13. Sacroiliac Joint Pain

Abstract

The sacroiliac joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the sacroiliac joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower limb(s). Because sacroiliac joint pain is difficult to distinguish from other forms of low back pain based on history, different provocative maneuvers have been advocated. Individually, they have weak predictive value, but combined batteries of tests can help ascertain a diagnosis. Radiological imaging is important to exclude "red flags" but contributes little in the diagnosis. Diagnostic blocks are the diagnostic gold standard but must be interpreted with caution, because false-positive as well as false-negative results occur frequently. Treatment of sacroiliac joint pain is best performed in the context of a multidisciplinary approach. Conservative treatments address the underlying causes (posture and gait disturbances) and consist of exercise therapy and manipulation. Intra-articular sacroiliac joint infiltrations with local anesthetic and corticosteroids hold the highest evidence rating (1 B+). If the latter fail or produce only short-term effects, cooled radiofrequency treatment of the lateral branches of S1 to S3 (S4) is recommended (2 B+) if available. When this procedure cannot be used, (pulsed) radiofrequency procedures targeted at L5 dorsal ramus and lateral branches of S1 to S3 may be considered (2 C+).

Mechanical lower back pain and sacroiliac joint dysfunction in golfers at two golf clubs in Durban, South Africa

“…Other studies on the prevalence of MLBP showed it to be 25%–34.5% among golfers, which is less than what this study showed (Finn 2013; Gosheger et al 2003; McHardy, Pollard & Luo 2006; McHardy et al 2007; Parziale & Mallon 2006; Reed & Wadsworth 2010; Wadsworth 2007). The prevalence of SIJD in this study (23%) fell within the range of SIJD prevalence reported among patients with lower back pain which is between 16% and 30% (Vanelderen et al 2010). There is no literature that reports on the prevalence of SIJD among golfers.…”

“…Sacroiliac joint dysfunction (SIJD) is one of the major contributing factors to MLBP accounting for approximately 16%–30% of cases (Cohen, Chen & Neufeld 2014; Kirkaldy-Willis & Bernard 1999; Vanelderen et al 2010). The SIJD generally refers to aberrant position or movement of sacroiliac joint (SIJ) structures that may or may not result in pain (Laslett, et al 2003, 2005).…”

Sacroiliac joint syndrome 10 years after lumbar arthroplasty: the importance of spinopelvic alignment

“…The preoperative assessment included a complete physical examination performed by one of the two senior authors consisting on a direct palpation test and on three provocative SIJ tests (compression test, distraction test, and active straight leg raise test) [1,6]. The clinical suspicion of SIJ dysfunction was confirmed afterward by SIJ blocks under fluoroscopy or CT scan guidance.…”

“…Despite a careful selection of cases, the failure rates after fusion has been reported to range from 5 to 30 % and SIJ has been suggested as a possible pain source by several authors [1,3]. Possible causes are an increased load transfer on the adjacent articulation associated to additional strains with translational motion that may lead to pain [4].…”

“…Nevertheless, SIJ pain after lumbosacral fusion is a well-known problem. It is defined as pain localized in the region of the SIJ, reproducible by stress and provocation tests, and reliably relieved by selective infiltration of the joint with local anesthetic [1]. SIJ pain is generally localized in the gluteal region but also lower lumbar region, groin, and upper lumbar region has been reported; referred pain in the lower limb and in the foot is more rarely associated [1,2].…”