacroiliac joint is a primitive synovial joint located in a most precarious position considering the amount of stress and shear force it must bear. The articulating surface is quite small and moonscape-like rather than shiny and smooth as in most moving joints. The joint is surrounded by a network of ligaments for stability, but these are susceptible to singular or repetitive trauma leading to painful hypersensitivity or recurrent inflammation. Ankylosing, spondylosis, gout, osteoarthritis, and metastatic disease may also affect the joint, but these are not the usual presenting complaints. Luckily, as we age, the degenerative and osteoarthritic changes tend to decrease movement allowing increased stability and decreased pain.

Once diagnosed, the treatment of SI Joint pain begins with specific physical therapy designed to restabilize the joint by increasing pelvic muscle strengthening. Addition of an NSAID or COX II inhibitor orally may help accelerate the treatment.

With failure of the above or if pain is too severe, a diagnostic/therapeutic injection into the SI joint with local anesthetic and steroid may be quite beneficial. Occasionally, blind infiltration of the iliosacral ligaments near the apex of the joint will relieve pain, but the most specific therapy is a fluorscopically-guided placement of drugs onto the articulating surfaces of the joint. Because the articulating surface is small and not easily accessible, even even the most experienced practitioner must use fluoroscopy. Intra-articular injection of dye must also be used to confirm placement. Typically, a single injection will be beneficial with repeat injections as needed. Physical therapy is usually continued after the injections. Historically, injection of sclerosing agents into the joint has been little studied, and surgical fusion is rarely performed.

If good relief of pain is obtained with local anesthetic and steroid blocks, but the effects are not long lasting, more permanent intervention should be considered. Radiofrequency denervation of the SI joint is recalcitrant cases may be of benefit.

www.wrh.org/physicians_me..._pain.html

irmi.gel.ulaval.ca/abstra...c_cryo.pdf

The Lumbopelvic Region – Current Research and its Clinical Application

Diane G. Lee Physiotherapist Corp.
Canada

www.manuellterapi.com/fil...n_2003.pdf

Quote:

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Over the past decade the sacroiliac joint and the role of the
pelvis in lumbopelvic pain has received considerable
attention and it is still a topic under debate. Many health
disciplines have contributed to our current level of
understanding and slowly a consensus is developing as to
the de.nition, diagnosis and treatment of pelvic impairment
or as it is more commonly known – sacroiliac joint dysfunction.

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