Differential Diagnosis for Sacral Pain

The following is a list of potential diagnoses for sacral pain, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Sacroiliitis: This is often the most common cause of sacral pain, resulting from inflammation of the sacroiliac joints. It can be due to various reasons including inflammatory arthritis (e.g., ankylosing spondylitis), infection, or trauma.

• Other Likely Diagnoses

  • Musculoskeletal Strain: Overuse or direct injury to the muscles and ligaments surrounding the sacrum can cause significant pain.
  • Degenerative Disc Disease: As discs in the lumbar spine degenerate, they can cause referred pain to the sacral area due to nerve irritation.
  • Coccydynia: Pain in the coccyx (tailbone) area, often resulting from a fall or direct trauma, can radiate to the sacrum.
  • Piriformis Syndrome: The piriformis muscle runs from the base of the spine to the thighbone, and when it compresses the sciatic nerve, it can cause pain in the sacral area.

• Do Not Miss Diagnoses

  • Cauda Equina Syndrome: A serious condition where the nerves in the spinal canal are compressed, leading to loss of bladder and bowel control, among other symptoms. It requires immediate medical attention.
  • Spinal Infection (e.g., Osteomyelitis, Discitis): Infections of the spine can cause severe pain and have serious consequences if not treated promptly.
  • Tumor: Both benign and malignant tumors can cause sacral pain by compressing nerves or destroying bone.
  • Fracture: Especially in individuals with osteoporosis or those who have experienced trauma, a fracture of the sacrum can be a cause of pain.

• Rare Diagnoses

  • Sacral Stress Fracture: More common in athletes, especially those involved in sports with repetitive stress on the lower back, such as gymnastics or football.
  • Tarlov Cysts: Abnormal fluid-filled sacs that can compress nerve roots, leading to pain.
  • Sacroiliac Joint Dysfunction: While not rare, when it presents with unique or atypical symptoms, it can be considered here, especially if other diagnoses are ruled out.
  • Neurogenic Claudication: Pain in the sacral area due to spinal stenosis, which worsens with walking or standing and improves with rest.