Lower back pain affects millions each year. While some assume the pain stems from issues with the spine or sciatica, the source could be the sacroiliac (SI) joint. Dr. Vikas Patel, orthopedic surgeon at CU Medicine Orthopedics – Highlands Ranch Specialty Care Center, explains what SI joint dysfunction is and how it’s treated.
The SI joint connects the spine to the pelvis, carrying body weight from the spine down through the pelvis. Dysfunction of this joint can lead to an array of symptoms like lower back, buttock and thigh pain, limited mobility and a feeling of instability in the pelvis or lower back.
“SI joint dysfunction is often confused with spine issues or sciatica because the pain patterns can be similar,” Patel said. “Properly identifying the source is key to developing the right treatment plan.”
Possible causes of SI joint dysfunction
While the exact cause of SI joint dysfunction is unknown, traumas like falling on your tailbone can be contributing factors to SI joint pain.
SI joint dysfunction causes include:
Trauma
Arthritis
Ligament instability
Symptoms associated with SI joint dysfunction
SI joint pain is not always the same for everyone and some may have one or multiple symptoms.
Common SI joint dysfunction symptoms are:
- Pain in buttocks and back of thighs and legs
- Sitting or standing in one place
- Getting in and out of the car
- Feeling of instability
How is SI joint dysfunction diagnosed?
Diagnosing SI joint pain presents challenges as imaging tests alone can't confirm whether the joint is causing pain. As a result, patients may be misdiagnosed with spinal issues or told nothing is wrong. However, an orthopedic specialist like Dr. Patel can evaluate a patient's symptoms and medical history for tell-tale signs of SI joint dysfunction. A physical exam includes maneuvers that place stress on the SI joint to assess pain response. This layered approach helps accurately identify the SI joint as a source of lower back and pelvic discomfort. “The best diagnostic test is to inject the joint under CT scan guidance with a numbing medication and steroids,” Patel said. “If the numbness provides pain relief that lasts hours or days later, it confirms the joint as the source.”
What are conservative treatment options for SI joint dysfunction?
Conservative and non-surgical treatments are always considered before surgery for SI joint dysfunction.
Non-surgical treatments for SI joint dysfunction:
- SI joint-specific physical therapy
- SI joint belt or brace for stabilization
- Fluoroscopy-guided injection
- Chiropractor
- Acupuncture
- Prolotherapy
- Radiofrequency (RF) ablation
How are moderate and severe cases of SI joint dysfunction treated?
If non-surgical treatments fail, then surgical treatment may be considered by your orthopedic provider. The main surgical treatment is the surgical fusion of the sacrum to the ilium.
Surgical treatment of SI joint dysfunction:
- Surgical fusion
Dr. Patel explains, “SI Joint fusion surgery used to be a big and painful surgery, but it can now be performed minimally invasively with specialized implants to stabilize the joint and has been proven to be highly successful in the right patients.”
Vikas Patel, MD serves as the Executive Vice Chair of the Department of Orthopedic Surgery at the University of Colorado School of Medicine. He practices at CU Medicine Orthopedics – Highlands Ranch Specialty Care Center, UCHealth Spine Center – Anschutz Medical Campus, UCHealth Highlands Ranch Hospital and UCHealth Orthopedics.
Learn more about CU Medicine Orthopedics and schedule your appointment today.