Localization
ISG arthrosis can manifest itself on both the right and left side due to the anatomical conditions.Malpositions of the spine or even the hips can lead to increased strain on one half of the body, causing the joint cartilage on one side to be worn down more than on the other side of the pelvis. In addition to malalignments, chronic inflammation can also be the main cause of unilateral ISG arthrosis. ISG arthrosis that occurs on both sides occurs less frequently than one that is limited to only one joint.
Malpositions and deformations of the pelvic ring can lead to incorrect posture and incorrect loading of both ISG. In addition to severe pain, this can be accompanied by an increased restriction of movement and everyday life. Relief of the bilateral sacroiliac joints is more difficult to achieve than with unilateral impairment.
Since ISG-arthrosis causes rather unspecific back pain, especially in its early stages, many patients first consult their family doctor for treatment. In the further course of the disease, in most cases a referral to an orthopedist is made. To diagnose ISG-arthrosis, a detailed conversation with the patient is necessary.
In this way, specific information about the existing complaints and pain, their localization and intensity can be obtained. With the help of so-called provocation tests, the physician can exert stress on the ISG during certain movements, which can trigger or intensify pain in case of degenerative or even inflammatory changes in the joint. In this way, the physician can gain some information about the exact localization of the pain and its spread.
In order to assess the bony structures and the joint surfaces, further diagnostics are useful. In the case of ISG arthrosis, the worn joint surface and any existing malpositions and curvatures in the pelvic region can be shown in the X-ray image. An MRI of the lumbar spine or an MRI of the pelvis serves primarily to divide ISG arthrosis into different stages.
If only the ISG is to be assessed, an MRI of the sacroiliac joint is most suitable. Furthermore, it is possible to inject locally acting painkillers into the affected joint under X-ray or CT control in order to determine whether the pain subsides under anesthesia. If the diagnosis ISG-arthrosis was made by the treating physician, it must be coded according to the ICD – 10, so that it can be correctly billed by the health insurance company later on.
The ICD – 10 is used as a key for naming diagnoses and is based on an international classification system: The diagnosis ISG-arthrosis is coded with M19. 9. In ISG arthrosis, X-rays are a diagnostic procedure that provides meaningful images, especially in advanced stages of the disease.
In the case of arthrosis, there is long-term wear and tear of the joint. In the early stages, x-rays provide hardly any evidence of arthrosis. Only at a late stage can the altered joint structures be detected.
Typically, the joint space is reduced and cartilaginous joint surfaces are visibly worn away over time. The bone also changes constantly over time. Due to the increased friction and wear of the bone near the joint, it rebuilds itself, which leads to an aggravation of the disease.
X-ray is also used in therapeutic diagnostics. Under precise X-ray control, painkillers and local anesthetics can be injected into the affected areas so that the exact location of the pain can be determined. If the pain subsides, the right area has been hit.
This also helps in planning further therapies. In rare cases, similar procedures can be used to permanently numb the painful areas. This is a symptomatic but effective therapy.
A vacuum phenomenon is a special feature in the X-ray or CT image that occurs in certain diseases and facilitates diagnosis. In these radiological procedures, the permeability of individual body tissues to radiation is measured. If, as in the case of ISG arthrosis, the cartilage in the joint is so worn out that it no longer exists and there is a cavity between the bones, this is noticeable in the CT image as a vacuum phenomenon.
The gas between the bones is so permeable to the rays that a black hole is visible instead of the original cartilage tissue. This is a direct indication that the cartilage tissue at this location is not intact. ISG arthrosis can cause severe chronic pain.In the case of chronic pain, the health care office can pronounce a so-called degree of disability, which varies depending on the illness in question.
Decisive for the calculation of the GdB of an ISG-arthrosis is the loss of function in the ISG. Since the function and movement in the ISG can differ significantly depending on the progress of the ISG-arthrosis, the GdB can vary considerably in patients suffering from ISG-arthrosis. With minor functional limitations, without loss of stability, one can be classified with a GdB of 10. In the case of medium functional losses with 20 and only in the case of severe functional limitations and instability, one can obtain a GdB of 30 – 40 in the case of ISG arthrosis. However, this can also vary considerably in individual cases.
