Robert Moghim MD
Anchor Healthcare
SI Joint Pain – Symptoms, Diagnosis, and Treatment
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The sacroiliac (SI) joint is a common cause of lower back and buttock pain, but it is often misdiagnosed. A precise diagnosis is key to effective treatment. Clinical exams help identify SI joint pain. One highly accurate test is the Fortin Finger Test, where patients pinpoint pain directly over the SI joint. Provocative maneuvers like the FABER and Gaenslen’s tests can reproduce pain, further confirming the diagnosis. Imaging is essential to rule out other causes. A hip X-ray ensures the pain isn’t coming from hip arthritis, while a lumbar MRI checks for disc or nerve issues in the spine. A sacral CT scan can provide detailed views of the SI joint to detect arthritis or other structural problems. The most reliable way to diagnose SI joint pain is a fluoroscopy-guided SI joint injection. Research shows that if an anesthetic injection relieves pain, it confirms the SI joint as the source with high accuracy. Treatment starts with physical therapy, bracing, and anti-inflammatory medications. If pain continues, SI joint injections with steroids or regenerative treatments like platelet rich plasma may provide relief. For chronic cases, advanced options like minimally invasive SI joint fusion or spinal cord stimulation (SCS) may help. Studies show that SCS can effectively manage SI joint pain by altering pain signals before they reach the brain. If you have ongoing lower back or buttock pain, proper imaging and precise diagnostic methods can lead to targeted treatment and lasting relief.
FAQs
How do SI joint injections work to alleviate pain?
SI joint injections involve delivering medication directly into the joint to reduce inflammation and pain. When guided by fluoroscopy, these injections can provide targeted relief, confirming the SI joint as the pain source. If successful, injections can manage symptoms effectively and suggest the need for further treatment.
How is SI joint pain accurately diagnosed?
Accurate diagnosis of SI joint pain involves several methods. Clinical exams, such as the Fortin Finger Test and provocative maneuvers like the FABER and Gaenslen’s tests, are used to pinpoint pain. Imaging tests, including hip X-rays, lumbar MRIs, and sacral CT scans, help rule out other conditions. A fluoroscopy-guided SI joint injection is the most reliable test, confirming the diagnosis if an anesthetic injection relieves the pain.
What are the common symptoms of SI joint pain?
SI joint pain typically manifests as pain in the lower back and buttocks, which can sometimes radiate down the legs. Patients often report discomfort when standing or walking for extended periods, and the pain may worsen with specific movements or activities.
What role does imaging play in diagnosing SI joint pain?
Imaging is crucial in diagnosing SI joint pain as it helps rule out other potential causes of lower back and buttock pain. Hip X-rays ensure that the pain isn’t due to hip arthritis, while lumbar MRIs check for disc or nerve issues in the spine. Sacral CT scans offer detailed views of the SI joint to detect arthritis or other structural problems, assisting in accurate diagnosis and treatment planning.
What treatment options are available for SI joint pain?
Treatment for SI joint pain begins with conservative methods such as physical therapy, bracing, and anti-inflammatory medications. If symptoms persist, options like SI joint injections with steroids or regenerative treatments like platelet-rich plasma may be recommended. For chronic SI joint pain, advanced treatments like minimally invasive SI joint fusion or spinal cord stimulation can provide relief.