Sacroiliac Joint Pain

Sacroiliac joint pain or SIJ pain is a common disorder that is seen in females much more than males. The SIJ is comprised of the surface between the sacrum and the iliac bones. The two iliac bones comprise the pelvis. The joint is essentially non-mobile in the vast majority of patients and although some believe the pain is from a hyper mobile joint, we believe that the pain originates from the tissues overlying the joint surface. The region of the SIJ is where many of the ligaments and tendons adhere to the sacrum that supports the spine. These tendons get damaged and torn and this leads to a chronic tendonitis type of picture which causes localized pain that is tender to the touch. The pain is usually contained to the region of the SIJ but in some people the pain can radiate into the buttock and even into the leg. Nonetheless, the common presentation is unilateral low back to buttock pain. Often a “knot” of tissue is felt under the skin where the pain is present. This “knot” of tissue represents the torn tissues and since the tendon tissues heal poorly, the pain tends to be persistent. Probably the wider and shallower pelvis of the female leads to the greater prevalence of the disease in women. Also, childbirth may lead to some the tissues overlying the pelvis to become damaged. The SIJ syndrome is also seen in males but less frequently. The diagnosis of the disorder includes tenderness over the joint region and elimination of the pain with a selective SIJ injection. There are other tests, such as Patrick’s test but if a SIJ injection doesn’t eliminate the pain then think of other causes. The treatment of SIJ pain can be as simple as rest or a back brace with anti-inflammatory medications. Injections of a corticosteroid into the joint can lead to pain relief for several weeks or months. This can be a long term treatment option if the relief lasts at least two to three months. If the relief of the SIJ injection is of short-term benefit then one could consider a SIJ debridement surgery which was pioneered by the doctors at MicroSpine. The SIJ surgery removes the damaged ligamental tissues surrounding the SIJ. This leads to permanent relief of the pain is 60% of the people and involves an incision of less than one inch. Other options include SIJ fusion surgery which involves fusing the joint with metal hardware to reduce motion in the joint. This has a success rate of around 50% and involves a 6 inch incision. There are also treatments that use a needle that burns the tissues around the joint. This is called radiofrequency lesioning and uses electrical energy to create heat to burn the tissues. This works less than 50% of the time and lasts around 6 months. The important thing to remember is that SIJ pain is not always from a hyper mobile joint and that fusion of the joint works only 50% of the time. Thus, minimally invasive procedures offer better outcomes with less trauma and should be considered when appropriate.

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