Referred pain location depends on the affected section of the sacroiliac joint
Pain referred from the sacroiliac joint (SIJ) may originate in the joint’s posterior ligamentous region. The site of referred pain may depend on which SIJ section is affected. This study aimed to determine the exact origin of pain referred from four SIJ sections.
The study included 50 patients with SIJ dysfunction, confirmed by more than 70 % pain relief after periarticular injection of local anesthetic into the SIJ. The posterior SIJ was divided into four sections—upper, middle, lower, and other (cranial portion of the ilium outside the SIJ)—designated sections 1, 2, 3, and 0, respectively. We then inserted a needle into the periarticular SIJ under fluoroscopy. After the patient identified the area(s) in which the needle insertion produced referred pain, we injected a mixture of 2 % lidocaine and contrast medium into the corresponding SIJ section.
Referred pain from SIJ section 0 was mainly located in the upper buttock along the iliac crest; pain from section 1, around the posterosuperior iliac spine; pain from section 2, in the middle buttock area; pain from section 3, in the lower buttock. In all, 22 (44.0 %) patients complained of groin pain, which was slightly relieved by lidocaine injection into SIJ sections 1 and 0.
Dysfunctional upper sections of the SIJ are associated with pain in the upper buttock and lower sections with pain in the lower buttock. Groin pain might be referred from the upper SIJ sections.
KeywordsSacroiliac joint Dysfunction Periarticular injection Referred pain Groin pain
The authors would like to acknowledge Dr. Atsushi Takahashi for his contribution to the paper.
Conflict of interest
None declared. We attest that the authors have not received and will not receive benefits for personal or professional use from any commercial party related directly or indirectly to the subject of this article.
- 1.Bernard TN, Classidy JD (1997) The sacroiliac joint syndrome. Pathophysiology, diagnosis and management. In: Frymoyer JW (ed) The adult spine: principles and practice. Lippincott-Raven Publishers, Philadelphia, pp 2343–2363Google Scholar
- 2.Vleeming A, Mooney V, Stoeckart R (2007) Movement, stability and lumbopelvic pain. Churchill Livingstone, Edinburgh, London, New york, Oxford, Philadelphia, St Luis, Sydney, TorontoGoogle Scholar
- 14.Luukkainen RK, Wennerstrand PV, Kautiainen HH et al (2002) Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol 20:31–37Google Scholar
- 16.Hackett GS (1958) Ligament and tendon relaxation (skeletal disability) treated by prolotherapy (fibro-osseous proliferation). Charles C Thomas publisher LTD, SpringfieldGoogle Scholar
- 21.Feinstein B, Langton JNK, Jameson RM et al (1954) Experiments on pain referred from deep somatic tissues. J Bone Jt Surg 36A:981–997Google Scholar