Sacroiliac joint (SIJ) pain

The sacroiliac joint (SIJ) is a synovial joint.

• prevalence of sacroiliac joint pain in patients presenting with lower back pain ranges from 15% to 25%
  
  
• SIJ pain can result from either intra-articular causes, for example arthritis or infection, or extraarticular causes, including enthesopathy, ligamentous injury, fractures ormyofascial pain
  
  
• SIJ pain cannot be diagnosed from history or physical examination alone, and X-ray and MRI are necessary

Treatment

• initial treatment should involve non-invasive measures such as anti-inflammatory medications and physiotherapy, focussing on exercises to improve lumbopelvic stability
• invasive treatment, which involves injection of the SIJ, can also be used in the diagnosis of SIJ pain
  • blind injections are unreliable and not recommended
  • radiologically guided SIJ injections can provide pain relief for up to 1 year (1)
    • injections are performed under fluoroscopy or CT or MRI guidance or more recently, realtime, high-resolution ultrasound guidance.

Reference:

• 1) Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg 2005; 101: 1440-53