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Sacroiliac Joint Pain

Dr. Dreyfuss is Clinical Professor, Department of Rehabilitation Medicine, University of Washington, Seattle, WA. Dr. Dreyer is Assistant Professor, Department of Orthopaedic Surgery, and Assistant Professor, Department of Physical Medicine and Rehabilitation, Emory Spine Center, Emory University, Atlanta, GA. Dr. Cole is Associate Clinical Professor, Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Mayo is in private practice, Tacoma Regional Trauma Center, Tacoma, WA.

Reprint requests: Dr. Dreyfuss, Washington Interventional Spine Associates, Suite 260, 925 116th Avenue NE, Bellevue, WA 98004.

The sacroiliac joint is a source of pain in the lower back and buttocks in approximately 15% of the population. Diagnosing sacroiliac joint–mediated pain is difficult because the presenting complaints are similar to those of other causes of back pain. Patients with sacroiliac joint–mediated pain rarely report pain above L5; most localize their pain to the area around the posterior superior iliac spine. Radiographic and laboratory tests primarily help exclude other sources of low back pain. Magnetic resonance imaging, computed tomography, and bone scans of the sacroiliac joint cannot reliably determine whether the joint is the source of the pain. Controlled analgesic injections of the sacroiliac joint are the most important tool in the diagnosis. Treatment modalities include medications, physical therapy, bracing, manual therapy, injections, radiofrequency denervation, and arthrodesis; however, no published prospective data compare the efficacy of these modalities.

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