Sacroiliac Joint Dysfunction

Common causes include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, pregnancy, collagen vascular disease.

Most patients complain of localized pain around the low back and upper leg that radiates into the posterior buttocks and groin, but not below the knee. It is usually made worse by activity and improved with rest and heat. It is usually constant and aching. Below are some specific physical exam test that can aid your physician in diagnosing this condition:

• Gaenslen Test – This pain provocation test applies torsion to the joint. With one hip flexed onto the abdomen, the other leg is allowed to dangle off the edge of the table. Pressure should then be directed downward on the leg in order to achieve hip extension and stress the sacroiliac joint.
• Iliac Gapping Test – Distraction can be performed to the anterior sacroiliac ligaments by applying pressure to the anterior superior iliac spine.
• Iliac Compression Test – Apply compression to the joint with the patient lying on his or her side. Pressure is applied downward to the uppermost iliac crest.
• FABER or Patrick Test – To identify if pain may come from the sacroiliac joint during flexion, abduction, and external rotation, the clinician externally rotates the hip while the patient lies supine. Then, downward pressure is applied to the medial knee stressing both the hip and sacroiliac joint.

• Plain X-rays may initially be obtained to rule out fractures and occult causes such as tumors.
• The current “Gold Standard” for diagnosis of sacroiliac joint dysfunction emanating within the joint is sacroiliac joint injection confirmed under fluoroscopy or CT-guidance using a local anesthetic solution. The diagnosis is confirmed when the patient reports a significant change in relief from pain and the diagnostic injection is performed on 2 separate visits.

• A multimodal approach should be employed including a combination of NSAIDs and physical therapy.
• Application of Heat and Cold may be beneficial.
• For patients who do not respond to initial conservative treatment in one to two weeks, injection of the SI joint with local anesthetic and a long acting steroid can be very effective.
• For patients who only get short-term relief from SI joint Steroid injections, long term relief may be achieved by lateral branch denervation of the L4 through S3 lateral branch nerves using radiofrequency ablation. This is an outpatient procedure, done with fluoroscopy that usually takes 30 minutes, usually performed by an interventional pain specialist.