Diagnosis of the SI joint as a source of symptoms

Sacroiliac (SI) joint disorders require appropriate interpretation of a patient’s history, clinical exam results, and imaging studies. Often hip pathology and lumbar pathology coexist with SI joint pathology. During physical examination, patients with SI joint disorders exhibit any/all of the following symptoms:

  • Lower back pain
  • Sensation of lower extremity: pain, numbness, tingling, weakness
  • Pelvis / buttock pain
  • Hip / groin pain
  • Feeling of leg instability (buckling, giving way)
  • Disturbed sleep patterns due to pain
  • Disturbed sitting patterns (unable to sit for long periods, on one side)
  • Pain going from sitting to standing

Video - History and Patient Presentation - Dr Swofford

Video - Basics of the SI Joint Exam

SI Joint Exam

  • Differential diagnosis to rule out other sources of pain
    • Negative lumbar spine exam
    • Negative hip exam
  • While standing, have the patient point to the location of pain (Fortin Test)
  • Tenderness over SIJ sulcus
  • Single leg stance test may induce pain on supporting side 
  • Positive active straight leg raise 
  • Pain to palpation inferior to PSIS    
  • Provocative Tests1
    • 3 of 5 positive (Distraction, Thigh Thrust, FABER, Compression, Gaenslen's)
  • Diagnostic injections of the SI joint

 

  1. Szadek, Karolina M, et al. “Diagnostic Validity of Criteria for Sacroiliac Joint Pain: a Systematic Review.” The Journal of Pain: Official Journal of the American Pain Society 10, no. 4 (April 2009): 354–368.

Learn