Sacroiliac joint syndrome
What is sacroiliac joint syndrome?
In the first part of the 20th century, sacroiliac (SI) joint syndrome was the most common diagnosis for low back pain. Any pain in the low back, buttock, or adjacent leg was usually referred to as SI joint syndrome. In the late 1980s, many physicians “rediscovered” the SI joints as a possible source of back pain. Yet even today, SI joint pain is often overlooked. Many physicians have not been trained to consider it, and many are reluctant to believe a joint that has so little movement can cause back pain.
What causes sacroiliac joint syndrome?
One of the most common causes of problems at the SI joint is an injury. The injury can come from a direct fall on the buttocks, a motor vehicle accident, or even a blow to the side of your pelvis. The force from these injuries can strain the ligaments around the joint. Tearing of these ligaments can lead to too much motion in the joint, which can eventually lead to wear and tear of the joint and pain from degenerative arthritis.
Another cause of sacroiliac joint syndrome is an abnormality of the sacrum bone. When your body is undergoing development in the womb, several vertebrae fuse together to form the sacrum. In some people, the bones that make up the sacrum never fuse together. In these cases, two or more of the vertebra that should fuse together remain separated. This creates an odd situation where the SI joint is malformed and a false joint occurs (sometimes called a “transitional syndrome”). People who have this syndrome seem to have more problems with their SI joints, as well as back pain that appears to come from that area.
The diagnosis usually begins with a complete history and physical exam. Your clinical exam may include the following orthopedic tests used to determine if the SI joints are involved. Pain during these tests is generally an indicator that the SI joints are indeed a problem.
The doctor stresses the SI joints by attempting to pull them apart a bit.
The two sides of a joint are forced together. Pain may indicate that this SI joint is involved.
The examiner will have you lie on a table with both legs brought up to the chest. You will then shift to the side of the table so that one buttock is over the edge. The unsupported leg drops over the edge and the supporting leg is flexed. In this position, SI joint problems will occur due to stress to the joint.
The heel of one leg is crossed on top of the opposite knee, and the top knee is pressed down to test for hip mobility and pain.
X-rays may also be recommended by your provider to determine if there are abnormalities of the joint.
A CT scan can sometimes show more detail about the joint surfaces and the surrounding bone. If the X-rays suggest something may be affecting the SI joints, the provider may recommend a CT scan to get a better look.
A bone scan can be useful in determining if the joint is inflamed. An inflamed SI joint usually shows up as a hotspot on a bone scan of the pelvis.
SI Joint Injection
Your doctor may also recommend that you undergo a fluoroscopic injection into the joint. During this test, a local anesthetic is injected into the joint. The doctor uses the fluoroscope to make sure the needle is actually in the joint before injecting the medication.
Once the needle is in the right place, anesthetic is injected to numb the joint. If the pain goes away, your doctor can be relatively sure that the problem is coming from the SI joint and not somewhere else in the spine.
Symptoms of SI joint syndrome are often difficult to distinguish from other types of low back pain. In most cases, there is a confusing pattern of back and pelvic pain that mimic each other, making the diagnosis of SI joint syndrome very difficult. The most common symptoms include:
- Low back pain
- Buttock pain
- Thigh pain
- Difficulty sitting in one place for too long due to pain
Patients commonly receive physical therapy treatment for SI joint problems. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
A sacroiliac belt may be issued to help stabilize a loose and painful SI joint. The belt wraps around the hips to squeeze and hold the SI joints together. This supports and stabilizes the pelvis and the SI joints.
SI joint injection
An injection into the SI joint using cortisone is helpful for calming pain and inflammation. The injection usually gives temporary relief for several weeks or months.
Surgery may become an option if all conservative methods of treatment fail. Surgery on the SI joint usually consists of a fusion of the joint (also called an "arthrodesis"). Fusing the two sides of a joint together to reduce pain has been used for many years as a treatment for arthritic joints.