(SI) Sacroiliac Joint Dysfunction
A Cause of Low Back Pain
The sacroiliac joint plays a role in back pain. The sacroiliac joint connects the spine to the pelvis. Many ligaments and fascial attachments provide the connections. The sacroiliac joint is more mobile in youth and becomes more fibrotic in adulthood.
Dysfunction of the sacroiliac joint can occur from an imbalance in the pelvis. Sustained unilateral force can create an imbalance of stress on the SI joints. Instability or subluxation is often the mechanism behind sacroiliac joint pain.
Symptoms of Sacroiliac Joint Pain
Pain is often experienced over the region of the sacroiliac joint, which is over the lower portion of the back lateral to the spine. The presentation symptoms with sacroiliac joint pain can be quite variable. It can be present in up to 30% of patients with low back pain. Pain can be present over the region of the sacroiliac joint and buttock or, less commonly, it can travel to the calf and foot.
Sacroiliac joint pain can be caused by trauma to the joints or unequal stresses applied to the joints. It may be associated with osteoarthritis, sacroiliitis, septic arthritis and traumatic sacroiliac joint instability or dislocation.
A detailed history is important to evaluate for any type of trauma. X-rays may potentially show some changes in the sacroiliac joints. Radionuclide bone scanning may also be helpful. Observation of the patient's gait may demonstrate an antalgic gait in which the patient shifts his weight so as not to put much stress on the affected sacroiliac joint.
Various physical examination tests may also help to diagnose sacroiliac joint disease. Patrick's test is a test which places stress on the hip and SI joint and may be useful. The patient may also point to the area of pain which, if it is close to the posterior superior iliac spine, suggests sacroiliac joint disease.
Sacroiliac joint disease is more common as one ages. For example, trauma to the sacroiliac joints and pelvis may precipitate it. Fusion of the spine down to the sacrum may also place additional stresses on the sacroiliac joints.
Massage and deep heat, as well as ultrasound may help along the sacroiliac joint line. Electrical stimulation may help to relax the muscles as well. A sacroiliac joint belt may apply direct pressure and also remind the patient to use proper body mechanics and limit rotation. Mobilization using physiotherapy techniques may be of benefit.
Sacroiliac joint injections may quickly reduce inflammation and pain along the joint line. The injections consist of an analgesic as well as a steroid. They are typically done under x-ray/fluoroscopic guidance. These injections may not only help the pain but also serve to help in the diagnosis.
Surgery for fusion of the Ilium to the sacrum can be done when pain is persistent and not consistently relieved with other measures.
Prognosis with appropriate measures is quite good, but can vary.
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