Severe pain in the sacroiliac region

Introduction Ankle sprains are often caused by improper posture posture, imbalance of muscle balance, and sudden torsion and disease. The main symptoms are severe pain in the lateral sacral sensation of the condyle, and the movement is not working. After an ankle sprain, the genital side of the ankle is severely painful, and the movement is not working. The complexion is pale and even shocked. The ipsilateral lower limbs do not dare to bear weight. The trunk is inclined forward and the disease side. About 20% to 60% of patients have ipsilateral Radiation pain in the lower extremities, mostly in the buttocks, the back of the thigh (the posterior cutaneous nerve of the femur), the sciatic nerve distribution area and the anterior medial aspect of the thigh root.

Cause

The ankle joint consists of an ear-shaped joint surface with uneven convexities and concaves. The ligaments with different lengths are stabilized, and the gravity of the trunk is transmitted to the lower waist through the ankle joint. When the pregnant woman is affected by endocrine changes, or because of prolonged bed rest, spinal anesthesia or general anesthesia can cause the ankle joint to relax, affecting the stability of the ankle joint, causing an ankle sprain or dislocation when subjected to external force. However, because the ankle is strong and stable, it is not easy to cause a sprain or misplacement. When the posture is not correct, the muscle strength is disordered, and the ligament is loose, the external force of the torsion may make the uneven surface of the ankle joint disorder disorder, and the gap is widened. In the case of negative pressure in the joint cavity, the synovial membrane is inhaled into the joint space, causing severe pain. According to the direction of the sprain, the anterior or posterior dislocation of the ankle can be caused.

(1) Anterior dislocation of the ankle joint

When the hip joint is straight, the knee joint is flexed, and the quadriceps and patellofemoral ligaments are pulled forward, the external force of the trunk, the spine and the tibia, which rotates backward, can shift the tibia forward.

(2) Dislocation of the ankle joint

When the hip joint is flexed, the knee joint is straight, and the hamstring muscle is pulled backwards, when the trunk spine and the tibia are rotated to the opposite side, the tibia and the tibia are reversed in opposite directions, which may cause the posterior tibial spine. Shift.

an examination

Related inspection

X-ray examination of bone and joint soft tissue CT examination

[clinical manifestations]

After an ankle sprain, the genital side of the ankle is severely painful, and the movement is not working. The complexion is pale and even shocked. The ipsilateral lower limbs do not dare to bear weight. The trunk is inclined forward and the disease side. About 20% to 60% of patients have ipsilateral Radiation pain in the lower extremities, mostly in the buttocks, the back of the thigh (the posterior cutaneous nerve of the femur), the sciatic nerve distribution area and the anterior medial aspect of the thigh root. The causes of radiation pain are:

1. The ligaments, muscles or other soft tissues near the ankle joint are dominated by the 4th and 5th lumbar nerves and the radial nerves. When the ankle joint is sprained, it can cause reflex nerve pain.

2. The sciatic nerve or the posterior cutaneous nerve bundle of the femur is close to the anterior side of the ankle joint and the piriformis. When the ligament around the ankle joint is hemorrhagic due to a sprain, swelling or piriformis tendon can directly stimulate the nerve bundle to cause radiation pain.

3. An ankle sprain with lumbosacral sprain can also stimulate nerve roots to cause sciatica.

When inspected, it can be found: stereo posture, the torso is tilted to the healthy side when standing, the weight of the healthy limb is taken, the waist is pointed to the ground, and the hip is supported by the hand to reduce the activity and pain. Sitting posture, sitting in the position of the ischial tuberosity weight bearing, hands to support to reduce the weight. In the bed posture, the patient sits at the bed first, then holds the affected limb with both hands to prevent the ankle joint pain. The pelvic separation test was positive and the adductor muscles were tense. The rotation test was positive. Straight leg lift is limited. The posterior superior iliac spine is raised or lowered from the opposite side. The tenderness is in the upper spine.

diagnosis

According to the history of trauma, clinical symptoms and signs, and with reference to X-ray films, the diagnosis can be confirmed. If the pain disappears immediately after hearing the ankle joint sound by the traction method, the diagnosis can be confirmed.

Differential diagnosis

The disease is often due to posture disorder, muscle imbalance, sudden torsion and disease, the main surface is the same as the sudden injury of the lateral sacral pain, the movement is not working, some patients may have radiation pain, some clinical diseases and this There are similar symptoms that require a differential diagnosis. The diseases that need to be identified include:

1, sprained lumbosacral joints.

2. Fibrous ring rupture.

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