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Sacroiliac Joint Dysfunction

What is the Sacroiliac Joint?

The Sacroiliac Joint is at the base of the spine and connects the tailbone (sacrum) to the pelvis. At this joint, the weight of the spine is transferred from the spine to the pelvis and legs. This places a considerable force on the joint. It acts as a small shock absorber as it passes the weight on to the legs.

The sacroiliac joint has synovium (joint lining) just like the hip and knee joints. It also has very strong connections from the sacrum to the pelvis. They consist of many strands of tough ligaments, which provide stability for the joint. The result is that this joint does not have much mobility. In fact, it typically only moves a fraction of an inch (millimeters). A normal degree of motion is only 2-4 degrees of rotation, and perhaps 2mm of up and down movement (translation). An exception is pregnancy where the ligaments become loser and allow the pelvis to open wider to accommodate the baby as it is born. With age, the sacroiliac joint stiffens and can become virtually fused together.

What is Sacroiliac Joint Dysfunction?

Sacroiliac Joint Dysfunction is a painful inflammatory condition of the sacro-iliac joint.

What causes Sacroiliac Joint Dysfunction?

Sacroiliac joint dysfunction is most commonly caused by wear and tear and the development of arthritis in the joint

Here are some common causes of sacroiliac joint dysfunction:

  • Trauma to the joint
  • Uneven leg length
  • Arthritis
  • Pregnancy

What is Sacroiliits?

Sacroiliitis is a severe form of Sacroiliac Joint Inflammation. It can be the result of infections or severe Joint Diseases. Here are some causes of Sacroillitis:

  • Infections such as urinary tract (UTI) or heart sac (endocarditis) which spreads to the joint
  • Intravenous drug abuse where infections from contaminated needles spread to the joint
  • Ankylosing Spondylitis
  • Rheumatoid Arthritis

Are there certain diseases which can cause Sacroiliac Joint Pain?

There are some specific types of joint inflammatory conditions affecting joints which can cause sacroiilitis (a severe inflammation of the sacroiliac joint):

  • Ankylosing Spondylitis
  • Psoriatric Arthritis
  • Reactive Arthritis

What is the difference between Sacroiliac Joint Dysfunction and Sacroiliitis?

Sacroiliitis is part of a specific form of arthritis or spondylitis, where as Sacroiliac Joint Dysfunction is a functional problem of the joint. Both conditions cause inflammation of the sacroiliac joint, but it is typically far more acute and severe in sacroiliitis than a sacroiliac joint dysfunction.

What are the symptoms of Sacroiliac Joint Dysfunction?

Here are some common symptoms of sacroiliac joint dysfunction and sacroiliitis:

  • Pain in the low back, typically more off to the side
  • Pain in the buttock
  • Pain radiating to the hip and leg
  • Pain with stair climbing
  • Pain with standing for longer periods of time
  • Pain when placing more weight on one leg more than another

How do Spine Specialists make the diagnosis of Sacro-iliac Joint Dysfunction?

Spine specialists use the information from the patient history, physical examination, and special tests to make this diagnosis:

1. History

In severe and acute cases of sacriliitis, a patient will come to the doctor with fevers and severe pain in the low back/buttock area. They will often have a strong limp, and very little mobility of the hip. These patients may have a recent history of infection.

With the more chronic type of sacroiliac joint dysfunction, the patient will often complain of nagging pain in the low back/buttock area and have a difficult time with stair climbing or standing. Some of these patients will have a history of trauma to the pelvis, a type of arthritis, or previous pregnancy.

2. Physical Examination

Here are some physical examination techniques the doctor might use to help make a diagnosis:

  • Looking at the spine and pelvis to look for areas of swelling, redness or asymmetry (inspection)
  • Measure the length of each leg
  • Look at the height of the top of each hip bone (iliac crest)
  • Touch and pressure over the sacroiliac joint (palpation)
  • Gaenslen’s test
  • FABERE’s test
  • Patrick’s test
  • Pelvic Rock test

3. Imaging

  1. X-Ray

X-Rays will show the sacroiliac joints. However, they often will not show a problem with the joint until a sacroiliac joint dysfunction or sacroiliitis is very advanced. It can take 10 years or more for that to be the case.

      2. CT-Scan

CT-Scans can show the anatomy of the sacroiliac joint very clearly and with better quality than an X-Ray. However, similar to X-Rays it may not show a problem until it is advanced. The CT scan also does not show inflammation in the joint.

      3. MRI Scan

MRI scans can show swelling and inflammation in the joint when special MRI images are taken. These are called STIR (Short Tau Inversion Recovery) images and those taken with intravenous contrast (Gadolinium). Both can show inflammation in the Sacroiliac Joint.

      4. Nuclear Bone Scan

A nuclear bone scan can show severe inflammation in the form of activity in the joint. However, bone scans are usually not taken for sacroiliac joint dysfunction.

     5. Diagnostic Injection

To diagnose a sacroiliac joint dysfunction or sacroiliitis, a doctor can inject the joint with the help of an X-Ray machine. Often a local anesthetic combined with an anti-inflammatory medication such as a steroid is injected. The patient is then evaluated for pain relief.

     6. Laboratory Tests

Sometimes doctors will use lab tests to find a cause of sacroiliitis. Here are some possible examples:

  • Complete Blood Count with differential (CBC with Diff):

This is a blood test which looks for elevated White Blood Cells and other more specialized cells (i.e. Neutrophils) which can be elevated in infection.

  • Sedimentation Rate (Sed. Rate):

This blood test looks for severe inflammation.

            C-Reactive Protein (CRP):

This test also looks for severe inflammation.

How is Sacroiliac Joint Disease treated?

  1. Non-Surgical

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy to Exercises and

Ultrasound Treatments. Mobilizing the joint and strengthening the muscles around the joint are frequent ways Physical Therapists will treat sacroiliac joint inflammation. Joint mobilization techniques can be manipulation, stretching and exercises.

F. Self Help Tools

  • Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. A specific Sacroiliac Belt is also available.

G. Spine Medications

    1. NSAIDS
    2. Steroids
    3. Pain Killers
    4. Muscle Relaxants
    5. Antidepressants
    6. Topical Medications

H. Injections

Here are some commonly offered injections for chronic Sacroilieitis:

  • Sacroiliac joint injection
  • Sacroiliac Joint Radiofrequency Ablation

2. Surgical Care

In very severe and chronic cases of a sacroiliac joint dysfunction orsacroiliitis, surgery can be performed. The surgery relies on permanently immobilizing the joint. There are sacroliliac joint fusion techniques available:Sacroiliac Joint Fusion