Three-Dimensional Movements of the Sacroiliac Joint: A Systematic Review of the Literature and Assessment of Clinical Utility

Abstract

The high frequency of static and dynamic palpation methods used during evaluation of SIJ problems in clinical practice demands an understanding of the factual quantity of movement at the SIJ. The objective of this systematic literature review was to synthesize three-dimensional (3-D) motion of the sacroiliac joint (SIJ) during various functional static postures and movements and to determine the clinical utility of movement during examination. A computer-based search was performed by means of OVID, which included Medline (February 1966 to April 2007) and CINAHL (February 1982 to April 2007) using the key words Pelvis, Kinematics, Imaging, Three-dimensional, and Stereophotogrammetric. Articles included in-vivo or in-vitro studies that investigated human SIJs with 3-D analysis. Three-dimensional analyses conducted using mathematical modeling, computerized modeling, and/or skin markers were not included because of concerns of transferability and validity. Studies that failed to report standard error of measurement (SEM) or defined tabulated values for translations or rotations using the Cartesian coordinate system were not considered for this study. Studies included for review were analyzed by the SBC biomechanical checklist to measure the quality of procedural design. Seven manuscripts were eligible for inclusion in this study. Rotation ranged between -1.1 to 2.2 degrees along the X-axis, -0.8 to 4.0 degrees along the Y-axis, and -0.5 to 8.0 degrees along the Z-axis. Translation ranged between -0.3 to 8.0 millimeters (mm) along the X-axis, -0.2 to 7.0 mm along the Y-axis, -0.3 to 6.0 mm along the Z-axis. Motion of the SIJ is limited to minute amounts of rotation and of translation suggesting that clinical methods utilizing palpation for diagnosing SIJ pathology may have limited clinical utility.

Precision and Accuracy Measurement of Radiostereometric Analysis Applied to Movement of the Sacroiliac Joint

“…Second, a potential source of error in our model is that the actual movement of interest exceeds ROM in our phantom. All clinical RSA studies describe small movements in the SI joint [5,[16][17][18][19][20]. In these studies, a maximum rotation of 3.6°is seen and the translation never exceeds 2 mm.…”

“…Different radiographic modalities have been used to measure movement in the sacroiliac (SI) joint objectively [7,12,15], whereas five studies have used RSA to evaluate movement between the sacrum and the ilium [16][17][18][19][20]. With RSA, a maximum rotation of 3.6°has been measured and the translation never exceeded 2 mm in the SI joint, which is less movement than other methods have revealed [5], and for this reason the method has been questioned [3]. Despite the use of pelvic RSA in clinical research, the accuracy and precision have not been fully evaluated.…”

The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature

“…These are very large numbers relative to some very conservative contemporary estimates of sacroiliac mobility, such as those of Sturesson et al [31][32][33] and those appearing in a review article by Goode et al 34 However, the 1.5 in of artificial LLI created by Pitkin and Pheasant is also very large compared with the amount of LLI produced or found in other studies herein reviewed, some of which showed a linear, monotonic dose response of pelvic torsion to induced LLI. Moreover, the mean amount of torsion reported by them is within shouting distance of other modern investigators who have reported far more torsion to occur, such as a clinical study by Cibulka et al, 35 a cadaveric study using advanced imaging by Smidt et al, 36 another clinical study by Smidt et al, 37 and the Drerup and Hierholzer 20 study included in this review.…”

Emotional-based practice

“…We now know that a wealth of evidence exists that suggests that palpation-based tests are not reliable or valid, during the diagnostic process for sacroiliac joint syndrome. [14][15][16][17] If one looks at this without emotion, it makes good sense; the movements are minute, 18 the joints are covered with excessive amounts of soft tissue and fat, and other diagnoses (that are typically more prevalent) such as low back pain will yield positive findings on palpation tests (findings are not unique to the sacroiliac joint). 19 Nonetheless, clinicians still advocate their use as diagnostic measures because they see changes in patients when they perform an intervention that is targeted to the sacroiliac joint.…”