Chapter 7

SI Joint Diagnosis: A Comprehensive Approach

Once the diagnosis of SI joint pathology is confirmed there are several steps that should be taken. Here is where a multidisciplinary approach works effectively, as proper patient identification requires a partnership of all specialists.

Etiology of SI joint pathology comes from a variety of sources: Acute or Chronic strain;  Adjacent segment disorder (prior lumbar surgery); Iatrogenic such as Iliac Crest Bone Graft harvest;  Inflammatory; or Instability, such as the multiparous 30-year-old female.

SI joint therapy can be administered by any of the key specialists who work with the SI joint patient.  Conservative therapy for the SI joint includes:

  • Medication  - Nonsteroidal anti-inflammatory prescription
  • Physical Therapy (6-8 weeks)
  • Manual manipulation
  • Family assisted correction
  • Self-mobilization techniques
  • External fixation (such as belting and taping)

It is important to note that a significant percentage of all SI joint patients stabilize with appropriate conservative therapy treatment by 8 weeks.

Of the 15-20% of patients who require non-conservative treatment, there are options that can be pursued, including minimally invasive SI joint fusion. 

It is important that the surgeon understands what to order from his SI joint specialist peers, in order to ensure that the correct orders are provided for the welfare of the SI joint patient.

After examining the SI joint patient and reviewing patient history and images, the surgeon should order the following from the pain physician and physical therapist:

  • A minimum of 5 provocative tests, with 3 positive, including either Compression or Thigh Thrust. Provocative testing can be done by the surgeon, or ordered from either PTs or pain management physicians.
  • A diagnostic SI joint injection block. It is important to ask the pain management physician to have the provocative tests repeated after the block to confirm SI joint diagnosis. It is also important to ask the patient to keep a pain diary for up to 24 hours post-injection, to assess their condition.

The surgeon should have the patient return within two weeks following all testing to discuss the findings. At that point, the appropriate therapy may be discussed and decided upon, in consultation with either pain management or PT specialists.


The iFuse Implant System is intended for sacroiliac fusion for conditions including sacroiliac joint dysfunction that is a direct result of sacroiliac joint disruption and degenerative sacroiliitis. This includes conditions whose symptoms began during pregnancy or in the peripartum period and have persisted postpartum for more than 6 months. There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit. For information about the risks, visit: www.si-bone.com/risks

"Once the diagnosis of SI Joint pathology is confirmed there are several steps that should be taken. 

To effectively diagnose the SI Joint, it is important to use the appropriate SI Joint management algorithm, which includes provocative testing and diagnostic joint injections.
 
Etiology of SI Joint pathology comes from a variety of sources:
Acute or Chronic strain; 
Adjacent segment disorder (prior lumbar surgery);
Iatrogenic such as Iliac Crest Bone Graft harvest; 
Inflammatory;
Instability, such as the multiparous 30-year-old female, or prior trauma.

SI Joint Therapy can be administered by any of the key specialists who work with the SI Joint patient.  Conservative therapy for the SI Joint includes: 

Medication  - Nonsteroidal anti-inflammatory prescription
Physical Therapy 6-8 weeks
Manual manipulation
Family assisted correction
Self-mobilization techniques
and External fixation, such as belting and taping

It is important to note that a significant percentage of all SI Joint patients stabilize with appropriate conservative therapy treatment by 8 weeks.    

Of the 15-20% of patients who require non-conservative treatment, there are options that can be pursued, including minimally invasive SI Joint fusion, and RF treatment.  

It should be noted, however, that RF treatment and therapeutic injections are intended for symptomatic relief, and do not address the underlying SI Joint dysfunction.

It is important that the surgeon understands what to order from his SI Joint specialist peers, in order to ensure that the correct orders are provided for the welfare of the SI Joint patient.

After examining the SI Joint patient and reviewing patient history and images, the surgeon should order the following from the pain physician and physical therapist:

A minimum of 5 provocative tests, with 3 positive, including either Compression or Thigh Thrust. 
Provocative testing can be done by the surgeon, or ordered from either PTs or pain management physicians.

A diagnostic SI Joint injection block. It is important to ask the pain management physician to have the provocative tests repeated after the block to confirm SI Joint diagnosis.

It is also important to ask the patient to keep a pain diary for up to 24 hours post-injection, to assess their condition.

The surgeon should have the patient return within two weeks following all testing to discuss the findings.

At that point, the appropriate therapy may be determined. Based on numerous publications, if there is recurrent pain after a second SI joint injection, the patient may want to consider a minimally invasive surgical procedure."