The sacroiliac joint (SIJ) is the largest joint in the human body, and is a frequent cause of low back and buttock pain. The sacroiliac joint connects the sacrum (tailbone) and the iliac bone of the pelvis (hip bone). 15-20% of all low back pain cases originate in the SIJ. SIJ pain, also known as sacroiliitis, can present in a variety of ways and is commonly overlooked or confused with other causes of low back pain, such as a herniated/bulging disc or facet joint arthritis. Treatments that are traditionally very effective for low back pain (i.e. epidurals) are often largely ineffective for sacroiliitis.
What is Sacroiliitis?
Sacroiliitis is pain and/or inflammation originating from the sacroiliac joint. Sacroiliac joint pain is a common cause of low back pain that can present as:
- Pain radiating from the buttock into the thigh
- Pain in the groin
- Low back pain
- Pain in the posterior thigh and leg
The cause of sacroiiliac joint pain can be inflammatory, degenerative, traumatic, metabolic, infectious, or oncologic. Additionally, “sacroiliac joint syndrome” is pain from the sacroiliac joint without an underlying anatomic cause.
What are the symptoms of Sacroiliitis?
Sacroiliac joint pain can be difficult to tell apart from other causes of low back pain, as there is no single factor distinguishing it from other pain conditions. There are, however, certain signs and symptoms that point to pain originating from the SIJ rather than other causes. Those include:
- Pain around the low back, buttocks, and posterior thigh.
- Pain made worse by changing from a sitting to a standing position, or with bending.
- Pain worsened with prolonged sitting.
- Pain improved with walking or standing.
- Tenderness to palpation over the sacroiliac joint.
SIJ pain is more likely to be one-sided, although in some cases it can occur in both sides at once. SIJ pain can radiate to various regions of the back, buttocks, and even the lower extremities.
What are the Causes of Sacroiliitis?
There are several factors that can predispose someone to SIJ pain, most of which include forces that place a large amount of stress on the joint, such as increased load, or a sudden rotation of the joint. Other factors include disruption of the lining of the joint, ligament injury, muscle strain, shearing forces, and cysts.
Reasons for sacroiliitis are typically divided into those that affect either the inside of the joint (intra-articular) or the outside of the joint (extra-articular).
Intra-articular causes include:
- Cystic disease
Extra-articular causes include:
- Ligament injury
- Myofascial pain
- Rapid weight gain or being overweight
- Cystic disease
About 40-50% of people with sacroiliac joint dysfunction report a history of trauma or some inciting event, with the leading causes being motor vehicle accidents, falls, cumulative strain, and pregnancy.
Pain from the SIJ can be difficult to distinguish from pain in the hip, spine or a pinched nerve. Diagnosing sacroiliitis is typically accomplished by a combination of a good history and physical exam, along with a positive response from a diagnostic block of the SIJ. Diagnostic imaging (CT scan, x-ray, and MRI) can be helpful in diagnosing or ruling out sacroiliitis.
What are my Treatment Options for Sacroiliitis?
At Unique Pain Medicine, our board certified physicians use in the latest and most advanced treatments for sacroiliac joint pain. We are experts in treating SIJ pain.
Treatment options include:
Sacroiliac Joint Injection – This simple procedure is considered to be the gold standard in diagnosing SIJ pain and is the first line of treatment. A small needle in inserted under x-ray guidance into the sacroiliac joint. A small amount of local anesthetic and a steroid medication is injected. If the cause of the pain is from the SIJ, the patient will almost immediately have a resolution of symptoms. This procedure only takes a few minutes, and can be done with local anesthesia, or IV sedation for comfort if desired.
Lateral Sacral Branch Blocks and Radiofrequency Ablation (RFA) – In cases where the SIJ injection provides only temporary relief, sacral branch blocks and sacral Radiofrequency Ablation can be utilized to increase the duration. During this safe procedure, radio waves are applied to a nerve plexus, which helps prevent the transmission of pain signals. This typically causes pain relief for a period of 6 months to 2 years.
Other Treatment Options for Sacroiliitis
Physical Therapy & Conservative Measures – Particular exercises can be useful to stabilize the joint, such as transversus abdominis muscle contractions.
Medication Management & Pharmacologic Therapy – In patients who do not have a correctable cause, pharmacotherapy may be used as an adjunct to treatment. Anti-inflammatory medications, (NSAIDs), and muscle relaxants may be of some benefit.
How long does a Sacroiliac (SI) joint injection last?
The SI joint injection can last weeks to months. If it relieves the inflammation around the joint, pain can resolve for years. Occasionally the injection can be repeated to increase the duration if needed. Other injections indirectly targeting SI joint can be performed and tend to last longer.
How many SI joint injections can you have?
At Unique Pain Medicine, we strive to perform the least number of injections with maximum benefit. Typically, we will perform at most 2 SI Joint injections per year. If pain is not completely abolished, SI joint radiofrequency ablation can be performed to ensure prolonged pain relief.
Are SI Joint injections Covered by Insurance?
Yes, all SIJ treatments are covered by all health insurance plans.
How long is the SI joint injection recovery time?
Typical recovery time is between 15-20 minutes.
What to expect after SI joint injection?
You should be able to return to your previous level of functioning within a few minutes. We ask patients to avoid strenuous activities, such as bending and lifting for a week after the procedure.
Are there any risks with SI joint injections?
Risks are extremely low, but include pain at the injection site, bleeding and infection. Patients may have mild leg weakness after the injection, which is temporary and will resolve after the local anesthetic wears off. You will be observed for signs of weakness after the procedure and will be discharged as soon as your leg feels stronger.
Are SI joint injections effective for SIJ pain from ankylosing spondylitis?
If Ankylosing Spondylitis is causing inflammation of the SIJ, the treatment is an SI joint steroid injection. The injection tend to help with pain and to restore quality of life.
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