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Sacroiliac joint dysfunction manifests as moderate to severe lower back, buttock and hip pain. It is caused by abnormal movement of the sacroiliac joints (SI joints).
One of the largest joints in the body, the SI Joints are found where the sacrum, or tailbone, connects to the iliac bones, also known as the pelvic bones, which connect directly to the femur. These joints are crucial to the distribution of weight to the lower limbs, walking, and movement of the torso.
The SI joint is secured to the bones by several large ligaments. The SI joint does not actively move, but moves in a combination of sliding, tilting and rotating.
Many factors may cause pain in this region. Pain may start in the joint, in surrounding ligaments, or in the many nerve endings. Once the source is identified, pain can be relieved.
Like most other joints in the body, the SI joint is cushioned by a cartilage layer that protects the bone and helps absorb shock and is susceptible to many kinds of arthritis. When the cartilage wears, the bones rub together causing pain. This condition is known as degenerative arthritis or osteoarthritis. This type of arthritis is the primary cause of most SI Joint pain.
A high impact injury, such as a fall, an automobile accident, or a sports injury may damage the SI joint. The impact may twist the pelvis, damaging the ligaments that keep the joint aligned.
Pregnancy can cause the development of SI joint dysfunction later in life. Hormones that allow the joint to become more relaxed and flexible to aid childbirth may lead to joint instability.
Sometimes, the SI joints did not connect correctly, which can lead misalignment and joint instability. Rotational misalignment can occur when an individual suffers from scoliosis, has a leg length inequality, hip osteoarthritis, a history of polio, or poor quality footwear. Lumbar spinal fusion patients may also have SI joint pain and instability.
Factors that may increase chances of development of sacroiliac joint pain include:
• Weak muscles in the area
• Bending or twisting the back
• Improper lifting
• Inflammatory conditions, such as ankylosing spondylitis or psoriatic arthritis
Mild-to-severe pain in the following areas may indicate the dysfunction of the SI joint:
• Low back
• In the buttocks
• Deep in the pelvis
• In the hip, groin, back of the thigh
• Radiating down the leg on the affected side
Because SI joint dysfunction can be the result of such a wide range of causes, it is often under diagnosed or misdiagnosed. A physician will review patient history, x-rays and CT scans of the lumbar spine and hip. While patient history and imaging may help identify problems with the joint, it may not be enough to isolate the cause because of the wide range of factors that may cause this condition. Pain in this region may be caused by spine conditions and not SI joint disfunction.
Your physician may examine your posture, your pain levels in various positions, your muscles strength and reflexes. Lab tests may be ordered to rule out infection or arthritis.
The most accurate way of determining whether the SI joint is causing pain is to perform a diagnostic injection of the joint. Because the joint is so deep, this is sometimes done using x-ray guidance with a fluoroscope (a type of real time X-ray) . During this procedure, an anesthetic is injected into the joint to numb the joint. If the pain goes away while the anesthetic is in the joint, it is likely that this is the pain source.
Surgery for the SI dysfunction involves the fusion of the joints. In this surgery, the cartilage covering the surfaces of the SI joints is removed and the bones are held together with plates and screw until they fuse together over time. This relieves pain in the area because it eliminates the motion in the area but it should not be considered unless other less invasive treatments have proven unsuccessful.
Conservative treatments focus on stabilizing the joints by strengthening the joints. Physical therapy, yoga, manual therapy and pilates may be helpful.
Steroid injections or nerve blocks may relieve pain in this area by reducing inflammation. Radiofrequency ablation, which is a procedure where the small nerves that send the message of painful sensation to the brain from the joint can be burned with a special needle.
Ibuprofen, naproxen or other anti-inflammatory medications, such as ibuprofen and naproxen may relieve the pain and inflammation in the joint. Acetominiphen, like Tylenol, will not control the inflammation but may relieve the pain. Depending on the cause of the SI joint pain the provider may suggest muscle relaxers, anti inflammatory medications, or oral-steroids.