Sacroiliac Joint Pain

what is Sacroiliac Joint?

The sacroiliac (SI) joint is located in the pelvis. It links the iliac bone (pelvis) to the sacrum (lowest part of the spine above the tailbone). This joint transfers weight and forces between your upper body and legs. It also permits small movements in rotatory movements of the spine. This also helps in absorbing shocks while jumping and loading.

There are 2 sacroiliac joints, one on each side.

What are the Causes of Sacroiliac Joint Dysfunction?

Sacroilitis is relatively common cause for low back pain. It goes un-diagnosed in most of the cases of low back pain.

some of the common causes of SI joint pain are:

• Degenerative arthritis occurs commonly
• Pregnancy
• Post child birth
• Other forms of arthritis – ankylosing spondylitis, rheumatoid arthritis, reactive arthritis etc.,
• Lumbar fusion surgery
• Can also be caused by leg length discrepancy, gait abnormalities, prolonged, vigorous exercise.

What are Symptoms of SI Joint Dysfunction?

• Lower back pain (below L5) that radiates to buttocks, into the back side of the thigh or just in the groin
• Sensation in lower extremity: pain, numbness, tingling, weakness
• Feeling of leg instability (buckling, giving way)
• Disturbed sleep patterns due to pain
• Pain worsens on sitting with legs crossed,
• Relieves on standing
• Altered sitting patterns (unable to sit for prolong hours, sitting more on unaffected side.)

How is the Diagnosis Made?

There is no definite imaging investigation to accurately diagnose SI joint dysfunction. X rays, MRI, CT scan, bone scan etc., just aid in assessing the anatomic integrity of the other possible pain sources that can mimic SIJ pain. It is also important to remember that more than one condition (like a disc or hip problem) can co-exist with SI joint problems.

Based on the complete medical history & comprehensive physical examination, your doctor may suspect the possible culprit of pain and plan for a diagnostic injection to confirm it.

Diagnostic Injections of the SI Joint are most widely used to determine the source of SI joint pain.

How is it Performed?

This injection is used to both diagnose and treat your low back pain caused by inflammation of the joint.

The patient lies on his / her stomach. With continuous monitoring of the patient, the skin on the target area (back or neck) is painted with an antiseptic solution and numbed with the local anaesthetic. Using either fluoroscopic guidance (real-time x-ray) or ultrasound guidance, the needle tip is placed at the targeted area & its position is confirmed with the help of the contrast (dye). Then, a low volume anaesthetic with strong anti-inflammatory medication is injected. Then the patient is monitored in the recovery room prior to discharge.

The procedure takes approximately 15-30 minutes to complete.

How Long Does the Effect Last?

The pain relief might be there for few hours to a few weeks or much longer. If there is good pain relief in first 1-2 hours, it indicates that the pain source is SI joint. It is very important for you to maintain the pain diary for the next hours to days following this injection and bring it with you to your next follow visit with Doctor.

What are the Risks and Side Effects?

Serious side effects and complications are very rare. Pain at the injection site, local bruising, headache, nausea, fainting, or dizziness are some of the most common side effects, which are transient and will subside on their own. The other uncommon complications are infection, bleeding and nerve injury. These complications are minimized by stopping blood thinners, using sterile technique, and fluoroscopic or ultrasound guided needle placement.

What Should be done after SI Joint Injection?

• Avoid self-drive on that day alone.
• Avoid doing strenuous activity.
• Avoid lifting heavy weights.
• Following the treatment, the patient is advised to do all the exercises and take all the medications as prescribed. The patient may resume their work from next day.