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Das Sakroiliakalgelenk und die sakroiliakale Dysfunktion

Review – Literaturüberblick

The sacroiliac joint and sacroiliac dysfunction

Review of the literature

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Zusammenfassung

Die sakroiliakale Dysfunktion (SD), d. h. der Schmerz, der vom Sakroiliakalgelenk und dessen periartikulären Strukturen ausgelöst wird, ist in den zahlreichen Publikationen als Teil des tief sitzenden Rückenschmerzes („low back pain“) angegeben. Die Diagnosestellung und Behandlung der SD werden jedoch kontrovers diskutiert und sind in der Literatur nicht standardisiert. Wie alle Verfahren der manuellen Medizin müssen sich diagnostische und therapeutische Techniken auch im Hinblick auf das Sakroiliakalgelenk nach wissenschaftlichen Kriterien bewerten lassen. Für die Diagnostik der SD stehen Schmerzprovokationstests und Bewegungsprüfungen bzw. Palpationstests zur Verfügung. Die Reliabilität der Provokationstests ist deutlich höher als die der Motilitätstest. Bei Anwendung mehrerer Schmerzprovokationstests wird eine gute Reliabilität und Validität erreicht. Die Wirksamkeit lokaler manualtherapeutischer Behandlungstechniken bei SD ist in verschiedenen Studien belegt. Dabei finden sich keine Unterschiede zwischen Manipulationen und Mobilisationen. Im vorliegenden Artikel werden neben anatomischen Besonderheiten und Angaben zu Epidemiologie, Ätiologie, Pathogenese und Differenzialdiagnostik verschiedene Diagnostikverfahren und Behandlungsmöglichkeiten der SD unter Berücksichtigung des vorliegenden Evidenzgrades beschrieben.

Abstract

Sacroiliac dysfunction (SD), i.e. the pain resulting from the sacroiliac joint and the periarticular structure, is classified in the many available publications as part of deep lying back pain. The diagnostic procedure and treatment of SD are, however, controversially discussed and there is no consensus in the literature. Just like all other methods in manual medicine, diagnostic and therapeutic techniques must be evaluated by scientific criteria with respect to the sacroiliac joint. For the diagnosis of SD, tests such as the pain provocation test and motility check or palpation tests are available. The reliability of the provocation test is much higher than the motility test and a good level of reliability and validity can be attained using several pain provocation tests. The effectiveness of local manual therapeutic treatment techniques for SD has been demonstrated in various studies and no differences between manipulation and mobilization have been demonstrated. In this article the anatomical characteristics, epidemiology, etiology and pathogenesis as well as the differential diagnosis using various diagnostic procedures and treatment options of SD will be described with respect to the individual evidence-based grading present.

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  1. Zentrum für spezielle Chirurgie des Bewegungsapparates, Charité – Universitätsmedizin Berlin –Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    R. Kayser

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Kayser, R. Das Sakroiliakalgelenk und die sakroiliakale Dysfunktion. Manuelle Medizin 46, 69–72 (2008). https://doi.org/10.1007/s00337-008-0594-5

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