Diagnosis and Management of Sacroiliac Joint Dysfunction. | SI-BONE

Diagnosis and Management of Sacroiliac Joint Dysfunction.

Ou-Yang DC, et al. J Bone Joint Surg Am. 2017 Dec 6;99(23):2027-2036. DOI: 10.2106/JBJS.17.00245.

ABSTRACT

  • Symptoms that suggest that the sacroiliac joint (SIJ), as opposed to pathology of the lumbar spine or hip, may be a source of pain include pain with position changes, such as standing from a seated position or sitting on a hard surface. Radiation to the groin or Fortin area also suggest sacroiliac joint as a source.
  • A constellation of findings, including pain referral patterns, provocative maneuvers, and response to injections, should be utilized when assessing SIJ pathology.
  • While its effectiveness remains unsubstantiated, manipulation of the SIJ is noninvasive and warrants consideration as an initial treatment modality.
  • The diagnostic validity of local anesthetic and/or corticosteroid injections is difficult to assess as the criteria for a positive response are not uniform in the literature, and evidence to support intra-articular injections for therapeutic purposes is weak.
  • SIJ fusion appears to be emerging as an acceptable treatment for patients with recalcitrant SIJ dysfunction; however, only a few long-term outcome studies have been done.
  • New minimally invasive fusion techniques appear to decrease the morbidity of open procedures with at least comparable outcomes.