From the Research
Introduction to Sacroiliac (SI) Related Hip and Buttocks Pain
Sacroiliac (SI) joint pain is a common cause of low back and buttock pain, affecting approximately 15% of patients with axial low back pain 1, 2, 3. The SI joint is a complex structure that transmits vertical forces from the spine to the lower extremities and plays a role in lumbopelvic dynamic motion 1.
Causes of SI Related Hip and Buttocks Pain
The causes of SI related hip and buttocks pain can be attributed to various factors, including:
- Trauma 1
- Pregnancy 1
- Certain athletic activities 1
- Structural causes, such as primary SI joint pathology 4
- Referral pain from the lumbar spine or hip joint 4
Diagnosis of SI Joint Pain
Diagnosing SI joint pain can be challenging, as the presenting complaints are similar to those of other causes of back pain 3. History and physical examination findings can be helpful in screening for SI joint pain, but individual provocative maneuvers have unproven validity 1. Fluoroscopically guided injections into the joint have been found to be helpful for diagnostic and therapeutic purposes 1, 3.
Treatment of SI Joint Pain
Treatment modalities for SI joint pain include:
- Conservative management, such as joint mobilization, anti-inflammatory medicines, and sacroiliac joint belts 1, 5
- Intra-articular injections, including corticosteroids, platelet-rich plasma, and stem cells 5
- Radiofrequency ablation, which can provide good outcomes for pain relief 5
- Surgical arthrodesis, which should be considered a procedure of last resort 1, 5
- SIJ fusion, which can be performed using different techniques, although the most appropriate modality is still debated 5
Dosing and Duration of Treatment
The dosing and duration of treatment for SI joint pain may vary depending on the specific modality used. For example, corticosteroids, platelet-rich plasma, and stem cells may have midterm lasting effects, lasting up to nine months 5. Radiofrequency ablation can provide good outcomes for pain relief, although the duration of relief may vary.
Differential Diagnosis and Caveats
It is essential to consider the differential diagnosis of SI joint pain, including pain generated from the lumbar spine, the SI joint, and the hip joint 4. Clinicians should quantify areas of pain when interviewing patients complaining of low back pain to distinguish potential pain generators 4. A thorough diagnostic workup, including fluoroscopy-guided diagnostic injections, may be necessary to confirm the source of pain.