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Evaluation and Treatment of Sacroiliac Joint Dysfunction in the Primary Care Setting: A Practical Review

Teaser: 

Sydney Rucker, BS, 1 Adrienne Kelly, MD, FRCSC,2 David W. Polly, MD,3Robert J. Ferdon, MS,4 Robert A. Ravinsky, MDCM, MPH, FRCSC,5

1Medical University of South Carolina College of Medicine, Charleston, SC.
2 Orthopaedic Surgeon, Sault Area Hospital, Assistant Professor, Northern Ontario School of Medicine, Sault Ste Marie, ON.

3 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.

4 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, University of South Carolina School of Medicine, Columbia, SC.

5 Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC.

CLINICAL TOOLS

Abstract: Mechanical dysfunction of the sacroiliac joint (SIJ) is an often overlooked, but a common cause of low back pain in the North American adult population. The diagnosis is primarily clinical and requires the exclusion of other potential etiologies of low back pain (LBP). A number of non-surgical treatment options are available for patients with this pathological entity. In cases of persistent, severe SIJ pain refractory to non-operative measures, SIJ fusion may be considered as a surgical intervention.
Key Words: sacroiliitis, sacroiliac dysfunction, sacroiliac joint (SIJ), low back pain (LBP), gluteal pain, SI joint fusion, percutaneous SI joint fixation.

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Pre-test CME Quiz Post-test CME Quiz
1. The SI joint is a known contributor to low back pain
2. Non-surgical treatment remains the primary management approach for SIJ dysfunction
3. Diagnostic intra-articular injections performed under image guidance are considered the gold standard for confirming SIJ-mediated pain
4. For patients with clinically debilitating mechanical SIJ dysfunction who have failed an exhaustive course of non-operative treatment, surgical options may be considered
1. SIJ dysfunction is a known contributor to low back pain, accounting for approximately 15-30% of LBP cases in the outpatient setting.
2. While imaging plays a role in excluding alternative diagnoses, no imaging modality has demonstrated reliable diagnostic utility for mechanical SIJ dysfunction although there is some utility of MRI in the setting of inflammatory sacroiliitis.
3. Patients with SIJ pain typically report symptoms consistently localized to an area within 1cm inferomedial to the posterior superior iliac spine (PSIS) that may radiate into the buttocks, groin, posterior thigh or even past the knee and into the foot.
4. Diagnosis is by physical examination which should include a variety of SIJ-specific provocation tests. Three or more positive results out of five standardized maneuvers is supported by Level 1 evidence for a Clinical Diagnostic Rule.
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Related Terms: Back Health, sacroiliitis, sacroiliac dysfunction, sacroiliac joint, low back pain, gluteal pain, SI joint fusion, percutaneous SI joint fixation