Sacroiliac Joint Dysfunction

Description

The sacroiliac joints, also called SI joints, connect the sacrum to the iliac bones on each side. The sacrum is the triangular bone below the lumbar spine and the iliac bones are the two large bones that form the pelvis. The SI joint consists of strong ligaments that permit limited motion. The SI joints support the full weight of the body when a person stands. The substantial stress can erode the cartilage of the joints and lead to arthritis. Sacroiliac joint dysfunction, or sacroiliitis, simply refers to inflammation of the SI joint due to any cause, resulting in pain.

Causes

  • Spondylosis or spinal arthritis: Over time, the cartilage of the SI joints undergoes wear and tear and the bones that make up the joint start to rub together, causing pain.
  • Other types of arthritis that can cause SI joint dysfunction include ankylosing spondylitis, gouty arthritis, and rheumatoid arthritis
  • Hormonal changes during pregnancy can cause the ligaments of the sacroiliac joint to relax, increasing flexibility at the SI joint. This increased flexibility of a normally stiff joint can cause lower back and pelvic pain.
  • Leg length discrepancy can place increased stress on the SI joints
  • Trauma due to motor vehicle accidents, sports or a fall can cause SI joint dysfunction
  • Sacroiliac joint pain can be secondary to an infection, however, this is a rare cause

Symptoms

  • Dull, aching lower back pain
  • Pain that travels to the hip, buttock or groin
  • Sciatica like pain that can extend to the knee
  • Stiffness in the lower back, pelvis and hips
  • Worsening pain with increased stress on the SI joint during running, climbing stairs or other forms of weight bearing

Diagnosis

Diagnosis sacroiliac joint dysfunction starts with a careful and detailed history and physical exam. The physician will feel for tenderness over the SI joints, legs, hips, spine and gluteal region. She or he may put gentle pressure on the SI joint to try to reproduce the pain. Neurologic tests are used to assess muscle weakness. Pain from SI joint dysfunction can mimic the pain associated with other lower back conditions such as herniated disks, confounding the diagnosis. The SI joint often appears normal on diagnostic imaging studies such as X-rays.

Injecting the sacroiliac joint with local anesthetic can be used as a provocative test. If the pain diminishes after the injection, it can confirm the SI joint as the source of pain.

Management

Non-steroidal anti-inflammatory medications such as ibuprofen and naproxen may be effective. Physical therapists can teach stretching and stabilizing exercises to help reduce SI joint pain. Pilates and yoga can help as well. Steroid injections into the sacroiliac joint, often with radiographic guidance, can be performed if more conservative therapies do not provide relief. Surgical fusion of the SI joint is used as the treatment of last resort to relieve symptoms.