By Prathima Moorthy, M.D., Pain Management Center of Naples
There are many different terms for sacroiliac joint problems, including SI joint dysfunction, SI joint syndrome, SI joint strain, and SI joint inflammation. Each of these terms refers to a condition that causes pain in the SI joints from a variety of causes.
As with most other joints in the body, the SI joints have a cartilage layer covering the bone. The cartilage allows for some movement and acts as a shock absorber between the bones. When this cartilage is damaged or worn away, the bones begin to rub on each other, and degenerative arthritis (osteoarthritis) occurs. This is the most common cause of SI joint dysfunction. Degenerative arthritis occurs commonly in the SI joints, just like other weight-bearing joints of the body.
Another common cause of SI joint dysfunction is pregnancy. During pregnancy, hormones are released in the woman’s body that allows ligaments to relax. This prepares the body for childbirth. Relaxation of the ligaments holding the SI joints together allows for increased motion in the joints and can lead to increased stresses and abnormal wear. The additional weight and walking pattern (altered gait) associated with pregnancy also places additional stress on the SI joints.
Any condition that alters the normal walking pattern places increased stress on the SI joints. This could include a leg length discrepancy (one leg longer than the other), or pain in the hip, knee, ankle, or foot. Patients with severe pain in the lower extremity often develop problems with either the lower back (lumbar spine) or SI joints. In most cases if the underlying problem is treated, the associated lumbar spine or SI joint dysfunction will also improve. here are many disorders that affect the joints of the body that can also cause inflammation in the SI joints.
These include gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. These are all various forms of arthritis that can affect all joints. Ankylosing spondylitis is an inflammatory arthritis that always affects the SI joints. It can lead to stiffness and severe ain in the SI joints. As the disease process continues, the SI joints fuse together and have no further motion. Once this occurs, there is no further pain associated with the SI joints.
What are sacroiliac joint dysfunction symptoms?
The most common symptom of SI joint dysfunction is pain. Patients often experience pain in the lower back or the back of the hips. Pain may also be present in the groin and thighs. In many cases, it can be difficult to determine the exact source of the pain. Your physician can perform specific tests to help isolate the source of the pain. The pain is typically worse with standing and walking and improved when lying down. Inflammation and arthritis in the SI joint can also cause stiffness and a burning sensation in the pelvis.
How is sacroiliac joint dysfunction diagnosed?
The first step in diagnosis is typically a thorough history and physical examination by a physician. The physician will ask questions to determine if there are any underlying disorders that could be causing the patient’s pain. This can also help differentiate pain coming from the SI joints, lumbar spine, or hips. There are various tests a physician can perform during the physical examination that can help isolated the source of the pain.
By placing your hips and legs in certain positions and applying pressure, the SI joints can be moved or compressed to identify them as a source of pain. Other portions of the examination are to exclude certain possibilities that could mimic sacroiliac disease. The next step in diagnosis is often plain radiographs (X-rays). The patient may have X-rays of the pelvis, hips, or lumbar spine depending on what the physician finds on the history and physical examination..
Both X-rays and MRI studies can help identify sacroiliitis. This can appear as sclerosis in the joints. More severe wear in the joints can appear as erosion of the bone around the SI joints. These tests can also look for fusion of the SI joints. A magnetic resonance imaging (MRI) scan can also be helpful. This provides a better evaluation of the soft tissues, including muscles and ligaments. It can also identify subtle fractures that may not be seen on an X-ray. The MRI can identify inflammation in the SI joint by the presence of excessive fluid in the joint. A bone scan can be obtained to help isolate the source of your pain and can be used to identify bony abnormalities. The bone scan can
identify areas of increased activity in the bone. This is a nonspecific test and can be positive in cases of arthritis, infection, fracture, or tumors of bone. Often the most accurate method of diagnosing and treating SI joint dysfunction is by performing an injection that can numb the irritated area, thereby identifying the pain source. An anesthetic material (for example, lidocaine [Xylocaine]) can be injected along with a steroid (cortisone) directly into the SI joint.
This is usually performed with the aid of an X-ray machine to verify the injection is in the SI joint. The anesthetic and steroid can help relieve the pain from inflammation that is common with SI joint dysfunction. What is the treatment for sacroiliac joint dysfunction? As stated above, injections into the SI joint can provide both diagnosis and treatment. The duration of pain relief from injection can last from one month to six months or a year. The injections can be repeated each month for a total of three.. Oral anti-inflammatory medications (NSAIDs, ibuprofen [Motrin], naproxen [Naprosyn]) are often effective in pain relief as well. These can be taken long term if the patient does not have any other medical problems that prevent them from taking these medications.
Physical therapy can be very helpful. Pain in the SI joint is often related to either too much motion or not enough motion in the joint. A physical therapist can teach various stretching or stabilizing exercises that can help reduce the pain. A sacroiliac belt is a device that wraps around the hips to help stabilize the SI joints, which can also help the SI joint pain. Other options to stabilize the SI joints include yoga, manual therapy, and Pilates.
Pain Management Center of Naples
3439 Pine Ridge Road Naples, FL
Prathima Moorthy, M.D.
239.593.9594 | agnpmc@gmail.com