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General Rehabilitation

When Your Sacroiliac Joints Decide to Tie the Knot: A Geriatric Wedding (of Bones) - A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Poster Presenter(s)

  • Chi Lam Kwok, DO

    Resident
    Nassau University Medical Center PM&R Program
    Flushing, New York

    • Co-Author(s)

  • FB

    Forrest Butensky, DO

    Resident Physician
    Nassau University Medical Center PM&R Program
    Rockville Centre, New York

  • BF

    Brent Fogel, DO

    Resident
    Nassau University Medical Center PM&R Program
    Melville, New York

  • Justin Wang, MD

    Resident Physician
    Nassau University Medical Center PM&R Program
    East Meadow, New York

  • Adam C. Isaacson, MD

    Attending Physician
    Nassau University Medical Center PM&R Program
    East Meadow, New York

Disclosure(s):
Forrest Butensky, DO: No financial relationships to disclose
Brent Fogel, DO: No financial relationships to disclose
Justin Wang, MD: No financial relationships to disclose
Adam C. Isaacson, MD: No financial relationships to disclose
Case Diagnosis: A 74-year-old Hispanic male with Ankylosing Spondylitis

Case Description or Program Description: A 74-year-old Hispanic male with a past medical history of heart failure, atrial fibrillation, hypertension, hyperlipidemia, and prediabetes presented to the Physical Medicine and Rehabilitation (PM&R) clinic for evaluation of chronic neck pain and stiffness. Referred by his primary care physician, he reported a 30-year history of neck pain, which had significantly worsened over the past 3-4 years. The discomfort was associated with substantial stiffness, limiting neck rotation and upward gaze. He described a sedentary lifestyle since retiring 15 years prior.

Setting: Tertiary care academic hospital.

Assessment/Results: On physical examination, the patient demonstrated severely limited spinal range of motion in all directions, along with significant neck and back stiffness. Schober's test showed a 1 cm excursion, and chest expansion was 1 cm. Evaluation in the PM&R clinic raised suspicion for Ankylosing Spondylitis (AS) or Diffuse Idiopathic Skeletal Hyperostosis (DISH). The physiatrist ordered laboratory and imaging studies, revealing a positive ANA, elevated ESR, and a negative HLA-B27. Radiographs showed sacroiliac joint fusion. Rheumatology referral confirmed the diagnosis of AS.

Discussion (relevance): While Ankylosing Spondylitis (AS) predominantly affects young Caucasian adults, with a median onset around 26 years, this case illustrates its presentation in a geriatric patient with multiple comorbidities. This highlights the necessity of a multidisciplinary approach for patients with chronic musculoskeletal pain and complex medical histories. In this case, early referral to a physiatrist facilitated timely AS diagnosis and intervention, minimizing long-term disability and improving patient quality of life.

Conclusions: This case, illustrating undiagnosed Ankylosing Spondylitis (AS) in a geriatric patient, underscores the vital role of the physiatrist in early diagnosis, referral, and comprehensive management. Prompt PM&R intervention is essential for improving patient mobility, reducing pain, and enhancing quality of life.