Say Kroe ILL EE I -tis: a review of sacroiliac joint pain, diagnosis and treatment

Spine & Nerve

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review a common cause of low back pain, sacroiliac joint (SI) pain. The SI joint is a large complex joint that involves the iliac bone and sacrum. The SI joint is a critical component of the connection between the spine and lower limbs, and one of the primary functions of the SI joint is stability.

Chronic SI joint pain is a relatively common cause of low back pain with epidemiologic studies demonstrating that SI joint pain significantly contributes to 10-38% of cases of chronic low back pain. Risk factors for SI joint pain include: leg length discrepancy, gait abnormality, scoliosis, spinal fusion, hip pathology, pregnancy, high force/velocity injury, seronegative HLA-B27 spondyloarthropathies, repetitive shear stress injuries in athletes.

The common clinical presentation for SI joint pain includes aching pain below the belt line, with radiating/referred pain to gluteal/buttock region, groin, posterior leg, and less commonly thigh. This pain is often worsened with prolonged sitting, sleeping positions, movement.

Physical exam results supportive of a diagnosis of SI joint pain include at least 3 positive tests, with at least one of these tests being thigh thrust or compression test. The 5 recommended provocative maneuvers include: 1) Distraction test 2) thigh thrust test 3) FABERE 4) Compression test 5) Gaenslen's maneuver.

A recent expert opinion article titled A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain, works to clarify the approach to diagnosis and treatment of SI joint pain. This review article highlights the importance of optimizing the diagnosis as soon as possible to guide treatment, and image guided injection remains the gold standard for the diagnosis of SI joint pain.

Listen as the doctors review SI joint pain, and discuss the algorithm presented in the recent expert opinion review article.

This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve.

References:

1. Falowski S, Sayed D, Pope J, Patterson D, Fishman M, Gupta M, Mehta P. A Review

and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain. J Pain Res.

2020;13:3337-3348.

2. Wallace P, Bezjian Wallace L, Tamura S, et al. Effectiveness of Ultrasound-Guided

Platelet-Rich Plasma Injections in Relieving Sacroiliac Joint Dysfunction. American

Journal of Physical Medicine & Rehabilitation. 2020 Aug;99(8):689-693.