Sacroiliac Joint Disorders Treatment Options

The sacroiliac joint is located in the lower part of the back, between the sacrum and the ilium bones of the pelvis. It is a critical component of the lower spine and pelvis and an important loadbearing buttress that transfers weight and forces between the torso, spine, and lower extremities. Sacroiliac joint disorders encompass a range of conditions that can cause pain and joint dysfunction.

• Degenerative arthritis (osteoarthritis): This is the most common form of arthritis that affects the SI joint and is characterized by the wearing away of the cartilage between the joints.
• Inflammatory arthritis: Conditions like ankylosing spondylitis or psoriatic arthritis can cause inflammation in the SI joints.
• Trauma: Injury caused by impact, such as from a fall or car accident, can damage the SI joints and cause posttraumatic arthritis.
• Pregnancy: Hormonal changes and weight increase during pregnancy can cause hypermobility and stress in the SI joints.

The primary symptom of an SI joint disorder is lower back, buttocks, or thigh pain. The pain may radiate into the legs. This pain may be aggravated by prolonged standing, climbing stairs, sleeping on one’s side, or other physical activities. Other symptoms may include:

• Stiffness or a burning sensation in the pelvis
• Pain that radiates to the lower limbs
• Numbness and tingling
• Weakness
• Buttocks pain
• Hip/groin pain
• Leg instability
• Instability or a feeling of the pelvis being out of alignment

Diagnosis typically involves a review of your medical history and an assessment of your symptoms. Dr. Ball will inquire about any history of injury, arthritis, or pregnancy. During the orthopedic examination, he will use specialized tests that manipulate the legs and torso to provoke SI joint pain and tests to evaluate your gait, range of motion, strength, and flexibility.

He may also evaluate neurological deficits, including reflexes and sensations. He will order X-rays and a CT scan or MRI scan to help identify SI joint disorders. He may order diagnostic injections directly into the SI joint. If the injection relieves pain, the SI joint is likely the source of pain.

When SI joint dysfunction is confirmed, treatment for SI joint disorders will be based on the cause. Conservative nonsurgical treatment includes physical therapy, NSAIDs for pain, SI joint belts to help stabilize the joint, education, and analgesic injection with or without steroids into the joint under fluoroscopic X-ray guidance, which can reduce inflammation, and pain and improve function. Ultrasound, deep heat, electrical stimulation, and traction can help relieve pain. Low-impact exercise and massage can help. Wearing a sacroiliac belt can provide support and ease pain.

If diagnostic injections confirm a diagnosis, radiofrequency nerve ablation (rhizotomy) can provide longer-term relief. If needed after nonoperative treatments have been exhausted, surgery to fuse the SI joint may be recommended.