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Manuelle Medizin

, Volume 56, Issue 1, pp 13–19 | Cite as

Über die Diagnostik des Sakroiliakalgelenks

  • W. von Heymann
Leitthema
  • 151 Downloads

Zusammenfassung

Es gibt zahlreiche Tests zur Überprüfung, ob ein Becken-Bein-Schmerz durch eine Fehlfunktion der Sakroiliakalgelenke (SIG) ausgelöst sein könnte. Die Evidenzlage dieser Tests ist weiterhin unübersichtlich und widersprüchlich. Da die biomechanisch mögliche Beweglichkeit dieser Gelenke minimal ist, wird eine Reihe sehr beliebter Bewegungspalpationen und vermeintlicher Funktionsprüfungen als nicht zuverlässig eingeschätzt. Einige Tests aus der Kategorie „Schmerzprovokationstest“ haben sich dagegen als verlässlich erwiesen, wenn sie nach einiger Übung in einer Kombination aus mehreren Tests durchgeführt werden. Dabei sollten mindestens 3 von 5 Tests zur gleichen positiven Aussage führen, um die Diagnose einer SIG-Dysfunktion zu stellen. Allerdings werden die bereits als zuverlässig evaluierten Schmerzprovokationstests nicht überall gelehrt. Daher werden derzeit die seit Langem in Deutschland und Österreich gelehrten Tests einer Überprüfung unterzogen. Nach dem Ergebnis dieser Studie kann entschieden werden, welche Kombination von Schmerzprovokationstests in Zukunft als zuverlässig empfohlen werden kann.

Schlüsselwörter

Evidenzbasierte Medizin Biomechanik Diagnostischer Test Muskuloskeletaler Schmerz Reliabilität 

Diagnostic tests for the sacroiliac joint

Abstract

There exist a vast number of tests to assess whether pain in the pelvic girdle and leg could be the result of sacroiliac joint (SIJ) dysfunction. The evidence for these tests still is confusing and contradictory. As the biomechanically possible mobility of these joints is minimal, quite a number of popular motion palpations and supposed functional tests cannot be assumed to be reliable. In contrast, several tests out of the “pain provocation tests” category have shown good reliability when applied by an experienced examiner in combination with multiple other tests. At least three of five tests should show the same positive result in order to diagnose SIJ dysfunction. However, the pain provocation tests which have already been proven to be reliable are not taught everywhere. Therefore, the tests that have been used for many years in Germany and Austria are currently being evaluated. The results of this study will enable a decision regarding which pain provocation tests can be recommended as reliable in the future.

Keywords

Evidence-based medicine Biomechanics Diagnostic test Musculoskeletal pain Reliability 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

W. von Heymann gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Barker PJ, Hapuarachchi KS et al (2014) Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Clin Anat 27(2):234–240CrossRefPubMedGoogle Scholar
  2. 2.
    Beales DJ, O’Sullivan PB, Briffa NK (2009) Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects. Spine (Phila Pa 1976) 34:861–870CrossRefGoogle Scholar
  3. 3.
    Berthelot JM, Labat JJ, Le Goff B, Gouin F, Maugars Y (2006) Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain. Joint Bone Spine 73:17–23CrossRefPubMedGoogle Scholar
  4. 4.
    Böhni U, Lauper M, Locher H (2012) Manuelle Medizin 2. Diagnostische und therapeutische Techniken praktisch anwenden. Thieme, Stuttgart, S 384–395Google Scholar
  5. 5.
    Böhni U, Locher H (2015a) Neurophysiologische Grundlagen der segmentalen Dysfunktion. In: Böhni U, Lauper M, Locher H (Hrsg) Manuelle Medizin 1. Fehlfunktion und Schmerz am Bewegungsorgan verstehen und behandeln. Thieme, Stuttgart, S 186–191Google Scholar
  6. 6.
    Böhni U (2015b) Lumbosakraler Übergang und Beckenring. In: Böhni U, Lauper M, Locher H (Hrsg) Manuelle Medizin 1. Fehlfunktion und Schmerz am Bewegungsorgan verstehen und behandeln. Thieme, Stuttgart, S 544–586Google Scholar
  7. 7.
    Bowen V, Cassidy JD (1981) Macroscopic and microscopic anatomy of the sacroiliac joint from embryonic life to the eighth decade. Spine (Phila Pa 1976) 6:620–628CrossRefGoogle Scholar
  8. 8.
    Dreyfuss P, Michaelsen M et al (1996) The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine (Phila Pa 1976) 21(22):2594–2602CrossRefGoogle Scholar
  9. 9.
    Grob KR, Neuhuber WL, Kissling RO (1995) Innervation of the sacroiliac joint of the human. Z Rheumatol 54:117–122PubMedGoogle Scholar
  10. 10.
    Fortin JD, Dwyer AP, West S et al. (1994) Sacroiliac joint: Pain referral maps applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine 19:1475–1482Google Scholar
  11. 11.
    Fortin JD, Kissling RO, O’Connor BL, Vilensky JA (1999) Sacroiliac joint innervation and pain. Am J Orthop 28(12):687–690PubMedGoogle Scholar
  12. 12.
    Fortin JD, Tolchin RB (2003) Sacroiliac arthrograms and post-arthrography computerized tomography. Pain Physician 6(3):287–290PubMedGoogle Scholar
  13. 13.
    Hancock MJ, Maher CG et al (2007) Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J 16:1539–1550CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Hungerford BA, Gilleard W et al (2007) Evaluation of the ability of physical therapists to palpate intrapelvic motion with the Stork test on the support side. Phys Ther 87(7):879–887CrossRefPubMedGoogle Scholar
  15. 15.
    Ikeda R (1991) Innervation of the sacroiliac joint. Macroscopical and histological studies. Nippon Ika Daigaku Zasshi 58:587–596CrossRefPubMedGoogle Scholar
  16. 16.
    Kissling R, Brunner C, Jacob HA (1990) Mobility of the sacroiliac joint in vitro. Z Orthop Ihre Grenzgeb 128:282–288CrossRefPubMedGoogle Scholar
  17. 17.
    Klein P, Sommerfeld P (2004) Biomechanik der menschlichen Gelenke – Grundlagen, Becken, untere Extremität. Urban & Fischer, München, S 142–168Google Scholar
  18. 18.
    Laslett M, Young SB et al (2003) Diagnosing painful sacroiliac joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother 49:89–97CrossRefPubMedGoogle Scholar
  19. 19.
    Laslett M, Aprill CN et al (2005) Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther 10(3):207–218CrossRefPubMedGoogle Scholar
  20. 20.
    Laslett M (2008) Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther 16(3):142–152CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Maigne JY, Aivaliklis A, Pfefer F (1996) Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine (Phila Pa 1976) 21:1889–1892CrossRefGoogle Scholar
  22. 22.
    McCombe PF, Fairbank JC, Cockersole BC et al (1989) 1989 Volvo Award in clinical sciences. Reproducibility of physical signs in low-back pain. Spine (Phila Pa 1976) 14:908–918CrossRefGoogle Scholar
  23. 23.
    Meijne W, van Neerbos K et al (1999) Intraexaminer and interexaminer reliability of the Gillet test. J Manipulative Physiol Ther 22(1):4–9CrossRefPubMedGoogle Scholar
  24. 24.
    Mens JM, Vleeming A, Snijders CJ et al (1999) The active straight leg raising test and mobility of the pelvic joints. Eur Spine J 8:468–473CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Mense S (2011) Unterschiede zwischen myofaszialen Triggerpunkten und „tender points“. Schmerz 25:93–103CrossRefPubMedGoogle Scholar
  26. 26.
    Ostgaard HC, Zetherström G, Roos-Hansson E (1994) The posterior pelvic pain provocation test in pregnant women. Eur Spine J 3:258–260CrossRefPubMedGoogle Scholar
  27. 27.
    Patel N, Gross A, Brown L et al (2012) A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med 13:383–398CrossRefPubMedGoogle Scholar
  28. 28.
    Potter N, Rothstein J (1985) Intertester reliability for selected clinical tests of the sacroiliac joint. Phys Ther 65:1671–1675CrossRefPubMedGoogle Scholar
  29. 29.
    Robinson HS, Brox JI et al (2007) The reliability of selected motion- and pain provocation tests for the sacroiliac joint. Man Ther 12(1):72–79CrossRefPubMedGoogle Scholar
  30. 30.
    Scheuer L, Black S (2000) Developmental Juvenile Osteology. San Diego: ElsevierGoogle Scholar
  31. 31.
    Solonen KA (1957) The sacroiliac joint in the light of anatomical, roentgenological and clinical studies. Acta Orthop Scand 28(Suppl):1–127Google Scholar
  32. 32.
    Stecco C, Pavan P, Pachera P, DeCaro R, Natali A (2014) Investigations of the mechanical properties of the human crural fascia and their possible clinical implications. Surg Radiol Anat 36:25–32CrossRefPubMedGoogle Scholar
  33. 33.
    Stecco C (2015) Chapter 3: Deep fasciae. In: Functional Atlas of the human fascial system. Churchill Livingstone, Edinburgh, S 51–102CrossRefGoogle Scholar
  34. 34.
    Sturesson B, Uden A, Vleeming A (2000a) A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine (Phila Pa 1976) 25:364–368CrossRefGoogle Scholar
  35. 35.
    Sturesson B, Uden A, Vleeming A (2000b) A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine (Phila Pa 1976) 25:214–217CrossRefGoogle Scholar
  36. 36.
    Szadek KM, Hoogland PV, Zuurmond WW et al (2008) Nociceptive nerve fibers in the sacroiliac joint in humans. Reg Anesth Pain Med 33:36–43CrossRefPubMedGoogle Scholar
  37. 37.
    Szadek KM, van der Wurff P et al (2009) Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. J Pain 10(4):354–368CrossRefPubMedGoogle Scholar
  38. 38.
    Szadek KM, Hoogland PV, Zuurmond WW et al (2010) Possible nociceptive structures in the sacroiliac joint cartilage: an immunohistochemical study. Clin Anat 23:192–198PubMedGoogle Scholar
  39. 39.
    Tullberg T, Blomberg S et al (1998) Manipulation does not alter the position of the sacroiliac joint. A roentgen stereophotogrammetric analysis. Spine (Phila Pa 1976) 23(10):1124–1129CrossRefGoogle Scholar
  40. 40.
    van der Wurff P, Hagmeijer RH, Meyne W (2000) Clinical tests of the sacroiliac joint. A systematic methodological review. Part 1: reliability. Man Ther 5(1):30–36CrossRefPubMedGoogle Scholar
  41. 41.
    van der Wurff P, Meyne W, Hagmeijer RH (2000) Clinical tests of the sacroiliac joint. Man Ther 5(2):89–96CrossRefPubMedGoogle Scholar
  42. 42.
    van der Wurff P, Buijs EJ, Groen GJ (2006) A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures. Arch Phys Med Rehabil 87:10–14CrossRefPubMedGoogle Scholar
  43. 43.
    Visser LH, Nijssen PG et al (2013a) Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis. Eur Spine J 22(7):1657–1664CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Visser LH, Woudenberg NP et al (2013b) Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial. Eur Spine J 22(10):2310–2317CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Vleeming A, Stoeckart R (2007) The role of the pelvic girdle in coupling the spine and the legs: a cinical-anatomical perspective on pelvic stability. In: Vleeming A, Mooney V, Stoeckart R (Hrsg) Movement, stability and lumbopelvic pain: integration and research. Churchill Livingstone, Edinburgh, S 113–137Google Scholar
  46. 46.
    Vleeming A, Albert HB, Ostgaard HC et al (2008) European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 17:794–819CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Vleeming A, Schuenke MD et al (2012) The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 221:537–567CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Yin W, Willard F, Carreiro J et al (2003) Sensory stimulation guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976) 28:2419–2425CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.BremenDeutschland

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