Dislocation of SIJ

A dislocation the SIJ is imaged on a ct scan and x-rays (more than one view) whereas the same ct scans and x-rays for "malalignment" does NOT show malalignment in the SIJ.  An elevated iliac crest is NOT indicative of a malalignment in the sacroiliac. Falsely overinterpreted in texts such as Professor Dihlman in Diagnostic Radiology of the Sacroiliac Joint, pp91-99. (Of 
note, Dick DonTigny gave me that book in 1990, the book published in 1980.) He clarifies that functional films such as standing on one leg and then the other cannot be read with a line across the top of the sacrum (ala) and contrasted with one across the top of iliac crests, unless there is a concommitant vertical change in the height of the symphysis pubis. If the vertical symmetry of the pubic changes when you stand on the other foot, AND the iliac and scarl lines
change; then yes a valid case of hypermobility is objectively noted. Simply observing an iliac crest being higher than the other can be a purely muscular phenomen and there are problems of patient positioning when the x-ray or ct is taken which I have detailed in my chapter on sacral torsion. Dihlman goes on to insightfully state on p95, "Functional films only provide information as to whether the displacement (pubic and crest) is mobile or interlocked, or wheteher the pelvic rigidity which developed with the displacement of the sacroiliac joints and the pubic symphysis is complete or incomplete. Such information is important for determining the therapy".  I assure you that any x-ray of iliac crests and SIJ's must include the entirity of the symphysis pubis  and standing on one leg and then the other with fluroscopy imaging or x-ray
imaging or standing CT scan are mandatory. For me, I would never ever let
someone talk me into getting surgery on the basis of uneven iliac crests, unless
that grape kool aide is very, very spiked, rendering me vulnerable. knowledge is
power and carries an ethical responsibility. I invite clinicians to participate
in this public forum.


Jerry Hesch, Hesch Institute