Gulf Coast Pain Management
SACROILIAC JOINT DYSFUNCTION

The sacroiliac joint lies next to the spine and connects the sacrum with the pelvis.
It is commonly a source of low back pain. It’s most common presentation is buttock pain
or low back pain that you can point to with one finger. The pain can also be similar to pain
caused by a lumbar disc herniation. The pain is typically felt on one side of the back or
buttocks, and can radiate down the leg. The pain usually remains above the knee.  The joint
acts as a shock absorber in the low back and transmits all the forces of the upper body to
the pelvis, hips, and legs.  It does not have very much motion; therefore, the pain is thought
to be due to too much or too little movement of the joint. Irritation of the sacroiliac joint can
also irritate the L5 nerve, which lies on top of it, and cause radiating pain down into the foot,
also called sciatica.

Sacroiliac pain is determined by a careful history and physical exam. It is typically diagnosed
through a process of exclusion. Injections of the sacroiliac joint are considered both diagnostic
and therapeutic. If the injection relieves the pain, it can be inferred that the sacroiliac joint is
the source of the pain. Usually a local anesthetic and steroid are injected at the same time.

The  local anesthetic helps numb the joint and determine if the joint is the source of the pain.
The steroid decreases inflammation in the joint and decreases pain. A sacroiliac joint injection
may be repeated several times. It is not recommended to have more than three injections in
one year. This is due to the accumulative effects of the steroid, which may cause adverse
effects. Oral non-steroidal anti-inflammatory medications, ice, and heat may be helpful. It is
recommended that the patient get involved in some type of therapy to improve the mobilization
and range of motion of the joint and low back.
 
If the patient receives temporary benefit from the sacroiliac joint injection, a rhizotomy
may be recommended to provide lasting relief.