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Diagnosing Sacroiliac Joint Pain

Thawrani, Dinesh P., MD, FACS; Agabegi, Steven S., MD; Asghar, Ferhan, MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: February 1, 2019 - Volume 27 - Issue 3 - p 85–93
doi: 10.5435/JAAOS-D-17-00132
Review Article

The sacroiliac joint (SIJ) is a diarthrodial joint that has been implicated as a pain generator in approximately 10% to 25% of patients with mechanical low back or leg symptoms. Unique anatomic and physiologic characteristics of SIJ make it susceptible to mechanical stress and also create challenges in the diagnosis of SIJ pain. A variety of inciting causes for SIJ pain may exist, ranging from repetitive low-impact activities such as jogging to increased stress after multilevel spine fusion surgery to high-energy trauma such as in motor vehicle accidents. Similarly, wide variability exists in the clinical presentation of SIJ pain from localized pain or tenderness around the SIJ to radiating pain into the groin or even the entire lower extremity. No pathognomonic clinical history, physical examination finding, or imaging study exists that aids clinicians in making a reliable diagnosis. However, imaging combined with clinical provocative tests might help to identify patients for further investigation. Although provocative physical examination tests have not received reliable consensus, if three or more provocative tests are positive, pursuing a diagnostic SIJ injection is considered reasonable. Notable pain relief with intra-articular anesthetic injection under radiographic guidance has been shown to provide reliable evidence in the diagnosis of SIJ pain.

From the Department of Orthopedic Surgery (Dr. Thawrani), Cincinnati VA Medical Center, University of Cincinnati College of Medicine, and the Department of Orthopedic Surgery, University of Cincinnati College of Medicine (Dr. Agabegi and Dr. Asghar), Cincinnati, OH.

Dr. Asghar or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons and the American Orthopaedic Association. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Thawrani and Dr. Agabegi.

© 2019 by American Academy of Orthopaedic Surgeons
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