Inflammation and dysfunction Sacroiliitis refers to inflammation of one or both sacroiliac joints, and is one cause of
low back pain. With sacroiliitis, the individual may experience pain in the low back, buttock or thigh. Common mechanical problems of the sacroiliac joint are often called
sacroiliac joint dysfunction (also termed SI joint dysfunction; SIJD). Sacroiliac joint dysfunction generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint—either too much or too little motion. It typically results in inflammation of the SI joint, or sacroiliitis.
Signs and symptoms The following are signs and symptoms that may be associated with an SI joint (SIJ) problem: • Mechanical SIJ dysfunction usually causes a dull unilateral low back pain. • The pain is often a mild to moderate ache around the dimple or posterior superior iliac spine (
PSIS) region. • The pain may become worse and sharp while doing activities such as standing up from a seated position or lifting the knee towards the chest during stair climbing. • Pain is typically on one side or the other (unilateral PSIS pain), but the pain can occasionally be bilateral. • When the pain of SIJ dysfunction is severe (which is infrequent), there can be
referred pain into the hip, groin, and occasionally down the leg, but rarely does the pain radiate below the knee. • Pain can be
referred from the SIJ down into the buttock or back of the thigh, and rarely to the foot. • Low back pain and stiffness, often unilateral, that often increases with prolonged sitting or prolonged walking. • Pain may occur during sexual intercourse; however, this is not specific to just sacroiliac joint problems. Sacroiliac joint dysfunction is tested using provocative and nonprovocative maneuvers. Nonprovocative sacroiliac joint examination maneuvers would include Gillet Test, prone knee flexion test, supine long sitting test, standing flexion test, and seated flexion test. There is a lack of evidence that these sacroiliac joint mobility maneuvers detect motion abnormalities. Given the inherent technical limitations of the visible and palpable signs from these sacroiliac joint mobility maneuvers, another broad category of clinical signs has been described called provocative maneuvers. These maneuvers are designed to reproduce or increase pain originating from within the sacroiliac joint. When the provocative maneuvers reproduce pain along the typical area, it raises suspicion for sacroiliac joint dysfunction. However no single test is very reliable in diagnosing of sacroiliac joint dysfunction. Weakness, numbness, or the loss of a related reflex may indicate nervous system damage. The current gold standard for diagnosis of sacroiliac joint dysfunction emanating within the joint is sacroiliac joint injection confirmed under fluoroscopy or CT-guidance using a local anesthetic solution. The diagnosis is confirmed when the patient reports a significant change in relief from pain and the diagnostic injection is performed on 2 separate visits. Published studies have used at least a 75 percent change in relief of pain before a response is considered positive and the sacroiliac joint deemed the source of pain.
Pregnancy Muscle imbalance, trauma (e.g., falling on the buttock) and hormonal changes can all lead to SIJ dysfunction. Sacroiliac joint pain may be felt anteriorly, however, care must be taken to differentiate this from hip joint pain. Women are considered more likely to suffer from sacroiliac pain than men, mostly because of structural and hormonal differences between the sexes, but so far no credible evidence exists that confirms this notion. Female anatomy often allows one fewer sacral segment to lock with the pelvis, and this may increase instability. ==Additional images==