FAQ’s on Sacroiliac Joint Pain
What is sacroiliac joint pain?
The sacrum is the triangle-shaped bone that is found above the coccyx, or tailbone. This is connected to the iliac bones that make up the pelvis. Thus, the sacroiliac joint (SI joint) connects the spine to the pelvis. The joint is held together by a collection of strong ligaments, and there is very little motion around this joint. It serves primarily a support purpose, bearing the entire weight of the upper body during erect posture.
Dysfunctions in the SI joint can cause low back pain, or leg pain. Risk factors for SI joint function include older age, history of degenerative diseases such as arthritis, pregnancy, previous history of trauma or spinal surgery, among others. The progressive wear and tear of the protective cartilage in the SI joint causes the bones to rub against each other, leading to inflammation and pain. Circulating hormones from pregnancy cause the ligaments in the pelvis to relax in preparation for childbirth: this can lead to increased motion, and thereby, wear and tear on the SI joints. Malignant and metastatic conditions can also cause SI joint pain. The clinical presentation of SI joint pain will vary depending on the exact underlying cause. It may be chronic (greater than 6 months) or acute (less than 6 months).
How is sacroiliac joint pain diagnosed?
SI joint pain can be caused by a multitude of conditions that include, but are not limited to, osteoarthritis, malignancy, misalignment, or surgery. The exact cause will be determined by the physician through a complete medical history and physical examination. Additional imaging studies are usually requested, and these include X-rays, Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI) scans, as well as ultrasonography.
SI joint pain can also be diagnosed with SI joint injections of local anesthetic and corticosteroids (strong anti-inflammatory medications). These are injected near the affected area under fluoroscopic (X-ray) guidance to improve accuracy, although the use of ultrasound and magnetic resonance imaging to guide the procedure have shown promise in providing pain relief and restoring function to patients. Relief of symptoms after this procedure positively identifies that SI joint as being involved in chronic pain. This is becoming an increasingly common procedure, and can be done by specialists in physical medicine and rehabilitation.
How is sacroiliac joint pain treated?
Treatment will depend on the underlying pathology. The options can range from conservative, non-surgical management like oral anti-inflammatory medications, to minimally invasive techniques such as radiofrequency ablation and neurolytic nerve blocks, to open surgery.
Medications and physical therapy are usually the first line of treatments advised by physicians. If the pain is unresponsive to these interventions, then techniques such as nerve blocks should be considered. Nerve blocks can be done through local anesthetics and corticosteroids, or through more permanent methods like radiofrequency ablation or neurolysis.
These procedures have been shown to have good outcomes, and are normally well tolerated by patients. Since there are always risks associated with surgical procedures, open surgery is often kept as a last option. Surgery carries with it the risk of infection, bleeding, or damage to surrounding muscles, nerves or soft tissues.
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