Causes of Sacroiliitis
Sacroiliitis can be caused by various factors, including:
Intra-articular (Inside the Joint): Trauma, Arthritis, Infection
Extra-articular (Outside the Joint): Trauma, Fractures, Pregnancy, Ligament Injury
Risk Factors include anything that puts a lot of pressure and stress on the joint: obesity, spine deformities, leg length discrepancy, previous spine surgery, ligament weakening from pregnancy.
Symptoms of Sacroiliitis
SI joint pain can be difficult to tell apart from lower back pain. However, there are certain symptoms that point to SI joint pain rather than other causes These include:
- Pain below the hip bone
- Pain worsens from transitioning from a sitting to standing position
- Pain improves with walking
- Tenderness of the SI joint
- Pain radiating to the thigh, groin, or butt
- Typically one sided pain
Impact of Sacroiliitis
Sacroiliitis can lead to:
- Osteoarthritis: The abnormal pressure placed on the joint causes damage and results in joint erosion and pain.
Diagnosis of Sacroiliitis
Diagnosing sacroiliitis typically involves:
Medical History: Discussion of symptoms, past medical conditions, and any history of hip or spine injuries.
Physical Examination: Assessment of reflexes, muscle strength, and sensation.
Diagnostic Nerve Block: Temporary decrease or elimination of pain following anesthetic injected into the joint is the gold standard to diagnosing sacroiliitis.
Diagnostic Imaging: X-rays, CT scans or MRI scans are of little help in diagnosing sacroiliitis.
Treatment of Sacroiliitis
Treatment options include:
Sacroiliac Joint Block: This is the first line treatment for sacroiliitis. A physician injects a small amount of local anesthetic. In true sacroiliitis, pain relief will be immediate and dramatic.
Conservative Treatments: Non-surgical approaches include:
Medications: Such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants for pain management.
Physical Therapy: Exercises to strengthen abdominal muscles (abs) can be useful to improve SI joint pain.
Radiofrequency Ablation (RFA): Radio waves are directed to a nerve to prevent the transmission of pain.
Surgical Intervention: When conservative measures are ineffective or symptoms worsen, surgery may be considered:
Joint Fusion: Stabilizing the SI joint by permanently fusing the joint together
Prognosis: Most people have a good outcome depending on the severity of the case. Mild cases should resolve in a few days to weeks. More severe cases may take several months. The most severe cases may need surgery
Procedure Videos
SI Joint injection
References:
https://ainsworthinstitute.com/conditions/sacroiliac-joint-pain-sacroiliitis/
https://my.clevelandclinic.org/health/diseases/17736-sacroiliitis
Buchanan BK, Varacallo M. Sacroiliitis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448141/
