Sacroiliac Joint Disease

What You Should Know About Sacroiliac Joint Disease

The sacroiliac joint is a firm, small joint that lies at the junction of the spine and the pelvis. Most often when we think of joints, we think of knees, hips, and shoulders--joints that are made to undergo motion. The sacroiliac joint does not move much, but it is critical to transferring the load of your upper body to your lower body.

Symptoms

Sacroiliac joint inflammation can be a difficult problem to diagnose for a few reasons: 

• The SI joint is not easily palpated or manipulated
• Tests tend not to isolate just the SI joint
• Studies (X-Rays, MRIs, CAT Scans, Bone Scans) are often normal
• Several other problems (back pain, sciatica, hip arthritis) can cause similar symptoms 

Diagnosis

The first method of diagnosis is to feel for the joint and see if the sacroiliac area is tender. Certain tests can place pressure across the joint, and may indicate a problem in that region. One test, called the FABER test, is done by lying down, flexing the hip, abducting the leg, and externally rotating the hip. This maneuver places pressure directly across the sacroiliac joint.

If the diagnosis is still unclear, an injection into the SI joint can be diagnostic. In this procedure, a numbing medication (like novacaine) is injected into the SI joint. If the injection alleviates the symptoms, then the test is positive for the sacroiliac joint as a source of the problem. This test may be performed in conjunction with a cortisone injection for treatment of SI joint problems.

Treatment

Sacroiliac joint inflammation tends to respond well to conservative therapy. The first step in treatment is to avoid the activities that cause symptoms. For athletes, this may mean avoiding their sport to let the inflammation subside. Second, an anti-inflammatory medication can help to minimize the inflammation. It is important to understand that the anti-inflammatory medication is not given as a pain medicine, but rather to decrease the inflammation. Therefore, stopping the medication before your doctor tells you to stop can prevent proper treatment. Even if the pain goes away, the anti-inflammatory properties of these medications may still be effective. Physical therapy is the last step in conservative treatment. A physical therapist can help strengthen the muscles around the SI joint and low back and help increase flexibility around the joint.

If all these treatments fail, an injection of cortisone into the joint may be effective. The cortisone injection delivers a more powerful anti-inflammatory medication directly into the sacroiliac joint itself. Because the SI joint is deeper within the body than most joints, the cortisone injections are usually given under live X-Ray guidance in a hospital setting.

When all of these non-surgical treatments have failed to relieve the pain, SI joint fusion, thorough a minimally invasive approach can be helpful in some patients.