Journal of Pain Research (Oct 2021)
Successful Diagnosis of Sacroiliac Joint Dysfunction
Abstract
Patrick Buchanan,1 Shashank Vodapally,2 David W Lee,3 Jonathan M Hagedorn,4 Christopher Bovinet,5 Natalie Strand,6 Dawood Sayed,7 Timothy Deer8 1Department of Pain Medicine, Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA; 2Department of Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA; 3Department of Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA; 4Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA; 5Department of Pain Medicine, The Spine Center of Southeast Georgia, Brunswick, GA, USA; 6Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA; 7Department of Anesthesiology, Division of Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA; 8Department of Pain Medicine, The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Patrick Buchanan Email [email protected]: Sacroiliac joint (SIJ) pain is one of the most common causes of low back pain, accounting for 15 to 30% of all cases. Although SIJ dysfunction accounts for a large portion of chronic low back pain prevalence, it is often overlooked or under diagnosed and subsequently under treated. The purpose of this review was to establish a best practices model to effectively diagnose SIJ pain through detailed history, physical exam, review of imaging, and diagnostic block.Methods: A literature search was performed on the diagnosis of sacroiliac joint pain and sacroiliac joint dysfunction. The authors proposed diagnostic recommendations based upon the available literature and a detailed understanding of diagnosing SIJ pain.Results: The practitioner must focus on the history, location of pain, observed gait pattern, and perform key points of the physical exam including sacroiliac provocative maneuvers. If the patient exhibits at least three provocative maneuvers then the SIJ may be considered as a possible source of pain. Additionally, a thorough review of the imaging should be performed to rule out other etiologies of low back pain. In the absence of any pathognomonic tests or examination findings, diagnostic SIJ blocks have evolved as the diagnostic standard.Conclusion: The diagnosis of SIJ pain is a multifaceted process that involves a careful assessment including differentiating other pain generators in the region. This involves careful history taking, appropriate physical examination including provocative maneuvers and diagnostic injections. Once the diagnosis is confirmed, long-term solutions may be considered, including recent advances in sacral lateral branch denervation and sacroiliac joint fusion.Keywords: sacroiliac joint, SIJ, low back pain, diagnosis, best practices, review
