"While sacroiliac joint dysfunction has been well documented as a clinically significant source of low back pain, it remains one of the under-diagnosed and under-treated areas in orthopedic practice.
Noted orthopedic surgeon Dr. Steven Garfin will review some important background about the SI Joint.
The SI joint may be responsible for up to 25 or 30% of complaints related to low back pain. That number may be even higher in long fusions that include the sacrum.
Despite the fact the literature on the SI joint goes back a long way it has truly been an under-appreciated, under-studied and under-diagnosed joint.
The SI joint was nothing we ever paid attention to. You learn about it in anatomy but diagnostically or therapeutically it just wasn’t an issue.
Recently there has been a summit meeting of individuals who are familiar with the SI joint and academic spine surgeons and clinically active spine surgeons such as me to talk about the SI joint.
Meta analysis was done of available literature. The discussions were summarized and we were able to come up with an agreement as to a consensus how to diagnose and potentially treat SI joint related problems that fortunately has been accepted for publication.
I realized that this is something I should listen to, pay attention to, and try to diagnose and try to teach my residents and fellows.
The algorithm lays out questions to ask for the history and for the physical exam. It includes examining the hip and neurologic exam for the spine, and then there are roughly five tests for the SI joint that stress the SI joint.
Three of them should be positive to lead or strongly lead to the diagnosis of the SI joint as a cause of pain.
These tests are not very complicated or too sophisticated. Most health care providers no matter what their specialty have learned them somewhere along their training. Unless you think about the SI joint you don’t do these tests. To add them in takes maybe five minutes maximum and it’s really sort of a thought process and a completeness of the exam and anybody can do that.
It’s critical for physicians and non-physicians, surgeons and non-surgeons to pay attention to the joint as a possible diagnosis and etiology related to low back pain."