Sacroiliac Joint Injury

Continuing Education Activity

• Sacroiliac joint injury is a common cause of low back pain.
• Differentiating SI joint pain from mechanical low back pain is essential.

Objectives

• Identify the etiology of sacroiliac joint injury medical conditions and emergencies.
• Review the appropriate evaluation of sacroiliac joint injury.
• Outline the management options for sacroiliac joint injury.
• Describe interprofessional team strategies for improving care.

Introduction

• SI joint (Sacroiliac joint) connects the spine and pelvis.
• Injury to the SI joint can cause significant low back and buttock pain.
• Forces acting on SI joint: shearing, torsion, rotation, tension.
• Challenges in diagnosing SI joint pathology due to overlap with lumbar pain.
• Up to 30% of low back pain is secondary to the SI joint.
• Risk factors: pregnancy, age (40-50), osteoarthritis.

Etiology

• Common causes: repetitive microtrauma, acute trauma, pregnancy.
• Fracture classification: Type 1 (minor), Type 2, Type 3 (major).
• Associated with: ankylosing spondylitis, osteoarthritis, anatomical variations.
• Pregnancy-related SI joint pain due to hormone relaxin.

Epidemiology

• 13% of chronic low back pain patients have SI joint dysfunction.
• 15-30% of low back pain attributable to SI joint injury.
• High prevalence in athletes and during pregnancy.

History and Physical

• Pain localized to the buttock, may radiate to the leg or groin.
• Physical exam: musculoskeletal and neurologic exam, tenderness in pelvic area.
• Special tests: Gaenslen test, FABER test, etc.

Evaluation

• Imaging: X-ray, MRI (critical for diagnosis), CT (when MRI is contraindicated).
• Diagnostic injections can confirm SI joint pain source.

Treatment / Management

• Conservative treatments: physical therapy, NSAIDs, exercises.
• Invasive options: corticosteroid injections, radiofrequency ablation, surgery.
• Importance of patient education and weight management.

Differential Diagnosis

• Includes: synovitis, capsulitis, infection, piriformis syndrome.
• Mechanical causes: leg length discrepancies, lumbar fusion.

Prognosis

• Most cases improve with conservative management.
• Sedentary lifestyle leads to worse outcomes.

Complications

• Recurrence rate over 30% in chronic cases.
• Possible chronic pain, disability, opioid dependence.

Consultations

• Specialists involved: physical medicine, sports medicine, pain management, radiologists.

Deterrence and Patient Education

• Education on posture, lifting techniques, and regular exercise.

Enhancing Healthcare Team Outcomes

• Requires interprofessional team: primary care, physical therapists, radiologists, orthopedic surgeons, rheumatologists.
• Effective management involves history taking, imaging, conservative therapy, and sometimes surgery.