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Sacroiliac joint dysfunction

Sacroiliac (SI) joint dysfunction refers to pain in the sacroiliac joint region caused by abnormal motion in the sacroiliac joints or stress on the joints. The SI joints connect the spine to the pelvis and support the entire weight of the upper body when you stand. Stress on the joints can wear down their cartilage, the flexible connective tissue that acts as a shock absorber between bones, and cause arthritis. Many conditions, including rheumatoid arthritis, gout, psoriasis and ankylosing spondylitis, can result in painful, debilitating inflammation of the SI joints.

Symptoms

  • Low back pain
  • Pain in the buttocks, groin, hip and/or thighs
  • Sciatic leg pain
  • A burning sensation in the pelvis
  • Transient numbness, prickling or tingling
  • Urinary frequency


Pain may increase with physical activity. Bending forward, climbing stairs or hills and rising from a seated position may also cause pain.

Diagnosis

Your doctor will perform a thorough history and physical examination, and ask questions to help determine whether the pain is coming from the SI joints, lumbar spine or hips. A neurosurgeon or pain medicine specialist can develop a probable diagnosis of SI joint dysfunction by palpating the painful areas and performing several movements that may cause pain:

The Gaenslen test applies torsion to the joint. With one hip flexed into the abdomen, the other leg is allowed to dangle off the edge of the table. Downward pressure on the leg causes hip extension and stresses the SI joint.

The iliac gapping test applies pressure to the anterior superior iliac spine.

The iliac compression test applies compression to the joint while you lie on your side.

The FABER or Patrick test helps determine if pain is coming from the SI joints during flexion, abduction and external rotation.

Diagnostic tests include x-rays, CT scan and MRI to evaluate the condition of the joints, bones, muscles and ligaments.

Your pain medicine specialist may inject an anesthetic and a steroid directly into the SI joint using fluoroscopy for either diagnosis or treatment.

Treatment

Treatments available include anesthetic and steroid injections, oral anti-inflammatory medications and, for short periods of time, oral steroids, including prednisone. Because too much motion or not enough motion may cause pain in the SI joint, physical therapy is often prescribed. Stretching and stabilizing exercises can help reduce the pain. Your doctor may also recommend yoga or Pilates to promote flexibility and build strength.

Surgery for SI joint dysfunction fuses the joints by holding them together with plates and screws until they grow together, eliminating all motion.

Surgery should be considered only if less-invasive treatments have failed to provide relief.

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