Sacroiliac (SI) Joint Pain

Sacroiliac (SI) joint pain is the result of damage or injury to the SI joint, the structure connecting the spine to the hips.

What’s in this section?

Signs and symptoms

Common symptoms of SI joint pain include:

  • Pain in the lower back and buttock
    • Can radiate into lower hip and upper thigh
    • Usually one sided
    • Worsens with sitting, standing, sleeping and movement such as walking
  • Pain when sitting or difficulty sitting for an extended period of time

Diagnosis

Diagnosis of SI joint pain starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose or rule out SI joint pain, including x-rays , computed tomography (CT), magnetic resonance imaging (MRI) and selective nerve root block.

Selective nerve root block is a method to inject an anesthetic and a steroid along a particular and targeted nerve root to help identify the correct nerve that is possibly causing your pain.

Treatment options

There are various treatment options for SI joint pain:

  • Physical therapy¬†to strengthen the surrounding muscles and stretch tight ligaments.
  • Medication¬†to reduce inflammation in the joint.
  • Joint injections.¬†This procedure is performed with the use of x-ray. A small needle is advanced into the joint. A small amount of local anesthetic and steroid are then slowly injected. If the injection results in a significant decrease in your pain, the SI joint is considered the source.
  • Radiofrequency ablation (rhizotomy). This is a procedure where high-frequency radio waves are used to generate heat and cause a lesion along a nerve that supplies sensation to a joint in your spine. This procedure is done after diagnostic lumbar facet joint/medial branch blocks have correctly identified the location of your spinal pain.¬†This procedure is performed in either the office or surgery center setting and typically takes about 20 – 30 minutes. The procedure involves a special needle that is advanced to the target area using fluoroscopic (x-ray) guidance. A small amount of electrical current is used to determine proper placement along the targeted nerve. You will feel a buzz or tapping sensation but it typically isn’t painful. Once the needle has been properly placed, a local anesthetic will be placed into the targeted area. The radiofrequency ablation, which typically lasts a few minutes, will then be performed. A combination of local anesthetic and injectable steroids is injected before the needle is removed.
  • Minimally invasive fusion.¬†The surgery is performed by going through the back, using a small incision in the area near the back of your hip bones/pelvis. Special x-ray imaging will be used in order to be certain that the fixation device(s) are appropriately placed. Occasionally allograft or other bone graft substitutions are used in addition to the fixation devices.

Conditions

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