Sacroiliac joint dysfunction simply refers to limited or improper functioning of the sacroiliac (SI) joints typically characterized by pain. SI joints are formed by the sacrum and the iliac bones. They have a cartilage layer covering the articular surface, which allows for some movement and shock absorption.
In degenerative joint diseases, such as osteoarthritis, the articular cartilage is damaged or worn away. This is the most common cause of SI joint dysfunction. Pregnancy is another common cause of SI joint dysfunction. Pregnancy-related hormones act on the SI joint and allow ligaments to relax, preparing the pelvic cavity to widen for childbirth. However, this may lead to increased stress and wear. Additional weight and associated with pregnancy induces further stress on the SI joints. Altered gait or walking pattern also places increased stress on the SI joints. This may be secondary to leg length discrepancy or hip/knee/ankle/foot pain. Generally speaking, if the underlying problem is treated, the associated SI joint dysfunction significantly improves.
Other conditions that may precipitate SI joint dysfunction include gout, rheumatoid arthritis, psoriatic arthritis, reactive arthritis, and ankylosing spondylitis.
Ankylosing spondylitis typically affects the SI joints, causing stiffness and severe pain in the SI joints, ultimately leading to bony fusion with no possible motion.
A thorough history and physical examination reveal the clinical presentation of the SI joint dysfunction. There are multiple tests that can be performed during the physical examination to help isolate the source of the pain – these include positioning patient’s hips and legs in certain ways and applying pressure, and moving the SI joints to look for areas of tenderness.
Plain radiographs (X-rays) of the pelvis, hips, or lumbar spine are performed next, guided by the history and physical examination. A computed tomography (CT) scan may be needed for a more detailed assessment of the joint and bones. Sacroiliitis appears as sclerosis in the joints on CT. Erosion of the bone could also be detected on CT. Magnetic resonance imaging (MRI) provides a better evaluation of the soft tissues, including muscles and ligaments. A bone scan can be considered where MRI is contraindicated.
The treatment of SI joint dysfunction involves symptomatic relief with oral NSAIDs. Oral steroids (prednisone) may be considered for short periods of time. Physical therapy can be considered, which involves stretching or stabilizing exercises that can help reduce the pain. A sacroiliac belt can be worn to help stabilize the SI joints. Exercises including yoga and pilates can be helpful too.
If these treatments fail, surgery might have to be considered as a last resort. Basically, a surgical fusion if the SI joint is performed by removing the articular cartilage and the bones are held together with plates and screws until they fuse. This renders the joint immobile but relieves the pain.