Diagnosis and Management of Sacroiliac Joint Dysfunction

Abstract

➤ Symptoms that suggest that the sacroiliac joint (SIJ), as opposed to pathology of the lumbar spine or hip, may be a source of pain include pain with position changes, such as standing from a seated position or sitting on a hard surface. Radiation to the groin or Fortin area also suggest sacroiliac joint as a source.➤ A constellation of findings, including pain referral patterns, provocative maneuvers, and response to injections, should be utilized when assessing SIJ pathology.➤ While its effectiveness remains unsubstantiated, manipulation of the SIJ is noninvasive and warrants consideration as an initial treatment modality.➤ The diagnostic validity of local anesthetic and/or corticosteroid injections is difficult to assess as the criteria for a positive response are not uniform in the literature, and evidence to support intra-articular injections for therapeutic purposes is weak.➤ SIJ fusion appears to be emerging as an acceptable treatment for patients with recalcitrant SIJ dysfunction; however, only a few long-term outcome studies have been done.➤ New minimally invasive fusion techniques appear to decrease the morbidity of open procedures with at least comparable outcomes.

Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients

“…Hyperlaxity of ligaments results in a loss in integrity of the force closure mechanism. Special attention should be given to patients who present with multiple system involvement or vague complaints without a specific history of injury . Evidence of familial connective tissue disorders or similar familial history of complaints may indicate a genetic rather than acquired condition …”

“…Affected individuals are prone to repetitive‐motion overuse injuries due to their increased flexibility. Because of the nature of this connective tissue disease, many individuals bruise easily, are prone to ligament or tendon rupture, have congenital hip dysplasia and temporomandibular joint dysfunction, and experience joint or bursa inflammation or fibromyalgia‐like symptoms . Other nonmusculoskeletal conditions associated with ligament hypermobility include generalized anxiety disorders, orthostatic tachycardia, gastrointestinal disorders, and pelvic and bladder dysfunction …”

“…Treatment goals for the hypermobile sacroiliac joint should address strength, flexibility, stabilization, restoration of normal neuromuscular lumbopelvic control, and correction of functional adaptive changes as well as pain reduction. These goals are best accomplished with multiple and integrative therapies …”

“…22,23 Evidence of familial connective tissue disorders or similar familial history of complaints may indicate a genetic rather than acquired condition. 23…”

“…4,7,23 Other nonmusculoskeletal conditions associated with ligament hypermobility include generalized anxiety disorders, orthostatic tachycardia, gastrointestinal disorders, and pelvic and bladder dysfunction. 23…”