Sacroiliac Joint: Pain, Causes and Treatment

Sacroiliac Joint: Pain, Causes and Treatment
Nabil A Ebraheim Orthopedist

Dr. Nabil Ebraheim is an orthopaedic surgeon practicing in Toledo, OH. Dr. Ebraheim specializes in the diagnosis, treatment and rehabilitation of injuries, diseases and disorders of the bodys musculoskeletal system. As an orthopaedic surgeon, Dr. Ebraheim tends to bones, ligaments, muscles, joints, nerves and tendons.... more

25% of patients with low back pain suffer as a result of sacroiliac joint related problems. Pain of the SI joint is an unappreciated problem that often simulates conditions associated with the lower back, spine, and hip. The symptoms sometime make it difficult to detect.

Patients experiencing low back pain can spend months or even years in treatment without the correct diagnosis (SI joint disorder). Symptoms of sacroiliac joint dysfunction include low back pain, buttock and thigh pain, and difficulty and discomfort while sitting.

The SI joints are weight bearing joints which distribute weight from the spine to the lower extremities through the hip joints.

There are many different conditions that simulate sacroiliac joint pain. In the hip, trochanteric bursitis and piriformis syndrome may simulate SI joint pain. Myofascial pain and lumbosacral disc herniation or bulge in the spine may simulate SI joint pain.

Sacroiliac joint pain is usually under-diagnosed and can be mistaken for other causes of low back pain. The Faber test is helpful but not specific in determining the presence of SI joint problems. The patient is usually lying supine on the examination table with the leg of the affected side externally rotated and abducted. The foot should be placed onto the opposite knee. The physician will press down gently but firmly on the flexed knee and the opposite anterior superior iliac crest. Pain in the back of the sacroiliac area indicates a problem with the sacroiliac joints.

Clinical examination and radiological studies are usually not reliable in the diagnosis of SI joint problems. Most sacroiliac joint pain is due to mechanical dysfunction. Normally there will be slight microscopic movement and instability of the joint of only a few degrees. Movement of the joint increases with wear or injury to the ligaments of the joint.

The patient should be checked to determine if a leg length discrepancy exists. The best method to diagnose if the pain is of SI joint origin is by administering an injection. If the patient shows improvement, the pain can then be attributed to the sacroiliac joint.

Treatment of sacroiliac joint pain includes anti-inflammatory medications, physical therapy and chiropractic manipulation, SI joint brace, steroid injection (short term effect), and SI joint stabilization or fusion.

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About Nabil Ebraheim, MD:

Dr. Nabil Ebraheim is an Orthopaedic Surgeon, practicing with the University of Toledo Medical Center. He earned his MD from Cairo University School of Medicine in Egypt, and completed his residency in Orthopedic Surgery at Downstate Medical Center in Brooklyn, New York.

Dr. Ebraheim specializes in general orthopedics, fractures, sacroiliac joint issues, nonunion bone infections, reconstructive surgery, and spine, hip, knee, and pelvic surgery. 

He is a member of the Academic Orthopaedic Society, Alpha Omega Alpha, Academy of Medicine of Toledo, AO International Association, Ohio Orthopaedic Society, and the Pan-American Trauma Society. He is an Advanced Trauma Life Support Instructor, and lectures to medical students as a Professor and Chairman of Orthopaedic Surgery at the University of Toledo.