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 an inflammation of the sacroiliac joints, which can cause pain in the sacral area. It is a common condition, especially in individuals with a history of inflammatory arthritis or those who have experienced trauma to the area.
- Other Likely Diagnoses
- Piriformis Syndrome: This condition occurs when the piriformis muscle, which runs from the base of the spine to the thighbone, compresses or irritates the sciatic nerve, leading to pain in the sacrum and potentially down the leg.
- Sacral Fracture: Fractures of the sacrum can occur due to trauma, osteoporosis, or stress fractures, leading to sacral pain.
- Degenerative Disc Disease: As discs in the spine degenerate, they can cause pain in the sacral area, especially if the degeneration affects the lower lumbar or sacral discs.
- Do Not Miss Diagnoses
- Cauda Equina Syndrome: A serious condition that occurs when the nerves in the spinal canal are compressed, leading to 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 with antibiotics.
- Tumor (Metastatic or Primary): Both metastatic and primary tumors can occur in the sacrum, causing pain and requiring urgent medical attention.
- Rare Diagnoses
- Sacral Insufficiency Fracture: More common in individuals with osteoporosis or those on long-term corticosteroid therapy, these fractures occur without significant trauma.
- Tarlov Cysts: These are rare, fluid-filled sacs that can form on the nerve roots in the sacrum, causing pain and other neurological symptoms.
- Sacrooccygeal Teratoma: A rare tumor that develops at the base of the coccyx (tailbone) and can cause sacral pain among other symptoms.
Each of these diagnoses has a different set of implications for treatment and prognosis, emphasizing the importance of a thorough diagnostic evaluation for sacral pain.