Sacroiliac Joint Disorders

The sacroiliac (SI) joints are located between the tailbone (sacrum) and each hip bone (ilium) in the pelvis. These joints are cushioned by cartilage and allow a small amount of movement between those bones. It is often difficult to determine the cause of SI joint pain; it can simply begin to hurt without a discernable reason. Luckily, the pain can be relieved even if the cause cannot be determined.


Symptoms

  • sharp or aching pain in lower back, usually just on one side
  • increase of pain when sitting for a long time
  • pain alleviated by standing or walking
  • numbness, tingling, or weakness in lower extremities is possible but rare


Risk Factors

  • age: the pain is often caused by arthritis.
  • injury: an injury, such as a fall or car accident, can knock the joint out of alignment.
  • leg length inequality: legs of different lengths can cause unequal strain on the SI joint.
  • multiple pregnancies: the hormone that loosens this joint near the end of pregnancy to ease childbirth is suspected to increase the chance of arthritis in later life.


Diagnosis

Diagnosis of sacroiliac joint pain is performed by physical examination, a review of your medical history, as well as several specific tests designed to pinpoint the location of the pain (Patrick's Test, Gaenslen's Test, Yeoman's Test). Medical resonance imaging (MRI), computed tomography (CT), or fluoroscopy (live x-ray) tests may be performed to rule out other potential causes for the pain, such as herniated disc.

Sometimes a diagnosis is reached by performing a diagnostic injection, in which an anesthetic is injected into the joint. If the pain subsides as the anesthetic takes effect, then it is likely that the SI joint was causing the pain.


Treatment

Initial treatment often includes watchful waiting, because it is unlikely to cause further damage and the pain may resolve itself without treatment. Over-the-counter medications can be used to alleviate pain or control the swelling. A sacroiliac belt can be worn to support and immobilize the joint to relieve the pain while the joint heals.

A physical therapist who is experienced with SI joint problems may be able to ease your symptoms through specific exercises to improve the strength of your back and abdominal muscles.

If these treatments do not relieve your symptoms, our doctors can perform intraarticular steroid injections to relieve your pain immediately

A surgical alternative for severe SI joint pain that cannot be handled any other way is fusing the painful joint together so that it no longer shifts when you move, preventing the nerves from being rubbed or pinched. Although fusing sometimes occurs gradually and naturally as people age, premature surgical fusing should be considered only as a last resort.


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