According the classification of the International Association for the Study of Pain (IASP), sacroiliac joint (SI joint) pain is defined as pain that is localised in the region of the SI joint, reproducible by stress and provocation tests, together with selective infiltration of the SI joint with local anaesthetics instantly resulting in temporary or complete pain reduction.
Depending on the used diagnostic criteria (physical examination, positive effect of intra-articular local anaesthetics and medical imaging) used, the reported prevalence of SI joint pain varies between 16% and 30%. In patients with persistent LBP after lumbar arthrodesis, the prevalence of SI joint pain was 35%, as was confirmed by selective infiltration of the SI joint with local anaesthetics.
The causes of SI joint pain can be subdivided into intra-articular (infection, arthritis, malignancy) and extra-articular (enthesopathy, fractures, ligament injury and myofascial). However, frequently, no specific aetiology can be demonstrated.
Signs and symptoms
Pain originating in the SI joint is located just above the buttocks in 94% of patients. Referred pain from the SI joint can be observed in the lower lumbar area (72%), upper leg (28%), groin (14%), leg (including the foot; 12%), upper lumbar area (6%) and abdominal area (2%).
No neurological deficits are present in SI joint pain.
Pain is provoked by static load, such as prolonged sitting and standing, and sauntering along. Walking and cycling usually work the best.
There is no evidence of the diagnostic value of the individual pain provocation test on the SI joint.
Reproducibility has been demonstrated in a number of SI tests, such as the SI compression test, the SI distraction test, the Patrick test, the Gaenslen test, the Thigh Thrust test, the Fortin finger test, and the Gillet test. At least three of five or six of such tests, performed in the same patient, must be positive. Furthermore, no physical signs of discogenic aetiology should be present.
Additional Somatic Diagnostics
- Additional imaging techniques should be performed in order to exclude so-called 'red flags', such as malignancies, SI inflammation, fractures or infection.
- RAND-36 (quality of life)
- VAS Pain (maximal, minimal, actual, average/week)
- PCS (catastrophising)
- HADS (fear and depression)
Additional Psycho-cognitive Diagnostics
Whether or not somatic treatment is indicated is based on the pain diagnosis. Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment consisting of various non-somatic treatments may be necessary.
- Psychological Treatment
- Depression Treatment
- Cognitive-Behavioural Treatment
- Rehabilitation Treatment
- Non-steroid Anti-inflammatories (short period)
- Manual/Musculoskeletal Medicine
- Physiotherapy (only exercises)
Interventional Pain Treatment