A clear understanding of the difference in symptoms between SI joint dysfunction (SIJD) and other likely pathologies is a major advantage when making the proper diagnosis. The following information is provided as an educational resource. Standard diagnostic procedures and publications should be referenced for more details.
To diagnosis SIJD, a thorough review of the patient’s past history, symptoms and complaints, and physical examination are required. Since the symptoms and complaints can mimic other back related problems, it is critical that the diagnosis of SIJD take into account specific methods to isolate SI generated pain and symptoms.3
SIJD should be considered if a patient presents with any or all of the below symptoms, which are the most common symptoms associated with SIJD.
- Low back pain
- Buttock pain
- Sciatic pain
- Pain and/or numbness in lower extremities
- Pain while sitting (or while transferring from sitting to standing)
- Difficulty sleeping on affected side due to pain
SIJD is known to occur as an isolated condition, or can be associated with other spinal disorders. Care should be taken to review the patient’s history and risk factors such as; female pregnancy (past), previous lumbar fusion, injury (fall, twist), pelvic or leg asymmetry.
After ruling out other diagnoses, usually by confirming a negative hip and back exam, and review of previous imaging, the patient should identify the specific area of their pain (Fortin Test). If the pain is located near the posterior superior iliac spine (PSIS) and tenderness over the sacral sulcus is confirmed, proceed with provocative maneuvers (distraction, thigh thrust, Faber, compression, and Gaenslen’s).
Confirmation of SIJD is usually identified if three or more of the five provocative maneuvers are positive. Following the physical exam, a SI joint injection should be completed to confirm the diagnosis. The SI joint injection should be completed using fluoroscopy to verify position. The diagnosis can be completed if the patient’s pain is transiently alleviated from the injection. . A subset of patients that have failed the injection may still benefit from the procedure.