Diagnosis and Management of Sacroiliac Joint Dysfunction

➤ Symptoms that suggest that the sacroiliac joint (SIJ), as opposed to pathology of the lumbar spine or hip, may be a source of pain include pain with position changes, such as standing from a seated position or sitting on a hard surface. Radiation to the groin or Fortin area also suggest sacroiliac joint as a source. ➤ A constellation of findings, including pain referral patterns, provocative maneuvers, and response to injections, should be utilized when assessing SIJ pathology. ➤ While its effectiveness remains unsubstantiated, manipulation of the SIJ is noninvasive and warrants consideration as an initial treatment modality. ➤ The diagnostic validity of local anesthetic and/or corticosteroid injections is difficult to assess as the criteria for a positive response are not uniform in the literature, and evidence to support intra-articular injections for therapeutic purposes is weak. ➤ SIJ fusion appears to be emerging as an acceptable treatment for patients with recalcitrant SIJ dysfunction; however, only a few long-term outcome studies have been done. ➤ New minimally invasive fusion techniques appear to decrease the morbidity of open procedures with at least comparable outcomes.