Advertisement

Sacroiliac Joint Pain

  • William Henry Márquez-Arabia
  • Francisco Javier Monsalve
  • Juan Gómez-Hoyos
  • Hal D. Martin
Chapter

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.

Keywords

Sacroiliac joint Low back pain Diagnostic injection Physical therapy Sacroiliac joint fusion 

References

  1. 1.
    Zelle BA, Gruen GS, Brown S, George S. Sacroiliac joint dysfunction: evaluation and management. Clin J Pain. 2005;21:446–55.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Bernard TN, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop. 1987;217:266–80.Google Scholar
  4. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 7.
    Rashbaum RF, Ohnmeiss DD, Lindley EM, Kitchel SH, Patel VV. Sacroiliac joint pain and its treatment. Clin Spine Surg. 2016;29:42–8.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Dreyfuss P, Dreyer S, Cole A, Mayo K. Sacroiliac joint pain. J Am Acad Orthop Surg. 2004;12:255–65.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 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. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Vrahas M, Hern TC, Diangelo D, Kellam J, Tile M. Ligamentous contributions to pelvic stability. Orthopedics. 1995;18(3):271–4.PubMedPubMedCentralGoogle Scholar
  17. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 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. 21.
    Prather H. Sacroiliac joint pain: practical management. Clin J Sport Med. 2003;13(4):252–5.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 24.
    Sembrano JN, Reiley MA, Polly DW, et al. Diagnosis and treatment of sacroiliac joint pain. Curr Orthop Pract. 2011;22(4):344–50.CrossRefGoogle Scholar
  25. 25.
    Polly D. The sacroiliac joint. Neurosurg Clin N Am. 2017;28:301–12.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Freburger JK, Riddle DL. Measurement of sacroiliac joint dysfunction: a multicenter intertester reliability study. Phys Ther. 1999;79:1134–41.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Van der Wurff P. Clinical diagnostic tests for the sacroiliac joint: motion and palpation tests. Aust J Physiother. 2006;52:308.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 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.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Elgafy H, Semaan HB, Ebraheim N, Coombs R. Computed tomography findings in patients with sacroiliac pain. Clin Orthop. 2001;382:112–8.CrossRefGoogle Scholar
  30. 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.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Rosenberg JM, Quint DJ, de Rosayro AM. Computerized tomographic localization of clinically-guided sacroiliac joint injections. Clin J Pain. 2000;16:18–21.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Lippitt A. Recurrent subluxation of the sacroiliac joint: diagnosis and treatment. Bull Hosp Jt Dis. 1995;54:94–102.PubMedPubMedCentralGoogle Scholar
  38. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  39. 39.
    Waisbrod H, Krainick J, Gerbershagen H. Sacroiliac joint arthrodesis for chronic lower back pain. Arch Orthop Trauma Surg. 1987;106:238–40.CrossRefPubMedGoogle Scholar
  40. 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.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • William Henry Márquez-Arabia
    • 1
    • 2
  • Francisco Javier Monsalve
    • 3
  • Juan Gómez-Hoyos
    • 4
    • 5
    • 6
  • Hal D. Martin
    • 7
  1. 1.Clínica Las Americas, Orthopedic SurgeryMedellinColombia
  2. 2.Sports Medicine ProgramSchool of MedicineMedellinColombia
  3. 3.Orthopedic DepartmentMedellinColombia
  4. 4.International Consultant, Hip Preservation Center / Baylor Scott and White Research InstituteBaylor University Medical CenterDallasUSA
  5. 5.Department of Orthopaedic Surgery - Health ProviderClínica Las Américas / Clínica del CampestreMedellinColombia
  6. 6.Professor - School of Medicine - Sports Medicine ProgramUniversidad de AntioquiaMedellínColombia
  7. 7.Medical and Research Director, Hip Preservation Center, Baylor University Medical CenterDallasUSA

Personalised recommendations