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Sacroiliac Joint Dysfunction: Evaluation and Management

Zelle, Boris A MD; Gruen, Gary S MD; Brown, Shervondalonn MD; George, Susan PT

doi: 10.1097/01.ajp.0000131413.07468.8e
Review Article

Sacroiliac joint dysfunction is believed to be a significant source of low back and posterior pelvic pain.

Methods: To assess the clinical presentation, diagnostic testing, and treatment options for sacroiliac joint dysfunction, a systematic literature review was performed using MEDLINE.

Results: Presently, there are no widely accepted guidelines in the literature for the diagnosis and treatment of sacroiliac instability. Establishing management guidelines for this disorder has been complicated by the large spectrum of different etiologic factors, the variability of patient history and clinical symptoms, limited availability of objective testing, and incomplete understanding of the biomechanics of the sacroiliac joint.

Conclusions: A reliable examination technique to identify the sacroiliac joint as a source of low back pain seems to be pain relief following a radiologically guided injection of a local anaesthetic into the sacroiliac joint. Most patients respond to non-operative treatment. Patients who do not respond to non-operative treatment should be considered for operative sacroiliac joint stabilization.

From the Department of Orthopaedic Surgery, Division of Orthopaedic Traumatology, University of Pittsburgh Medical Center, Pittsburgh, PA.

Received for publication November 28, 2003; revised March 28, 2004; accepted April 18, 2004.

Reprints: Gary S. Gruen, MD, Professor, Department of Orthopaedic Surgery,

University of Pittsburgh Medical Center, Kaufmann Building, Suite 1010, 3471 Fifth Avenue, Pittsburgh, PA 15213 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.