Abstract
Pain from the sacroiliac joint commonly occurs when lifting in an awkward position that puts strain on the joint, its supporting ligaments, and soft tissues. The sacroiliac joint is also susceptible to the development of arthritis from various conditions that can damage the joint cartilage. Osteoarthritis is the most common form of arthritis that results in sacroiliac joint pain; rheumatoid arthritis and posttraumatic arthritis are also common causes of sacroiliac joint pain. Less common causes include the collagen vascular diseases such as ankylosing spondylitis, infection, and Lyme disease. Collagen vascular disease generally manifests as polyarthropathy rather than as monarthropathy limited to the sacroiliac joint, although sacroiliac pain secondary to ankylosing spondylitis responds exceedingly well to the intraarticular injection technique described later. Occasionally, patients present with iatrogenically induced sacroiliac joint dysfunction resulting from overaggressive bone graft harvesting for spinal fusion. Most patients presenting with sacroiliac joint pain secondary to strain or arthritis complain of pain localized around the sacroiliac joint and upper leg that radiates into the posterior buttocks and backs of the legs; the pain does not radiate below the knees. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. On physical examination, the affected sacroiliac joint is tender to palpation. The patient often favors the affected leg and lists toward the unaffected side. Spasm of the lumbar paraspinal musculature is often present, as is limited range of motion of the lumbar spine in the erect position; range of motion improves in the sitting position owing to relaxation of the hamstring muscles.
Keywords
sacroiliac joint, ankylosing spondylitis, ultrasound guided injection, diagnostic sonography, pelvic pain, back pain, hip pain, degenerative arthritis, septic arthritis, Reiter syndrome, Yeoman test, Gaenslen test, Stork test, Piedailu test, Van Durson test
ICD-10 CODE M53.3
Keywords
sacroiliac joint, ankylosing spondylitis, ultrasound guided injection, diagnostic sonography, pelvic pain, back pain, hip pain, degenerative arthritis, septic arthritis, Reiter syndrome, Yeoman test, Gaenslen test, Stork test, Piedailu test, Van Durson test
ICD-10 CODE M53.3
The Clinical Syndrome
Pain from the sacroiliac joint commonly occurs when lifting in an awkward position that puts strain on the joint, its supporting ligaments, and soft tissues. The sacroiliac joint is also susceptible to the development of arthritis from various conditions that can damage the joint cartilage. Osteoarthritis is the most common form of arthritis that results in sacroiliac joint pain; rheumatoid arthritis and posttraumatic arthritis are also common causes of sacroiliac joint pain. Less common causes include the collagen vascular diseases such as ankylosing spondylitis, infection, and Lyme disease. Collagen vascular disease generally manifests as polyarthropathy rather than as monarthropathy limited to the sacroiliac joint, although sacroiliac pain secondary to ankylosing spondylitis responds exceedingly well to the intraarticular injection technique described later. Occasionally, patients present with iatrogenically induced sacroiliac joint dysfunction resulting from overaggressive bone graft harvesting for spinal fusion.
Signs and Symptoms
Most patients presenting with sacroiliac joint pain secondary to strain or arthritis complain of pain localized around the sacroiliac joint and upper leg that radiates into the posterior buttocks and backs of the legs ( Fig. 87.1 ); the pain does not radiate below the knees. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. On physical examination, the affected sacroiliac joint is tender to palpation. The patient often favors the affected leg and lists toward the unaffected side. Spasm of the lumbar paraspinal musculature is often present, as is limited range of motion of the lumbar spine in the erect position; range of motion improves in the sitting position owing to relaxation of the hamstring muscles.
Patients with pain emanating from the sacroiliac joint exhibit a positive pelvic rock test result. This test is performed by placing the examiner’s hands on the iliac crests and the thumbs on the anterior superior iliac spines and then forcibly compressing the patient’s pelvis toward the midline. A positive test result is indicated by the production of pain around the sacroiliac joint. Other physical examination tests for sacroiliac joint dysfunction include the Yeoman, Gaenslen, Stork, Piedailu, and Van Durson tests ( Fig. 87.2 ).
Testing
Plain radiography is indicated in all patients who present with sacroiliac joint pain ( Fig. 87.3 ). Because the sacrum is susceptible to stress fractures and to the development of infection and both primary and secondary tumors, magnetic resonance imaging of the distal lumbar spine and sacrum is indicated if the cause of the patient’s pain is in question ( Fig. 87.4 ). Computerized tomographic scanning and ultrasound imaging may also provide valuable clinical information ( Fig. 87.5 ). Radionuclide bone scanning should also be considered in such patients to rule out tumor and insufficiency fractures that may be missed on conventional radiographs. Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, erythrocyte sedimentation rate, human leukocyte antigen (HLA)-B27 screening, antinuclear antibody testing, and automated blood chemistry.
