Download - Biomechanics of si joint
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Biomechanics Of
Sacroiliac Joints
Venus Pagare
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• Introduction • Osteology • Articulating surfaces• Ligaments• Blood supply• Nerve supply• Factors promoting • Stability• Kinematics• Functional consideration• Clinical anatomy• SI Dysfunction
FLOW OF THE LECTURE
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Sacroiliac (SI) Joint : • Articulations between Left and right articular surfaces on sacrum
and left and right iliac bones
INTRODUCTION
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• Plane synovial joint → modified
amphiarthrodial joint
• Stable, rigid; relatively immobile; allowing
effective load transfer
• Each of two SI joints are about 1-2 mm wide
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• Connects spine to pelvis
• Absorbs vertical forces from spine and
transmitting them to pelvis and lower
extremities
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SACRUM• Large flattened triangular bone• Formed by fusion of five sacral verebrae• Forms postero-superior part of bony pelvis
OSTEOLOGY
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• Upper part (base) of sacrum is massive
• Supports body weight & transmits it to hip bones
• Lower part (apex) is free from weight and therefore tapers rapidly
• Sacrum has pelvic, dorsal, & right & left lateral surface
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ILIUM
• Upper expanded plate like part of hip bone
Parts: • Upper end called iliac crest• Lower end which is smaller & fused with pubis
& ischium at acetabulum
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• Three borders: anterior, posterior & medial• Three surfaces: gluteal, iliac fossa &
sacropelvic surface
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SACRUM:• Auricular (C)-shaped on sides of fused sacral vertebrae • Covered with hyaline cartilage• Thicker than iliac cartilage
ILIA:• Covered with fibrocartilage• Type II collagen, typical of hyaline cartilage, has been
identified
ARTICULATING SURFACES
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• Flat and smooth in foetus
• Postpubertal : marked by a central groove or
surface depression
• Rough irregular surface with many large
ridges and depression
• Form an interlocking mechanism with the
ilium, fitting together like pieces of a puzzle
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• 6 times more resistant to lateral forces than
lumbar spine
• 1/20 resistance to forces in axial compression
• 1/2 resistance to rotational forces compared to
lumbar spine
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Primary Ligaments: Secondary Ligaments:a. Anterior sacroiliac a. Sacrotuberousb. Posterior sacroiliac b. Sacrospinousc. Interosseous
LIGAMENTS
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1. Anterior Sacroiliac Ligament• Iliac crests to tubercles of first four sacral vertebrae• Join ilia to sacrum• Thickening of part of capsule• Thin, not very strong
2. Interosseous SI ligament• Strong & massive• Superficial & Deep: Superior band Inferior band
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3. Posterior Sacroiliac Ligament• Stronger than anterior ligament and connects
sacrum to PSIS. • Categorized into two sets; - short (superior) posterior SI ligament;
horizontal - long (inferior) posterior SI ligament; vertical• Short & long
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4. Sacrospinous Ligament• Connects ischial spines to lateral borders of
sacrum and coccyx• Forms inferior border of greater sciatic notch
5. Sacrotuberous Ligament • Connects the ischial tuberosities to posterior
spines at ilia and lateral sacrum and coccyx• Forms inferior border of lesser sciatic notch.
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• Cartilaginous joint• Joins 2 ends of pubic bones• 3 ligaments associated are - superior pubic ligament - inferior pubic ligament - posterior ligament
SYMPHYSIS PUBIS
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• Branches of posterior division of internal iliac artery :
• Iliolumbar
• Lateral sacral &
• Superior gluteal arteries
Blood supply
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• Superior gluteal nerve
– Ventral rami &
– Lateral branches of dorsal rami of first & second sacral nerve
NERVE SUPPLY
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• Stability is primary requirment of joint• Maintained by: - Interlocking of articular surfaces - Thick & strong interosseous & posterior
sacroiliac ligaments - Vertebropelvic ligaments - With advancing age partial synostosis of
joint takes place which further reduces movements
FACTORS PROVIDING STABILITY
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• Very slight motion is available
• The SIJs are linked to symphysis pubis in a
closed kinematic chain
• Any motion at symphysis pubis is accompanied
by
motion at SIJs and vice versa
• Rotational motion : 0.2 – 2⁰
KINEMATICS
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• Translation motion : 1 – 2 mm
• Rom increase during pregnancy in which all
ligaments of pelvis become loose under
influence of hormones, to facilitate delivery of
foetus
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NUTATION COUNTER
NUTATION
• Movement of sacral promontory anteriorly & inferiorly
• Posterior ilium-on- sacrum rotation rotation
• Anterior tip of sacral promontory moves posteriorly & superiorly
• Anterior ilium-on- sacrum rotation
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• Coccyx moves posteriorly in relation to ilium
• AP diameter of pelvic brim is ↓
• AP diameter of pelvic outlet is ↑
• Coccyx moves anteriorly in relation to ilium
• AP diameter of pelvic brim is ↑
• AP diameter of pelvic outlet is ↓
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• SIJs and symphysis pubis are closely linked functionally to hip joint
• Affects and gets affected by movements of trunk and lower extremities
Hip flexion in supine position
Posterior tilting of ilium
Nutation at SIJs
↑ diameter of pelvic outlet
Facilitates delivery of Foetal head
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Hip flexion in supine
Anterior tilting of ilium
Counternutation at SIJs
↑ diameter of pelvic brim
Descent of foetal head in pelvis
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• Hip extended position is favored early in birthing process to facilitate descent of fetal head into pelvis
• Hip flexed position is used during delivery
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Movements of Ilium• Posterior Rotation• Anterior Rotation• Motion of innominate relative to sacrum occurs
about a coronal axis
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Posterior Rotation
• In Single leg standing:Both weight bearing and non
weight bearing innominates, posteriorly rotates relative to sacrum which is relatively nutated
• SIJ is thus in closed packed position
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• It is also associated with side flexion of pelvis.
a) Non-weight-bearing innominate: antero-superior relative to the sacrum.
b) Weight-bearing side: posterior and superior relative to the sacrum.
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Anterior Rotation• Occurs during extension of the freely
swinging leg
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2 main functions of SIJs:a. Stress relief in pelvic ring• During walking• During child birth
b. Stable means for transfer of load between axial skeleton and lower extremities
• SIJ plane is nearly vertical• Susceptible to slipping
FUNCTIONAL CONSIDERATIONS
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• Nutation ↑ stability by increasing compression and frictional forces
• Closed pack position = Full Nutation• Forces that create nutation torque include: - Gravity - Passive tension in stretched ligaments - Muscle tension
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Gravity
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Stretched Ligaments
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Muscles that reinforce and stabilize SIJ:• Erector Spinae• Lumbar multifidi• Abdominal muscles: External & Internal
obliques Rectus abdominis Transversus abdominis• Hamstrings such as biceps femoris
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• Lumbosacral trunk & ventral ramus of s1 nerve crosses pelvic surface of joint & may involved in area of their distribution
• During pregnancy pelvic joints & ligaments are relaxed, & locking mechanism becomes less efficient, it naturally puts greater strain on ligaments, the sacroiliac strain thus produced may persist even after pregnancy
CLINICAL ANATOMY
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• After childbirth ligaments are tightned up again, so that locking mechanism returns to its original efficiency
• Sometimes locking occurs in rotated position of hip bones adopted during pregnancy
• This results in subluxation of joint, causing low backache due to strain on ligaments
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The systemic causes of sacroiliac dysfunction:– Inflammatory conditions• Ankylosying spodylitis, Rheumatoid
Arthritis– Joint infections• Brucellosis, Tuberculosis
–Metabolic disorders• Gout, Hyper parathyroidism
–Miscellaneous• Osteitis condensans illi, Paget’s disease
SACROILIAC DYSFUNCTION
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Doubts??
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NUTATION
COUNTER NUTATION
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