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Biomechanics
Of
Sacroiliac Joints
Venus Pagare
1
• Introduction
• Osteology
• Articulating surfaces
• Ligaments
• Blood supply
• Nerve supply
• Factors promoting
• Stability
• Kinematics
• Functional consideration
• Clinical anatomy
• SI Dysfunction
FLOW OF THE LECTURE
2
Sacroiliac (SI) Joint :
• Articulations between
Left and right articular surfaces on sacrum and left and
right iliac bones
INTRODUCTION
3
• 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
4
• Connects spine to pelvis
• Absorbs vertical forces from spine and transmitting
them to pelvis and lower extremities
5
SACRUM
• Large flattened triangular bone
• Formed by fusion of five sacral verebrae
• Forms postero-superior part of bony pelvis
OSTEOLOGY
6
• 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
7
8
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
9
• Three borders: anterior, posterior & medial
• Three surfaces: gluteal, iliac fossa & sacropelvic surface
10
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
11
• 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
12
• 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
13
Primary Ligaments: Secondary Ligaments:
a. Anterior sacroiliac a. Sacrotuberous
b. Posterior sacroiliac b. Sacrospinous
c. Interosseous
LIGAMENTS
14
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
15
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
16
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.
17
• Cartilaginous joint
• Joins 2 ends of pubic bones
• 3 ligaments associated are
- superior pubic ligament
- inferior pubic ligament
- posterior ligament
SYMPHYSIS PUBIS
18
• Branches of posterior division of internal iliac artery :
• Iliolumbar
• Lateral sacral &
• Superior gluteal arteries
Blood supply
19
• Superior gluteal nerve
– Ventral rami &
– Lateral branches of dorsal rami of first & second
sacral nerve
NERVE SUPPLY
20
21
• 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
22
• 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
23
• 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
24
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
25
• 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 ↓
26
• 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
27
Hip flexion in supine
Anterior tilting of ilium
Counternutation at SIJs
↑ diameter of pelvic brim
Descent of foetal head in pelvis
28
• Hip extended position is favored early in birthing
process to facilitate descent of fetal head into pelvis
• Hip flexed position is used during delivery
29
Movements of Ilium
• Posterior Rotation
• Anterior Rotation
• Motion of innominate relative to sacrum occurs
about a coronal axis
30
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
31
• 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.
32
Anterior Rotation
• Occurs during extension of the freely swinging leg
33
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
34
• 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
35
Gravity
36
Stretched Ligaments
37
Muscles that reinforce and stabilize SIJ:
• Erector Spinae
• Lumbar multifidi
• Abdominal muscles: External & Internal obliques
Rectus abdominis
Transversus abdominis
• Hamstrings such as biceps femoris
38
• 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
39
• 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
40
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
41
Doubts??
42
43
NUTATION
COUNTER
NUTATION
44
45

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Biomechanics of si joint

  • 2. • Introduction • Osteology • Articulating surfaces • Ligaments • Blood supply • Nerve supply • Factors promoting • Stability • Kinematics • Functional consideration • Clinical anatomy • SI Dysfunction FLOW OF THE LECTURE 2
  • 3. Sacroiliac (SI) Joint : • Articulations between Left and right articular surfaces on sacrum and left and right iliac bones INTRODUCTION 3
  • 4. • 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 4
  • 5. • Connects spine to pelvis • Absorbs vertical forces from spine and transmitting them to pelvis and lower extremities 5
  • 6. SACRUM • Large flattened triangular bone • Formed by fusion of five sacral verebrae • Forms postero-superior part of bony pelvis OSTEOLOGY 6
  • 7. • 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 7
  • 8. 8
  • 9. 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 9
  • 10. • Three borders: anterior, posterior & medial • Three surfaces: gluteal, iliac fossa & sacropelvic surface 10
  • 11. 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 11
  • 12. • 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 12
  • 13. • 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 13
  • 14. Primary Ligaments: Secondary Ligaments: a. Anterior sacroiliac a. Sacrotuberous b. Posterior sacroiliac b. Sacrospinous c. Interosseous LIGAMENTS 14
  • 15. 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 15
  • 16. 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 16
  • 17. 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. 17
  • 18. • Cartilaginous joint • Joins 2 ends of pubic bones • 3 ligaments associated are - superior pubic ligament - inferior pubic ligament - posterior ligament SYMPHYSIS PUBIS 18
  • 19. • Branches of posterior division of internal iliac artery : • Iliolumbar • Lateral sacral & • Superior gluteal arteries Blood supply 19
  • 20. • Superior gluteal nerve – Ventral rami & – Lateral branches of dorsal rami of first & second sacral nerve NERVE SUPPLY 20
  • 21. 21
  • 22. • 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 22
  • 23. • 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 23
  • 24. • 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 24
  • 25. 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 25
  • 26. • 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 ↓ 26
  • 27. • 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 27
  • 28. Hip flexion in supine Anterior tilting of ilium Counternutation at SIJs ↑ diameter of pelvic brim Descent of foetal head in pelvis 28
  • 29. • Hip extended position is favored early in birthing process to facilitate descent of fetal head into pelvis • Hip flexed position is used during delivery 29
  • 30. Movements of Ilium • Posterior Rotation • Anterior Rotation • Motion of innominate relative to sacrum occurs about a coronal axis 30
  • 31. 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 31
  • 32. • 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. 32
  • 33. Anterior Rotation • Occurs during extension of the freely swinging leg 33
  • 34. 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 34
  • 35. • 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 35
  • 38. Muscles that reinforce and stabilize SIJ: • Erector Spinae • Lumbar multifidi • Abdominal muscles: External & Internal obliques Rectus abdominis Transversus abdominis • Hamstrings such as biceps femoris 38
  • 39. • 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 39
  • 40. • 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 40
  • 41. 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 41
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