Differential Diagnosis for Atraumatic Sacral Pain
The differential diagnosis for atraumatic sacral pain can be organized into the following categories:
- Single Most Likely Diagnosis
- Sacroiliitis: This is often the most common cause of atraumatic sacral pain, especially in younger individuals. It can be due to inflammatory conditions such as ankylosing spondylitis or reactive arthritis.
- Other Likely Diagnoses
- Sacral stress fracture: Although more common in athletes or individuals with osteoporosis, stress fractures can occur in anyone and cause significant sacral pain.
- Piriformis syndrome: This condition, where the piriformis muscle irritates the sciatic nerve, can cause sacral and buttock pain.
- Coccydynia: Pain in the coccyx (tailbone) area can sometimes be perceived as sacral pain, especially if the pain radiates.
- Do Not Miss Diagnoses
- Cauda equina syndrome: A serious condition where the nerves in the spinal canal are compressed, leading to severe pain, numbness, and potentially permanent nerve damage if not promptly treated.
- Spinal infection (e.g., osteomyelitis, discitis): Infections of the spine can cause severe pain and have serious consequences if not treated promptly.
- Sacral insufficiency fracture with malignancy: Although rare, sacral pain could be the first sign of a malignancy, especially in older adults or those with a history of cancer.
- Rare Diagnoses
- Tarlov cysts: These are rare, fluid-filled cysts that can form on the nerve roots in the sacrum, causing pain and other neurological symptoms.
- Sacral osteonecrosis: A rare condition where the bone tissue in the sacrum dies due to lack of blood supply, leading to pain and potentially collapse of the bone structure.
- Intradural sacral meningeal cysts: These are rare, fluid-filled cysts that can compress nerves and cause pain, numbness, and other neurological symptoms.