Posture Analysis and Presence of Sacroiliac Joint Dysfunction in Patients With Chronic Lower Extremity Edema

Abstract

Abstract Background and Aim: Chronic lower extremity edema has been associated with postural impairment, sacroiliac joint dysfunction (SIJD), and abnormal gait. Lymphedema and lipedema are important chronic lower extremity causes. This study aimed to detect the presence of SIJD and postural disorders in patients with lower extremity edema and the relationship between them. Methods: This is a comparative, prospective cohort study. Fifty-three patients with lower extremity edema and 53 healthy subjects were included in the study. Pain provocation tests were used to determine SIJD. Postural analysis was conducted with PostureScreen® Mobile 11.2 (PostureCo, Inc., Trinity, FL) software. The life quality of participants was determined by the Lymphedema Quality of Life (LYMQOL) scale. The functional status of the patients was determined by the Oswestry Disability Index and Lower Extremity Functional Scale. Results: SIJD (18.9%) was more common in the edema group. There was a positive correlation between volume differences, percentages, and the development of SIJD. We found deviations in the head, shoulder, and hip angulations in the edema group. Q angle and lateral shoulder angulation were significantly higher in patients with SIJD in the edema group. In the edema group, LYMQOL-leg total score was higher in patients with SIJD. Conclusion: Chronic lower extremity edema was found to be associated with postural deviations and SIJD. Besides edema control, postural disorders and SIJD should also be considered in these patients.

Keywords

• Lower extremity edema
• Sacroiliac joint dysfunction
• quality of life
• posture
• Alt ekstremite ödemi
• Sakroiliyak eklem disfonksiyonu
• Yaşam kalitesi
• Postür

Kronik Alt Ekstremite Ödemi Olan Hastalarda Sakroiliyak Eklem Disfonksiyonu Varlığı ve Postür Analizi

Abstract

Özet Amaç: Kronik alt ekstremite ödemi, postür bozukluğu, sakroiliak eklem disfonksiyonu ve anormal yürüyüş paterni ile ilişkilendirilmiştir. Lenfödem ve lipödem önemli kronik alt ekstremite nedenleridir. Bu çalışmada alt ekstremite ödemi olan hastalarda sakroiliyak eklem disfonksiyonu ve postürel bozuklukların varlığı ve aralarındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: Çalışmamız prospektif, karşılaştırmalı bir kohort çalışmasıdır. Çalışmaya alt ekstremite ödemi olan 53 hasta ve 53 sağlıklı kişi dahil edildi. Sakroiliak eklem disfonksiyonu tanısı içi ağrı provokasyon testleri kullanıldı. Postür analizi, PostureScreen® Mobile 11.2 (PostureCo, Inc., Trinity, FL) yazılımı ile gerçekleştirildi. Katılımcıların yaşam kaliteleri Lenfödem Yaşam Kalitesi Ölçeği (LYMQOL) ile, fonksiyonel durumları ise Oswestry Dizabilite İndeksi ve Alt Ekstremite Fonksiyonel Skalası ile belirlendi. Bulgular: Alt ekstremite ödemi olan hastalarda sakroiliyak eklem disfonksiyonu daha sıktı (%18.9). Alt ekstremite hacim farkları ve yüzdeleri ile sakroiliyak eklem gelişimi arasında pozitif korelasyon saptandı. Ödem grubunda baş, omuz ve kalça açılarında deviasyonlar saptandı. Ödem grubunda sakroiliyak eklem disfonksiyonu olan hastalarda Q açısı, lateral omuz angulasyonu ve LYMQOL-leg ölçeği total skoru daha yüksekti. Sonuç: Çalışmamızda kronik alt ekstremite ödemi ile postural sapma ve sakroiliyak eklem disfonksiyonu arasında ilişki bulundu. Kronik alt ekstremite ödemi olan hastalarda ödem kontrolünün yanı sıra, postür analizi ve sakroiliak eklem değerlendirmesi uygun bir yaklaşım gibi gözükmektedir.

Keywords

• Alt ekstremite ödemi
• Sakroiliyak eklem disfonksiyonu
• Yaşam kalitesi
• Postür

References

1. 1. Stout N, Partsch H, Szolnoky G, et al. Chronic edema of the lower extremities: international consensus recommendations for compression therapy clinical research trials. Int Angiol 2012;31(4):316-29.
2. 2. Doruk Analan P, Kaya E. Postural Stability in Patients with Lower Limb Lymphedema. Lymphat Res Biol 2019;17(6):647-650.
3. 3. Canning C, Bartholomew JR. Lipedema. Vasc Med 2018;23(1):88-90.
4. 4. Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int 2020;117(22-23):396-403.
5. 5. Kiapour A, Joukar A, Elgafy H, Erbulut DU, Agarwal AK, Goel VK. Biomechanics of the Sacroiliac Joint: Anatomy, Function, Biomechanics, Sexual Dimorphism, and Causes of Pain. Int J Spine Surg 2020;14(Suppl 1):313.
6. 6. Chuang CW, Hung SK, Pan PT, Kao MC. Diagnosis and interventional pain management options for sacroiliac joint pain. Ci Ji Yi Xue Za Zhi. 2019;31(4):207-210.
7. 7. Crane P. Management of sacroiliac dysfunction and lower extremity lymphedema using a comprehensive treatment approach: a case report. Physiother Theory Pract 2009;25(1):37-43.
8. 8. Johnson KC, Kennedy AG, Henry SM. Clinical measurements of lymphedema. Lymphat Res Biol. 2014 Dec;12(4):216-21.

9. 9. Allen M, Schwartz M, Herbst KL. Interstitial Fluid in Lipedema and Control Skin. Womens Health Rep (New Rochelle) 2020;1(1):480-487.
10. 10. Palsson TS, Gibson W, Darlow B, et al. Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. Phys Ther 2019;99(11):1511-1519.
11. 11. Thawrani DP, Agabegi SS, Asghar F. Diagnosing Sacroiliac Joint Pain. J Am Acad Orthop Surg 2019;27(3):85-93.
12. 12. Polly DW Jr. The Sacroiliac Joint. Neurosurg Clin N Am 2017;28(3):301- 312.
13. 13. Telli H, Telli S, Topal M. The Validity and Reliability of Provocation Tests in the Diagnosis of Sacroiliac Joint Dysfunction. Pain Physician 2018;21(4):E367-E376.
14. 14. Al-Rawi NH, Yousef H, Khamis M, Belkadi O, Ahmed S, Ali S. Vertebral Malalignment among Male Dentists with Work-related Musculoskeletal Pain in the United Arab Emirates. J Contemp Dent Pract 2018;19(7):773-777.
15. 15. Szucs KA, Brown EVD. Rater reliability and construct validity of a mobile application for posture analysis. J Phys Ther Sci 2018;30(1):31-36.
16. 16. Santos JGL, Montezuma T, Perez CS, Sverzut CE, Trivellato AE, Guirro ECO. Body postural realignment in the first 2 months after orthognathic surgery. Am J Orthod Dentofacial Orthop 2021;159(3):e281-e290.
17. 17. Keeley V, Crooks S, Locke J, Veigas D, Riches K, Hilliam R. A quality of life measure for limb lymphedema (LYMQOL). J Lymphoedema 2012;5:345–349.
18. 18. Borman P, Yaman A, Denizli M, Karahan S. The Reliability and Validity of Lymphedema Quality of Life Questionnaire-Leg in Turkish Patients with Lower Limb Lymphedema. Lymphat Res Biol 2020;18(1):42-48.
19. 19. Binkley JM, Stratford PW, Lott SA, Riddle DL et al. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther 1999;79(4):371-83.
20. 20. Citaker S, Kafa N, Hazar Kanik Z, Ugurlu M, Kafa B, Tuna Z. Translation, crosscultural adaptation and validation of the Turkish version of the Lower Extremity Functional Scale on patients with knee injuries. Arch Orthop Trauma Surg 2016;136(3):389–95.
21. 21. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000;25(22):2940-52; discussion 2952.
22. 22. Yakut E, Düger T, Oksüz C, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976) 2004;29(5):581-5.
23. 23. Peebles R, Jonas CE. Sacroiliac Joint Dysfunction in the Athlete: Diagnosis and Management. Curr Sports Med Rep 2017;16(5):336-342.
24. 24. Harrison DE, Harrison DD, Troyanovich SJ. The sacroiliac joint: a review of anatomy and biomechanics with clinical implications. J Manipulative Physiol Ther 1997;20(9):607-17.
25. 25. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 2012;221: 537-567.
26. 26. Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van Wingerden JP, Snijders CJ. The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Spine (Phila Pa 1976) 1995;20(7):753-8.
27. 27. Shin SJ, Kim TY, Yoo WG. Effects of various gait speeds on the latissimus dorsi and gluteus maximus muscles associated with the posterior oblique sling system. J Phys Ther Sci 2013;25(11):1391-2.
28. 28. Khong LAM, Buckley A, Johnson W, Cavalheri V. Lower limb chronic edema management program: Perspectives of disengaged patients on challenges, enablers and barriers to program attendance and adherence. PLoS One 2019;14(11):e0219875.
29. 29. Gasparis AP, Kim PS, Dean SM, Khilnani NM, Labropoulos N. Diagnostic approach to lower limb edema. Phlebology 2020;35(9):650-655.
30. 30. Greene A, Meskell P. The impact of lower limb chronic oedema on patients' quality of life. Int Wound J 2017;14(3):561-568.
31. 31. Franks PJ, Quéré I, Keeley V, et al. Quality of Life and Costs Within Decongestive Lymphatic Therapy in Patients with Leg Lymphedema: A Multicountry, Open-Label, Prospective Study. Lymphat Res Biol 2021;19(5):423-430.
32. 32. Telli H, Hüner B, Kuru Ö. Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life. Spine (Phila Pa 1976) 2020;45(8):549-554.
33. 33. Hopkins BB, Vehrs PR, Fellingham GW, George JD, Hager R, Ridge ST. Validity and Reliability of Standing Posture Measurements Using a Mobile Application. J Manipulative Physiol Ther 2019;42(2):132-140.
34. 34. Timurtaş E, Avcı EE, Mate K, Karabacak N, Polat MG, Demirbüken İ. A mobile application tool for standing posture analysis: development, validity, and reliability. Ir J Med Sci. 2021:1–9.
35. 35. Moreira R, Teles A, Fialho R, et al. Mobile Applications for Assessing Human Posture: A Systematic Literature Review. Electronics 2020;9 (8):1196.
36. 36. Choudhary R, Malik M, Aslam A, Khurana D, Chauhan S. Effect of various parameters on Quadriceps angle in adult Indian population. J Clin Orthop Trauma 2019;10(1):149-154.