scholarly journals Perinatal Sacroiliitis Diagnostic Challenges: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 01-06
Author(s):  
Emam M. Kheder ◽  
Hussain H. Sharahili ◽  
Salma y. Albahrani ◽  
Abdullah M. Alfarhan ◽  
Abdulrahman M. Alquraynis ◽  
...  
Keyword(s):  
Pathogenic Bacteria ◽  
Post Partum ◽  
Vital Signs ◽  
Symphysis Pubis ◽  
Pelvic Girdle ◽  
Pelvic Girdle Pain ◽  
Clinical Impression ◽  
X Rays ◽  
Lower Back ◽  
The Right

Background: Lumbo-pelvic (LPP) pain is common and non specific problem during pregnancy and post partum. Despite the fact that perinatal pyogenic sacroiliitis (PSI) during this period is rare, it should be considered as a vital differential diagnosis in women who have debilitating lower back and pelvic girdle pain. Case: A 34 years old primigravida presented to the emergency department with extreme right sided lower back pain radiating to the right gluteal region and down to the back of the right thigh. This pain began twelve days prior to her presentation and eventually worsened to the point that she couldn't stand or walk. Her vital signs were within normal limits, and she was febrile. Apart from a slight widening of the symphysis pubis, her pelvic and lumbo-sacral plain x-rays revealed no important findings. With the clinical impression of right LPP, the patient was admitted for pain management and further inquiries. Conclusion: Despite the fact that lower back and pelvic girdle pain are normal throughout pregnancy and the postpartum period, perinatal PSI is uncommon. It's a tough diagnosis to make because the symptoms and signs aren't clear, and the tests aren't definitive. When pathognomonic clinical and radiologic signs indicate an infectious process and isolation of pathogenic bacteria is not possible, medical management with empirical antibiotics should not be delayed.

scholarly journals Perinatal sacroiliitis diagnostic challenges

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110524
Author(s):  
Emam M Kheder ◽  
Hussain H Sharahili ◽  
Salma Y Albahrani ◽  
Abdullah M Alfarhan ◽  
Abdulrahman M Alquraynis ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Symphysis Pubis ◽  
Pelvic Girdle Pain ◽  
Clinical Impression ◽  
X Rays ◽  
Pyogenic Sacroiliitis ◽  
Lower Back ◽  
Normal Ranges ◽  
Pregnancy And Postpartum ◽  
The Right

Lumbo-pelvic pain is a common and non-specific problem during pregnancy and postpartum. Although perinatal pyogenic sacroiliitis is uncommon during this time, it might be difficult to distinguish from reactive sacroiliitis in women who are experiencing significant lower back and pelvic girdle pain, as the symptoms and signs are not clear and the tests are not definitive. A 34-year-old primigravida went to the emergency department with severe lower back pain radiating to the right gluteal region and down to the back of the right thigh. This pain began 12 days prior to her presentation and eventually worsened to the point that she could not stand or walk. Her vital signs were within normal ranges, and she was experiencing a fever. Apart from a slight widening of the symphysis pubis, her pelvic and lumbo-sacral pain X-rays revealed no important findings. With the clinical impression of right lumbo-pelvic pain, the patient was admitted for pain management and further inquiries. Despite the fact that the antibiotherapy was prescribed to treat a urinary tract infection, the significant recovery of the patient’s symptoms, even in the absence of a definitive culture of aspirate from the right sacroiliac joint, supported the diagnosis of pyogenic sacroiliitis.

scholarly journals Case series of pubic bone diastasis causing severe pelvic girdle pain in pregnancy

2019 ◽  
Vol 8 (11) ◽  
pp. 4612
Author(s):  
Pooja Gupta ◽  
Renuka Malik
Keyword(s):  
Conservative Management ◽  
Post Partum ◽  
Treatment Guideline ◽  
Case Series ◽  
Pelvic Girdle ◽  
Pelvic Girdle Pain ◽  
Treatment Modalities ◽  
Pubic Bone ◽  
X Rays ◽  
Pubic Symphysis Diastasis

Pelvic girdle pain (PGP) is a pregnancy discomfort that causes pain and limitation of mobility and functioning in any of the three pelvic joints. The patient usually presents antenatally with persistent suprapubic pain which is exaggerated during moving, walking or climbing stairs. Intrapartum, this could be associated with disruption of sacroiliac joint, hematuria and bladder dysfunction in severe cases. Pelvic X-rays, ultrasound, and magnetic resonance imaging aid in confirmation of diagnosis by measuring the degree of separation of symphysis. Treatment modalities range from conservative management to orthopedic interventions in form of pelvic strapping, open reduction and internal fixation. Postpartum pain often masks clinicians to make the diagnosis of pubic symphysis diastasis. A case series of three cases which were diagnosed and confirmed with ultrasound and managed with orthopedic consultation. till their delivery and in post-partum period till recovery. Although there is still no specific consensus on treatment guideline, management generally of conservative management to surgical in the form of pelvic bracing or strapping. Awareness of this rare condition can help in management of pain and associated disability which improves post-delivery.

scholarly journals Evaluation of the Ability of Physical Therapists to Palpate Intrapelvic Motion With the Stork Test on the Support Side

2007 ◽  
Vol 87 (7) ◽  
pp. 879-887 ◽  
Author(s):  
Barbara A Hungerford ◽  
Wendy Gilleard ◽  
Michael Moran ◽  
Cathryn Emmerson
Keyword(s):  
Load Transfer ◽  
Physical Therapists ◽  
Weight Bearing ◽  
Pelvic Girdle ◽  
Pelvic Girdle Pain ◽  
Point Scale ◽  
Good Reliability ◽  
Clinical Indicators ◽  
Functional Load ◽  
The Right

Background and Purpose Clinical indicators of pelvic girdle dysfunction are limited. However, research has shown that the pattern of intrapelvic motion is altered during single-leg support in subjects with pelvic girdle pain (PGP). Functionally, no relative motion should occur within the pelvis during load transfer, whereas anterior rotation of the innominate bone relative to the sacrum occurs during weight bearing in the presence of PGP. The aim of this study was to investigate whether the pattern of intrapelvic motion could be detected reliably during a new clinical assessment test for functional load transfer: the Stork Test on the support side. Subjects and Methods Three physical therapists were randomly assigned to palpate the motion of the innominate bones and sacrum in 33 subjects during the Stork Test on the support side. The direction of bone motion was indicated on 2-point and 3-point scales. Results When a 2-point scale was used, intertherapist agreement on the pattern of intrapelvic motion occurring during load transfer showed good reliability (left κ=.67, right κ=.77), and the percentage of agreement was high (left=91.9%, right=89.9%). A 3-point scale resulted in moderate reliability for both the left and the right sides (left κ=.59, right κ=.59), and the percentage of agreement decreased to 82.8% (left) and 79.8% (right). Discussion and Conclusion The ability of the physical therapists to reliably palpate and recognize an altered pattern of intrapelvic motion during the Stork Test on the support side was substantiated. The ability to distinguish between no relative movement and anterior rotation of the innominate bone during a load-bearing task was good. Further research is needed to determine the validity of this test for detecting pelvic girdle dysfunction.

Ultrasound for Endotracheal Tube Tip Position in Term and Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Sabrina Salvadori ◽  
Daniel Nardo ◽  
Anna Chiara Frigo ◽  
Martina Oss ◽  
Irene Mercante ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Neonatal Intensive Care ◽  
Vital Signs ◽  
X Rays ◽  
Right Pulmonary Artery ◽  
Chest X Ray ◽  
Tip Position ◽  
The Right ◽  
A Prospective Study ◽  
Mean Time

<b><i>Background and Objective:</i></b> Placing an endotracheal tube (ETT) in neonates is challenging and currently requires timely radiographic confirmation of correct tip placement. The objective was to establish the reliability of ultrasound (US) for assessing ETT position in the neonatal intensive care unit (NICU), time needed to do so, and patients’ tolerance. <b><i>Methods:</i></b> A prospective study on 71 newborns admitted to our NICU whose ETT placement was evaluated with US (ETT-echo) and confirmed on chest X-rays (CXR). Data were collected by 3 operators (2 neonatologists and a resident in pediatrics). The right pulmonary artery (RPA) was used as a landmark for US. The distance between the tip of the ETT and the upper margin of the RPA was measured using US and compared with the distance between the tube’s tip and the carina on the CXR. <b><i>Results:</i></b> Seventy-one intubated newborns were included in the study (<i>n</i> = 34 &#x3c; 1,000 g, <i>n</i> = 18 1,000–2,000 g, <i>n</i> = 19 &#x3e; 2,000 g). Statistical analysis (Bland-Altman plot and Lin’s concordance correlation coefficient) showed an excellent consistency between ETT positions identified on US and chest X-ray. The 2 measures (ETT-echo and CXR) were extremely concordant both in the whole sample and in the subgroups. Minimal changes in patients’ vital signs were infrequently observed during US, confirming the tolerability of ETT-echo. The mean time to perform US was 3.2 min (range 1–13). <b><i>Conclusions:</i></b> ETT-echo seems to be a rapid, tolerable, and highly reliable method worth further investigating for future routine use in neonatology with a view to reducing radiation exposure.

scholarly journals Trajectories of lower back, upper back, and pelvic girdle pain during pregnancy and early postpartum in primiparous women

2019 ◽  
Vol 15 ◽  
pp. 174550651984275 ◽  
Author(s):  
Guinn Dunn ◽  
Marlene J Egger ◽  
Janet M Shaw ◽  
Jingye Yang ◽  
Tyler Bardsley ◽  
...  
Keyword(s):  
Pelvic Girdle ◽  
Pelvic Girdle Pain ◽  
Low Back ◽  
Prevalence Rates ◽  
Lower Back ◽  
Single Location ◽  
Early Postpartum ◽  
Primiparous Women ◽  
Time Point ◽  
Experience Pain

Objective: Most studies about truncal pain during and after pregnancy focus on low back pain, few prospectively define change in pain, and even fewer evaluate pain in all three major truncal areas: upper back, lower back, and pelvic girdle. Thus, the objective of this prospective cohort study was to describe, in primiparous women delivered vaginally, prevalence rates and severities of upper back, lower back, and pelvic girdle pain during pregnancy and 6–10 weeks postpartum and to describe the trajectory of pain constellations between time points. Study design: Participants completed questionnaires at each time point. Pain intensity was rated on a visual analogue scale ranging from 0 to 100. Results: Of the 288 participants, 94% reported truncal pain during pregnancy, while 75% did so postpartum. Prevalence rates of upper back, lower back, and pelvic girdle pain with or without other types of pain during pregnancy were 42%, 77%, and 74% and postpartum were 43%, 52%, and 41%, respectively. Pain severity was highest for women endorsing pain in three locations (median 55–60). Of women with the most common pain constellation during pregnancy, lower back and pelvic girdle (32%), 18% had persistent low back and pelvic girdle pain postpartum, 20% had no pain, and the remainder had pain in a different location. Of women with pain in all three locations during pregnancy (27%), 34% had persistent pain in three locations postpartum, 13% had no pain, and the remainder had pain in at least one location. Conclusion: More women experience pain in a constellation of locations than in a single location. Severity increases as number of pain sites increase. Women with pain in three sites during pregnancy are least likely to have pain resolve. Interventions should focus on the entire trunk and not simply one site of pain.

scholarly journals Validation of self-administered tests for screening for chronic pregnancy-related pelvic girdle pain

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Monika Fagevik Olsén ◽  
Paulina Körnung ◽  
Sophie Kallin ◽  
Helen Elden ◽  
Gunilla Kjellby Wendt ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Post Partum ◽  
Pelvic Girdle ◽  
The Self ◽  
Pelvic Girdle Pain ◽  
Test Results ◽  
Provocation Tests ◽  
Pain Provocation ◽  
Significant Difference

Abstract Background Many women develop pelvic girdle pain (PGP) during pregnancy and about 10% have chronic pain several years after delivery. Self-administered pain provocation tests are one way to diagnose and evaluate this pain. Their validity in post-partum women is not yet studied. The purpose of this study was to evaluate the validity of self-administered test for assessment of chronic pregnancy-related PGP several years after delivery. Methods Women who previously have had PGP during pregnancy and who participated in one of three RCT studies were invited to a postal follow up of symptoms including performance of self-administered tests after two, 6 or 11 years later, respectively. In total, 289 women returned the questionnaire and the test-results. Of these, a sub-group of 44 women with current PGP underwent an in-person clinical examination. Comparisons were made between test results in women with versus without PGP but also, in the sub-group, between the self-administered tests and those performed during the clinical examination. Results Fifty-one women reported PGP affecting daily life during the last 4 weeks, and 181 reported pain when performing at least one of the tests at home. Those with chronic PGP reported more positive tests (p < 0.001). There was no significant difference between diagnosis from the self-administered tests compared to tests performed during the in-person clinical examination (p = 0.305), either for anterior or posterior PGP. There were no significant differences of the results between the tests performed self-administered vs. during the clinical examination. Conclusion A battery of self-administered tests combined with for example additional specific questions or a pain-drawing can be used as a screening tool to diagnose chronic PGP years after delivery. However, the modified SLR test has limitations which makes its use questionable.

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