The Sacroiliac joint
is a large fluid filled joint formed by the junction of the sacrum and ileum. The joint allows a small amount of rotation and forward and backward movement. The greatest amount of movement occurs when individuals rise from a sitting or lying position to standing position. In middle age and beyond, fibrous adhesions (scar tissue) and degenerative changes result in gradual loss of the synovial cavity which occurs in both sexes. This occurs earlier in men, and after menopause in women. The joint can dysfunction as a result of injury, abnormal weight bearing, leg length discrepancies, fractures, changes in walking patterns, pregnancy, and a host of other arthritic disorders. Pain can also be referred to the area by the lumbar discs.
To diagnose pain from the sacroiliac joint, a physical exam can be helpful, but it is not always reliable. Imaging studies such as x-rays, CT scan and MRI can be normal in patients who have problems from this area. Therefore, diagnosis of the offending joint requires intra-articular diagnostic block of the sacroiliac joint under fluoroscopy.
The procedure begins by numbing the skin with a local anesthetic. A needle is then placed under fluoroscopic guidance into the sacroiliac joint. A numbing medicine, such as Novocaine, is placed into the joint. This will help the physician identify the joint as the source of pain. Typically Cortisone is also injected into the joint for the inflammation as well to provide extended pain relief.
Once the pain is controlled, a trial of physical therapy or manual therapy is prescribed to correct the underlying mechanical problems.