Very well explained presentation about the problems of sacroiliac joints. What about the cure for such different situations? Do some exercises will help in some cases or one needs invasive surgery in some other situations? Or should we live with the pain?
Exercises are helpful for many of these problems. While exercises and occasional painkillers are recommended for osteitis condensans and degeneration due to anatomical variants, it is now believed that stronger medication must be prescribed for axial spondyloarthritis, in parallel with physiotherapy. You should consult a rheumatologist.
What is the rhomboid skin depression on the sacroiliac joint area, which is slightest darker than the rest of the skin? That same area hurts. Would that be an infection, or…?
Do osteitis condensus will have focal narrowing of anteror- inferior aspect/ synovial component of bilateral Si joint with Subchondral bone irregularity with erosion bone changes mainly on the iliac side? Also the affected marrow demonstrate high signal on STIR change representing osteitis. Is this more of sacroilits or OCI? Any possibility of ax SpA?
Based on your description, the findings-particularly the focal narrowing, subchondral bone irregularity, and bone marrow edema on STIR-are more suggestive of sacroiliitis rather than osteitis condensans ilii (OCI). However, the location of the osteitis in the anterior joint region does give a reason to consider osteitis condensans. If you'd like, feel free to upload your images using this link public.berlincaseviewer.com/secondopinion, and I'd be happy to review them for a more detailed evaluation.
@gaiksuanlee1910 I now found your uploaded images. However, only three of them. It is better to upload all images of your MRI scan. From what I see on the second image your condition seems to be osteitis condensans. There are only very small spots of osteitis/bone marrow edema visible.
We always welcome guests here in our department. However, first schedule an appointment with a skilled rheumatologist who should double check your situation.
Hi, I understand you're not interested in providing me with a second opinion of my MRI scans. I just wonder if there's a way how to distinguish between sacroiliitis, Ankylosing spondylitis and bone marrow cancer, because all of these pathologies appear as high signal in bone marrow "oedema" on MRI - T2 - STIR sequence the same. Is there any pattern that can distinguish between bone marrow inflammation and cancer of the bone marrow in sacroiliac joint and iliac bone? Or only trepanobiopsy can tell? Regards
@berlincaseviewer Thank you so much dear professor, I know you are extremely busy with your clinical work, and I appreciate your help. I will upload the images or ask someone to help me, because, I'm not an expert on image and data transfer. Martin
What should I ask my Dr to do? I have had si joint pain that came right after my l5 s1 fusion. Xray noted osteoarthritis in both si joints one year after the lumbar fusion . Si pain continues daily but newest xray now says no si issues noted, but subchondral sclerosis in both hips. Plans were being made to treat the si joints but now I don't trust the diagnosis?
In order to answer your question we might need to review your images. Please follow this link, fill in the information and drag/drop your images onto the form. public.berlincaseviewer.com/askdrkay
My doctor told me that an MRI will not show ligament damage, is that true? I’ve had undiagnosed SI joint/hip pain for 3+ years. I’ve had many MRI’s done and they are all normal. Physical therapy and manipulation help for a few days, but then my pelvis feels out of alignment again. Do you think there’s possibly an issue with my ligaments?
MRIs are perfectly suitable for visualizing ligaments. It is important that a specialized radiologist looks at the images for the complex pain syndrome you have described. We are available for a second opinion. Upload the images here: cases.berlincaseviewer.com/secondopinion
Usually, damage in the SI joint can be seen easily on CT or MRI scans. Dynamic contrast-enhanced MRI was promoted in the late 1990ies but did not prove useful in clinical routine over time.
@@berlincaseviewer Thank you. I had different answers about, thus somebody affirmed that high damaged SI joint would be detected by MRI than others. I would just understand about a hypermobile SI joint, where its movement can provoke sciatic nerve symptom s (numbness at random various leg levels, those expire by itself after some time) according to posture maintained (pelvic tilt in particular). Thank you.
Very well explained presentation about the problems of sacroiliac joints. What about the cure for such different situations? Do some exercises will help in some cases or one needs invasive surgery in some other situations? Or should we live with the pain?
Exercises are helpful for many of these problems. While exercises and occasional painkillers are recommended for osteitis condensans and degeneration due to anatomical variants, it is now believed that stronger medication must be prescribed for axial spondyloarthritis, in parallel with physiotherapy. You should consult a rheumatologist.
What is the rhomboid skin depression on the sacroiliac joint area, which is slightest darker than the rest of the skin? That same area hurts. Would that be an infection, or…?
Do osteitis condensus will have focal narrowing of anteror- inferior aspect/ synovial component of bilateral Si joint with Subchondral bone irregularity with erosion bone changes mainly on the iliac side? Also the affected marrow demonstrate high signal on STIR change representing osteitis. Is this more of sacroilits or OCI? Any possibility of ax SpA?
Based on your description, the findings-particularly the focal narrowing, subchondral bone irregularity, and bone marrow edema on STIR-are more suggestive of sacroiliitis rather than osteitis condensans ilii (OCI). However, the location of the osteitis in the anterior joint region does give a reason to consider osteitis condensans. If you'd like, feel free to upload your images using this link public.berlincaseviewer.com/secondopinion, and I'd be happy to review them for a more detailed evaluation.
@gaiksuanlee1910 I now found your uploaded images. However, only three of them. It is better to upload all images of your MRI scan. From what I see on the second image your condition seems to be osteitis condensans. There are only very small spots of osteitis/bone marrow edema visible.
Very well explained, thank you. I wish I had your expertise to review my imaging.
I should go to Berlin for my MRI and CT Scans. I'll get a better explanation of my problems and how to resolve them.
We always welcome guests here in our department. However, first schedule an appointment with a skilled rheumatologist who should double check your situation.
Hi, I understand you're not interested in providing me with a second opinion of my MRI scans.
I just wonder if there's a way how to distinguish between sacroiliitis, Ankylosing spondylitis and bone marrow cancer, because all of these pathologies appear as high signal in bone marrow "oedema" on MRI - T2 - STIR sequence the same. Is there any pattern that can distinguish between bone marrow inflammation and cancer of the bone marrow in sacroiliac joint and iliac bone? Or only trepanobiopsy can tell? Regards
I'm always here to help. I'm just overwhelmed with clinical work - I'm sorry! I sent you instructions via email. Let's do it!
@berlincaseviewer Thank you so much dear professor, I know you are extremely busy with your clinical work, and I appreciate your help. I will upload the images or ask someone to help me, because, I'm not an expert on image and data transfer. Martin
What should I ask my Dr to do? I have had si joint pain that came right after my l5 s1 fusion. Xray noted osteoarthritis in both si joints one year after the lumbar fusion . Si pain continues daily but newest xray now says no si issues noted, but subchondral sclerosis in both hips. Plans were being made to treat the si joints but now I don't trust the diagnosis?
In order to answer your question we might need to review your images. Please follow this link, fill in the information and drag/drop your images onto the form. public.berlincaseviewer.com/askdrkay
🔥🔥🔥👍👍👍
My doctor told me that an MRI will not show ligament damage, is that true? I’ve had undiagnosed SI joint/hip pain for 3+ years. I’ve had many MRI’s done and they are all normal. Physical therapy and manipulation help for a few days, but then my pelvis feels out of alignment again. Do you think there’s possibly an issue with my ligaments?
MRIs are perfectly suitable for visualizing ligaments. It is important that a specialized radiologist looks at the images for the complex pain syndrome you have described.
We are available for a second opinion. Upload the images here:
cases.berlincaseviewer.com/secondopinion
MRI, is very sensitive for ligament assessment, u should try consultation with a rheumatologist or musculoskeletal pain specialist.
This is very informative thank you 🙏🏻
Excellent presentation very thorough and informative thank you very much for sharing
So grateful for your praise!
Thanks,very informative
thank you
Thanks
Excellent , very well explained .Thanks a lot .
You are welcome
Professor, please may I have your email address?
Please approach me on Instagram, LinkedIn or X.
@@berlincaseviewer Dear Professor, Thank you for your response. I will make an Instagram account, please what means X? Martin
@@martinfricek4787 Twitter is now called X.
@berlincaseviewer OK sure, thank you I will do. Martin
@@martinfricek4787 I suggest you use our contact form. berlincaseviewer.de/contact/
Can a damaged SI joint not be detected by MRI, CT or RX? If yes, would dynamic MRI be more useful? Thank you.
Usually, damage in the SI joint can be seen easily on CT or MRI scans. Dynamic contrast-enhanced MRI was promoted in the late 1990ies but did not prove useful in clinical routine over time.
@@berlincaseviewer Thank you. I had different answers about, thus somebody affirmed that high damaged SI joint would be detected by MRI than others.
I would just understand about a hypermobile SI joint, where its movement can provoke sciatic nerve symptom s (numbness at random various leg levels, those expire by itself after some time) according to posture maintained (pelvic tilt in particular). Thank you.