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5 cm2 . There is wide variability in the adult SI joint, encompassing size, shape, and surface contour. Large disparities may even exist within the same individual. The SI joint is most often characterized as a large, auricular-shaped, diarthrodial synovial joint. In reality, only the anterior third of the interface between the sacrum and ilium is a true synovial joint; the rest of the junction is comprised of an intricate set of ligamentous connections. The sacroiliac joints are two paired "kidney bean" or L-shaped joints having a small amount of movement that are formed between the articular surfaces of the sacrum and the ilium bones.The two sacroiliac joints move together as a single unit. The SIJ's stability is maintained mainly through a combination of only some bony structure and very strong intrinsic and extrinsic ligaments. As we age the characteristics of the sacroiliac joint change. The joint's surfaces are flat or planar in early life but as we start walking, the sacroiliac joint surfaces develop distinct angular orientations.
Ligaments
Ventral Sacroiliac Ligament Assists the symphysis pubis in resisting separation or horizontal movement of the innominate bones at the SI joint. Palpated at Baer's SI point (Point on a line from the umbilicus to the anterior superior iliac spine (ASIS) 5 cm from umbilicus). Stressed using transverse anterior/posterior compression pain provocation test. Weakest among the sacro iliac ligaments. Long Dorsal Sacroiliac Ligament During incremental loading of the sacrum, it becomes tense during counternutation (base of the sacrum moves backward) and slackens with nutation (opposite movement of sacrum) [6]. Palpated in the area directly caudal to the posterior superior iliac spine (PSIS). Interosseous Sacroiliac Ligament
Largest syndesmosis in the body and functions as the major bond between the bones filling the irregular space posterior-superior to the joint. Resist anterior and inferior movement of the sacrum. Primary barrier to direct palpation of SIJ. Sacrotuberous Ligament Plays significant role in stabilizing against nutation of the sacrum, and conteracting against the dorsal and cranial migration of the sacral apex during weight bearing. Tension increaseswith contraction of Gluteus maximus. Sacrospinous Ligament Along with sacrotuberous ligament, it opposes forward tilting of the sacrum on the hip bone during weight bearing of the trunk and vertebral column.
Outflare
When the lumbar spine is extended and the sacrum nutates we have a bilateral outflare. Or when a single innominate is posteriorly rotated, the ASIS on that side may move away from the mid-line, (a unilateral outflare). This outflare (or external rotation) of the innominate means that the position of the acetabulum has changed, and the hip joint will be also externally rotated. However, the hip joint may compensate with internal rotation. It is also possible that the innominate can be pulled to an outflare position by muscular and fascial forces, without necessarily rotating the innominate posteriorly. Remember that living bone is pliable and plastic. Some of the most common culprits here are the tensor fascia lata, the iliotibial band, and gluteus minimus.
Inflare
When the spine is flexed, and the sacrum counter-nutates and the ASISs move toward each other, we have a bilateral inflare. A unilateral inflare can occur when a single innominate is anteriorly rotated (the ASIS on that side moves toward the mid-line). However, the anterior portion of the innominate can be pulled toward the mid-line without the presence of anterior
rotation. As with outflares, it is usually muscular and connective tissue force that causes the inflare, via the iliacus, internal obliques, sartorius and a contracturing inguinal ligament.
DOWNSLIP
It follows that there is the possibility of a downslip, or inferior shear, the opposite of an upslip. A downslip would usually immediately self-correct upon weight-bearing. However, even if corrected by weight-bearing, the sacral joints and the pubic symphysis may not all necessarily correct automatically. One or more joints may be held misaligned due to a persistent muscle imbalance caused by the original shearing. If the downslip does not correct on its own, it may imply a dislocation of the S.I. joints and pubic symphysis, and would present as severely painful.
nutation and resist returning to neutral. Therefore, during walking the S.I. joints will lose some of their mobility.