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Reg Anesth Pain Med. 2008 Jan-Feb;33(1):36-43.
Nociceptive nerve fibers in the sacroiliac joint in humans.
Szadek KM, Hoogland PV, Zuurmond WW, de Lange JJ, Perez RS.
Department of Anesthesiology, VU University Medical Center, Amsterdam, The
Netherlands. [email protected]
BACKGROUND AND OBJECTIVES: A positive response to sacroiliac joint
intra-articular infiltration with local anesthetics is used to confirm sacroiliac
joint pain. However, current anatomical and histological knowledge concerning the
anatomy of pain perception within the sacroiliac joint intra- and peri-articular
structures is insufficient to explain the efficacy of this infiltration, because
of the use of unspecific histochemical visualization techniques. METHODS: In this
study, immunohistochemistry for calcitonin gene-related peptide (CGRP) and
substance P was used to trace nociceptive fibers and receptors in the anterior
and interosseous sacroiliac ligaments obtained from 5 human cadavers without
history of sacroiliac joint pain. RESULTS: Microscopic analysis of stained slides
showed presence of CGRP and substance P immunoreactive fibers. Thick, wavy,
formed bundles were observed in dense and loose connective tissue, whereas
single, beaded nerve fibers, occasionally ramified, were observed more frequently
in the dense connective tissue and next to blood vessels. Based on their
morphologic features, these immunoreactive structures were classified as
receptors type IV. Additionally, receptors type II were found in anterior and
interosseous ligaments, which contained CGRP or substance P immunoreactive free
nerve endings. CONCLUSIONS: We conclude that the presence of CGRP and substance P
immunoreactive fibers in the normal anterior capsular ligament and interosseous
ligament provides a morphological and physiological base for pain signals
originating from these ligaments. Therefore, diagnostic infiltration techniques
for sacroiliac joint pain should consider extra- as well as intra-articular
approaches.
Nociceptive nerve fibers in the sacroiliac joint in humans.
Szadek KM, Hoogland PV, Zuurmond WW, de Lange JJ, Perez RS.
Department of Anesthesiology, VU University Medical Center, Amsterdam, The
Netherlands. [email protected]
BACKGROUND AND OBJECTIVES: A positive response to sacroiliac joint
intra-articular infiltration with local anesthetics is used to confirm sacroiliac
joint pain. However, current anatomical and histological knowledge concerning the
anatomy of pain perception within the sacroiliac joint intra- and peri-articular
structures is insufficient to explain the efficacy of this infiltration, because
of the use of unspecific histochemical visualization techniques. METHODS: In this
study, immunohistochemistry for calcitonin gene-related peptide (CGRP) and
substance P was used to trace nociceptive fibers and receptors in the anterior
and interosseous sacroiliac ligaments obtained from 5 human cadavers without
history of sacroiliac joint pain. RESULTS: Microscopic analysis of stained slides
showed presence of CGRP and substance P immunoreactive fibers. Thick, wavy,
formed bundles were observed in dense and loose connective tissue, whereas
single, beaded nerve fibers, occasionally ramified, were observed more frequently
in the dense connective tissue and next to blood vessels. Based on their
morphologic features, these immunoreactive structures were classified as
receptors type IV. Additionally, receptors type II were found in anterior and
interosseous ligaments, which contained CGRP or substance P immunoreactive free
nerve endings. CONCLUSIONS: We conclude that the presence of CGRP and substance P
immunoreactive fibers in the normal anterior capsular ligament and interosseous
ligament provides a morphological and physiological base for pain signals
originating from these ligaments. Therefore, diagnostic infiltration techniques
for sacroiliac joint pain should consider extra- as well as intra-articular
approaches.