Successful Diagnosis of Sacroiliac Joint Dysfunction

Abstract

Background: Sacroiliac joint (SIJ) pain is one of the most common causes of low back pain, accounting for 15 to 30% of all cases. Although SIJ dysfunction accounts for a large portion of chronic low back pain prevalence, it is often overlooked or under diagnosed and subsequently under treated. The purpose of this review was to establish a best practices model to effectively diagnose SIJ pain through detailed history, physical exam, review of imaging, and diagnostic block. Methods: A literature search was performed on the diagnosis of sacroiliac joint pain and sacroiliac joint dysfunction. The authors proposed diagnostic recommendations based upon the available literature and a detailed understanding of diagnosing SIJ pain. Results:The practitioner must focus on the history, location of pain, observed gait pattern, and perform key points of the physical exam including sacroiliac provocative maneuvers. If the patient exhibits at least three provocative maneuvers then the SIJ may be considered as a possible source of pain. Additionally, a thorough review of the imaging should be performed to rule out other etiologies of low back pain. In the absence of any pathognomonic tests or examination findings, diagnostic SIJ blocks have evolved as the diagnostic standard. Conclusion:The diagnosis of SIJ pain is a multifaceted process that involves a careful assessment including differentiating other pain generators in the region. This involves careful history taking, appropriate physical examination including provocative maneuvers and diagnostic injections. Once the diagnosis is confirmed, long-term solutions may be considered, including recent advances in sacral lateral branch denervation and sacroiliac joint fusion.

What You Need to Know About Sacroiliac Dysfunction

“…Special tests are manually performed by the healthcare provider to rule in or rule out a particular diagnosis, in this case SIJD, and are part of the clinical examination. Recent and older literature recommends the use of pain-provoking SI joint special tests (Buchanan et al, 2021; Falowski et al, 2020; Laslett, 2019; Saueressig et al, 2021; Vleeming et al, 2008).…”

“…Sacroiliac joint dysfunction (SIJD) is estimated to occur in 15%–30% of patients who have nonspecific low back pain (LBP), has been reported to be as high as 40% (Ramírez et al, 2018; Visser et al, 2013), as well as is underdiagnosed and undertreated (Buchanan et al, 2021; Falowski et al, 2020). LBP is considered globally to be the leading cause of “years lived with a disability” according to the Global Burden of Disease Study 2017 (the Global Burden of Diseases, Injuries, and Risk Factors Study 2017; http://www.healthdata.org/gbd/data; Wu et al, 2020).…”

Sacroiliitis: A Review on Anatomy, Diagnosis, and Treatment

“…Because the SI joint is below several layers of tissues, the reliability of palpation has been questioned recently. It is argued that eliciting symptoms on palpation is not specific to SI joint dysfunction only and may lead to misdiagnosis [ 15 ].…”

Special type of distal junctional failure exhibits pelvic incidence changes: sacroiliac joint-related pain following lumbar spine surgery

“…Patients were diagnosed with SIJ-related pain following lumbar spine surgery if they: (I) experienced pain within 2 years of surgery below the L5 spinous process, buttocks, posterior thighs and groin area, and had a SIJ score based on (i) one-finger test (3 scores), (ii) groin pain (2 scores), (iii) pain while sitting on a chair (1 score), (iv) SIJ shear test (1 score), (v) tenderness of posterosuperior iliac spine (1 score), or (vi) tenderness of sacrotuberous ligament (1 score) (24,25), the scores, ranging from 0 to 9 points, had a cutoff value of 4; (II) had no residual compression findings of the nerve roots and cauda equina on lumbar magnetic resonance imaging; and (III) had 3 or more provocation tests that were positive in 6 specialized physical diagnostic tests [i.e., the FABER (flexion, abduction, external rotation), gapping test/distraction test, compression test/approximation test, thigh thrust test/femoral shear test, Gaenslen test/ pelvic torsion test, and sacral thrust test/sacral base spring test] (26,27). If necessary, an SIJ intra-articular block was performed for patients with a difficult final diagnosis, and SIJP was diagnosed as 70% pain relief within 3 hours (28)(29)(30)(31)(32).…”