Skip to main content
SpringerLink
Log in

Sacroiliac Joint Pain

  • Chapter
  • First Online:
Posterior Hip Disorders

  • 1389 Accesses

Abstract

The sacroiliac joint (SIJ) as a source of symptoms has been controversial; however, as knowledge about the joint increased, its role as a pain generator in patients complaining of symptoms that are often attributed to spinal pathology has become better appreciated. The literature reported that 10–25% of chronic low back pain is attributable to the sacroiliac joint. Provocative physical examination maneuvers and confirmatory intra-articular injections can help diagnose SI joint pain. The most definitive evaluation is image-guided injection of anesthetic solutions into the joint which is diagnostic if there is at least 75% symptom relief acutely. Treatment modalities include medications, physical therapy, manual therapy, injections, radiofrequency denervation, and arthrodesis. SI joint fusion may be performed using a variety of approaches and techniques, both open and minimally invasive. Several implant devices are available that promote fusion by simply crossing the joint space, but according to several authors, SI joint fusion should be considered unproven. To help guide selection of the appropriate treatment, further studies need to be conducted to establish which approach or technique is best.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zelle BA, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005;21:446–55.

    Article  PubMed  Google Scholar 

  2. Dreyfuss P, Michaelsen M, Pauza K, McLarty J. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine. 1996;21:2594–602.

    Article  CAS  PubMed  Google Scholar 

  3. Bernard TN, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop. 1987;217:266–80.

    Google Scholar 

  4. Fortin JD, Aprill CN, Ponthieux B, et al. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: clinical evaluation. Spine. 1994;19:1483–9.

    Article  CAS  PubMed  Google Scholar 

  5. Liliang PC, Lu K, Liang CL, et al. Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks. Pain Med. 2011;12:565–70.

    Article  PubMed  Google Scholar 

  6. De Palma MJ, Ketchum JM, Saullo TR. Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Med. 2011;12:732–9.

    Article  Google Scholar 

  7. Rashbaum RF, Ohnmeiss DD, Lindley EM, Kitchel SH, Patel VV. Sacroiliac joint pain and its treatment. Clin Spine Surg. 2016;29:42–8.

    Article  PubMed  Google Scholar 

  8. Dreyfuss P, Dreyer S, Cole A, Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004;12:255–65.

    Article  PubMed  Google Scholar 

  9. Rahl M. Anatomy and biomechanics. In: Dall BE, Eden SV, Rahl MD, editors. Surgery for the painful, dysfunctional sacroiliac joint. A clinical guide. New York: Springer; 2015. p. 15–35.

    Google Scholar 

  10. Lanzieri CG, Hilal SK. Computed tomography of the sacral plexus and sciatic nerve in the greater sciatic foramen. AJR Am J Roentgenol. 1984;143:165–8.

    Article  CAS  PubMed  Google Scholar 

  11. McGrath C, Nicholson H, Hurst P. The long posterior sacroiliac ligament: a histological study of morphological relations in the posterior sacroiliac region. Joint Bone Spine. 2009;76(1):57–62.

    Article  PubMed  Google Scholar 

  12. Pool-Goudzwaard AL, Kleinrensink GJ, Entius C, Snijders CJ, Stoeckart R. The sacroiliac part of the iliolumbar ligament. J Anat. 2001;199:457–63.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Yin W, Willard F, Carreiro J, et al. Sensory stimulation guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976). 2003;28:2419–25.

    Article  Google Scholar 

  14. Barker PJ, Hapuarachchi KS, Ross JA, Sambaiew E, Ranger TA, Briggs CA. Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Clin Anat. 2014;27(2):234–40.

    Article  CAS  PubMed  Google Scholar 

  15. Rebello da Veiga T, Da Silva A, Gomes da Silva R, Machado Carvalho S, Orsini M, Sila J. Intra-observer reliability in three-dimensional kinematic analysis of sacroiliac joint mobility. J Phys Ther Sci. 2015;27:1001–4.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Vrahas M, Hern TC, Diangelo D, Kellam J, Tile M. Ligamentous contributions to pelvic stability. Orthopedics. 1995;18(3):271–4.

    PubMed  CAS  Google Scholar 

  17. Nagamoto Y, Iwasaki M, Sakaura H, Sugiura T, Fujimori T, Matsuo Y, Kashii M, Murase T, Yoshikawa H, Sugamoto K. Sacroiliac joint motion in patients with degenerative lumbar spine disorders. J Neurosurg Spine. 2015;23(2):209–16.

    Article  PubMed  Google Scholar 

  18. Cibulka MT, Sinacore DR, Cromer GS, Delitto A. Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine. 1998;23(9):1009–15.

    Article  CAS  PubMed  Google Scholar 

  19. Kiapour A, Abdelgawad AA, Goel VK, Souccar A, Terai T, Ebraheim NA. Relationship between limb length discrepancy and load distribution across the sacroiliac joint – a finite element study. J Orthop Res. 2012;30(10):1577–80.

    Article  PubMed  Google Scholar 

  20. Dall B, Eden S, Rahl M, Graham Smith A. Algorithm for the diagnosis and treatment of the dysfunctional sacroiliac joint. In: Dall BE, Eden SV, Rahl MD, editors. Surgery for the painful, dysfunctional sacroiliac joint. A clinical guide. New York: Springer; 2015. p. 57–67.

    Google Scholar 

  21. Prather H. Sacroiliac joint pain: practical management. Clin J Sport Med. 2003;13(4):252–5.

    Article  PubMed  Google Scholar 

  22. Laslett M, Aprill CN, McDonald B, et al. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005;10(3):207–18.

    Article  PubMed  Google Scholar 

  23. Fortin JD, Dwyer AP, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: asymptomatic volunteers. Spine (Phila Pa 1976). 1994;19(13):1475–82.

    Article  CAS  Google Scholar 

  24. Sembrano JN, Reiley MA, Polly DW, et al. Diagnosis and treatment of sacroiliac joint pain. Curr Orthop Pract. 2011;22(4):344–50.

    Article  Google Scholar 

  25. Polly D. The sacroiliac joint. Neurosurg Clin N Am. 2017;28:301–12.

    Article  PubMed  Google Scholar 

  26. Freburger JK, Riddle DL. Measurement of sacroiliac joint dysfunction: a multicenter intertester reliability study. Phys Ther. 1999;79:1134–41.

    PubMed  CAS  Google Scholar 

  27. Van der Wurff P. Clinical diagnostic tests for the sacroiliac joint: motion and palpation tests. Aust J Physiother. 2006;52:308.

    Article  PubMed  Google Scholar 

  28. Riddle DL, Freburger JK. Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study. Phys Ther. 2002;82:772–81.

    PubMed  Google Scholar 

  29. Elgafy H, Semaan HB, Ebraheim N, Coombs R. Computed tomography findings in patients with sacroiliac pain. Clin Orthop. 2001;382:112–8.

    Article  Google Scholar 

  30. Eskander J, Ripoll J, Calixto F, Beakley B, Baker J, Healy P, Gunduz O, Shi L, Clodfelter J, Liu J, Kaye A, Sharma S. Value of examination under fluoroscopy for the assessment of sacroiliac joint dysfunction. Pain Physician. 2015;18:E781–6.

    PubMed  Google Scholar 

  31. Rosenberg JM, Quint DJ, de Rosayro AM. Computerized tomographic localization of clinically-guided sacroiliac joint injections. Clin J Pain. 2000;16:18–21.

    Article  CAS  PubMed  Google Scholar 

  32. Tullberg T, Blomberg S, Branth B, Johnsson R. Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine. 1998;23:1124–8.

    Article  CAS  PubMed  Google Scholar 

  33. Kennedy D, Engel A, Kreiner S, Nampiaparampil D, Duszynski B, MacVicar J. Fluoroscopically guided diagnostic and therapeutic intra-articular sacroiliac joint injections: a systematic review. Pain Med. 2015;16:1500–18.

    Article  PubMed  Google Scholar 

  34. Cohen S, Chen Y, Neufeld N. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99–116.

    Article  CAS  PubMed  Google Scholar 

  35. Yin W, Willard F, Carreiro J, Dreyfuss P. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine. 2003;28:2419–25.

    Article  PubMed  Google Scholar 

  36. Belanger T, Dall B. Sacroiliac arthrodesis using a posterior midline fascial splitting approach and pedicle screw instrumentation: a new technique. J Spinal Disord. 2001;14:118–24.

    Article  CAS  PubMed  Google Scholar 

  37. Lippitt A. Recurrent subluxation of the sacroiliac joint: diagnosis and treatment. Bull Hosp Jt Dis. 1995;54:94–102.

    PubMed  CAS  Google Scholar 

  38. Rand J. Anterior sacro-iliac arthrodesis for post-traumatic sacro-iliac arthritis: a case report. J Bone Joint Surg. 1985;67(A):157–9.

    Article  CAS  PubMed  Google Scholar 

  39. Waisbrod H, Krainick J, Gerbershagen H. Sacroiliac joint arthrodesis for chronic lower back pain. Arch Orthop Trauma Surg. 1987;106:238–40.

    Article  CAS  PubMed  Google Scholar 

  40. Zaidi H, Montoure A, Dickman C. Surgical and clinical efficacy of sacroiliac joint fusion: a systematic review of the literature. J Neurosurg Spine. 2015;23(1):59–66.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clínica Las Americas, Orthopedic Surgery, Medellin, Antioquia, Colombia

    William Henry Márquez-Arabia MD

  2. Sports Medicine Program, School of Medicine, Medellin, Antioquia, Colombia

    William Henry Márquez-Arabia MD

  3. Orthopedic Department, Medellin, Antioquia, Colombia

    Francisco Javier Monsalve MD

  4. International Consultant, Hip Preservation Center / Baylor Scott and White Research Institute, Baylor University Medical Center, Dallas, TX, USA

    Juan Gómez-Hoyos MD

  5. Department of Orthopaedic Surgery - Health Provider, Clínica Las Américas / Clínica del Campestre, Medellin, Antioquia, Colombia

    Juan Gómez-Hoyos MD

  6. Professor - School of Medicine - Sports Medicine Program, Universidad de Antioquia, Medellín, Antioquia, Colombia

    Juan Gómez-Hoyos MD

  7. Medical and Research Director, Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA

    Hal D. Martin DO

Authors
  1. William Henry Márquez-Arabia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francisco Javier Monsalve MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juan Gómez-Hoyos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hal D. Martin DO
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Medical and Research Director, Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA

    Hal D. Martin

  2. International Consultant, Hip Preservation Center / Baylor Scott and White Research Institute, Baylor University Medical Center, Dallas, TX, USA

    Juan Gómez-Hoyos

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Márquez-Arabia, W.H., Monsalve, F.J., Gómez-Hoyos, J., Martin, H.D. (2019). Sacroiliac Joint Pain. In: Martin, H., Gómez-Hoyos, J. (eds) Posterior Hip Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-78040-5_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-78040-5_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-78038-2

  • Online ISBN: 978-3-319-78040-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation