SI (sacroiliac) Joint

About SI Joint Pain
Pain in the lower back, buttock and hip commonly arises from the sacroiliac joint (SI joint). This pain is called sacroiliitis. The SI joint is the joint between your spine and pelvis. The sacroiliac joint is the located between the spine (sacrum) and the hips (ilium). It is a large joint held together by strong muscles and ligaments.

SI joint pain maybe felt under your jean pocket. SI joint may cause back, buttock and leg pain. The pain is worse sitting especially on the butt cheek and with activity.This pain may be brought on or worsened by lifting, walking, running or even sleeping on the involved side. The SI joint can become injured or develop “wear and tear” arthritis called degeneration; this may be more common after lumbar fusion surgery.

Causes of SI joint pain include arthritis (degenerative sacroiliitis), separation or weakness of the joint (SI joint disruption or laxity), abnormal joint from birth (sacral dysgenesis), inflammation and swelling (ankylosing spondylitis, Reiter’s syndrome or inflammatory bowel disease (IBD)), break or fracture, infection, bone disease and tumor.

Diagnosing SI Joint Pain
SI joint pain can be difficult to diagnose and often is associated with spinal disease. SI joint pain can be diagnosed by careful history, physical examination and diagnostic injections. A needle is placed into the joint under x-ray or CT scan and steroid and pain medicine is injected. Pain relief confirms the diagnosis of SI joint pain.

SI joint pain may mimic degenerative disk disease (DDD) or arthritis in the facet joints (facet arthropathy). People with back, buttock and hip pain require a history and physical exam to determine if SI joint may be the cause of the pain. X-rays, CT scan and MRI may be helpful in diagnosing SI joint disorders. After a tentative diagnosis has been madeconfirmation is done with a diagnostic SI joint injection.

Diagnostic injection is done in a procedure room with an x-ray machine. Under x-ray guidance a needle is placed into the SI joint and pain medication (lidocaine) and steroid are injected. If your symptoms are decreased by at least 75%, then the SI joint may be either the source, or major contributor to your pain.

SI Joint Pain Treatment

People may benefit from physical therapy, anti-inflammatory medicine and steroid injections. Patients who fail conservative treatment may consider fusion surgery. Fusion surgery “fuses” the sacrum to the ilium to prevent pain. This is done by surgically placed implants. Many people will have coexisting spinal disease requiring spinal surgery.

Initial treatment is physical therapy, chiropractic manipulation and anti-inflammatories. Pelvic belt may provide some pain relief. If conservative treatments fail then surgery may be considered.

Traditional surgery required large incision, significant tissue damage and long recovery time. Today there is a minimally invasive option. The procedure involves the percutaneous placement of 3 small titanium implants across the SI joint through a small incision. These implants stabilize and fuse the joint. The procedure takes about one hour. The patient may be discharged home the same day or after a short hospital stay.

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