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How do doctors DX SI pronblems?

snookiessnookie Posts: 359
edited 06/11/2012 - 8:51 AM in Sacroiliac (SI) Joint Problems
Both my GP and the WCB Dr said that I presented like I had SI joint dysfunction, and they both said that SI wasn't the problem. So how is it DX'd? Can it be seen on an MRI? If not, what test are done? MRI and a bone scan were all that I had done, and both Dr's already had ruled out the SI before that, even though they said that it presented as that. So it really has me wondering, how do doctors DX it?


  • snookie,
    A dignosis is made on the basis of a good history, a good physical exam, and the results of any tests that the H&P led to. The H&P is usually good enough to diagnosis about 90% of problems, and tests are used to confirm the impression (and to CYA in this litigious society). SI dysfunction usually presents with pain over the SI joint, increased with weight bearing, and certain maneuvers of the legs that put pressure on the SI joint (such as the "Figure-4" position or crossing the legs with the ankle on the knee). In spondyloarthropathies that affect the SI joint or significant trauma (falling from a height and landing on one foot), disorders of the SI joint are usually visible on flat plate x-rays. CT scan is best for looking at the bony architecture, MRI is for looking at the soft tissues of the joint (ligaments, joint capsule, effusion), and a bone scan is very sensitive for detecting inflammation (even before the other studies). Hope this sheds some light on the subject.

  • What about effective treatment options?

    I'm 15 months nonunion L4-5 PLIF with SI joint dysfunction, which is intensely painful.

    During a caudal approach endoscopic lysis of adhesions, I had a SI Arthrogram as well. On the oblique view, multiple cystic structures were noted on the anterior and posterior capsule. Capsule is still intact.



  • sleeprgirl,
    Cystic structures within a joint are usually seen in arthropathies (both osteo and inflammatory). In the SI joint, the spondyloarthropathies and autoimmune disorders, are more common than osteoarthropathy or trauma arthropathy. First is to get a sound diagnosis. Till then, treatment is aimed at controlling the symptoms: Avoid activities with a lot of single stance weight bearing (a good activity is water aerobics or swimming using mostly the arms); tylenol, NSAID's, other pain meds as needed; steriods, oral or injected into the joint, are sometimes used; physical therapy for strengthening of trunk and postural muscles; hot tubs or hot baths; etc. Once a diagnosis is made, (a rheumatologist is usually at least consulted), then disease modifying medications can be used. As to surgically fusing the joint, the results are mixed. (Autofusion is seen in some arthropathies, but stress is usually transferred to other areas, such as the hip joint and spine.)
    Hope that helps a little. If you have a rheumatologist, he is a good resource to discuss treatment options with.

  • I work with someone who is training to fuse them where I live. Otherwise, there is no one doing that procedure in my city.

    Actually, I have been diagnosed with Hashimoto's with secondary Adrenal Insufficiency. I take cortef, and do not do well with steroid boluses. Have developed severe cushingoid symptoms with ESI's and with the Neurolysis procedures. My cortisol level dropped to 0.2, so I'm trying to maintain a steady state cortisol level.

    Have been diagnosed with osteoarthitis as well.

    I am, of course, highly interested in how the inflammatory has effected/caused my spinal/SI issues.

    This started 4 yrs ago, and did consult rheumatology at the time. I only had generalized joint pain/fatigue. He did diagnosed the osteo, but no other autoimmune diagnosis. Ironically got the Hashi diagnosis from my gynecologist two months later. Within the year, I developed the spine/SI symptoms.

    You confirmed my need to have another rheumatology consult.

    Lost an amazing career and life...looking to recover a little joy lost to chronic pain. It has been an abyss..

    Thanks again,

  • My sacroilitis was diagnosed via a bone scan. The SI joints lit up like a Christmas tree, right worse than left. It was pretty cool seeing that.
  • The gold standard for confirming sacroiliac joint disruption and dysfunction is an injection with CT or fluoroscopic guidance accurately placed in the SI joint. The pain response indicates the role of the SI joint in each case:

    If no pain improvement, then test was negative. SI joint is not a pain generator.
    If > 75% pain improvement, then test was positive. SI joint is considered a pain generator.
    If 50-75% pain improvement, then test was equivocal. Repeat to confirm SI joint as a pain generator, and consider the existence of multiple pain generators.

    If symptoms are decreased by a minimum of 75% with one injection or by 50% each time with two injections, it can be concluded that the SI joint is either the source, or a major contributor, to the particular patient's low back pain.

  • I have been suffering from pain in my left hip, back left hip, front/back of thigh, lower back, and pain in my but. The pain is worse when I lay om my side & when I sit for long periods of time. I have trouble walking and walk with a gait. Since the pain started almost a year ago, I was diganosised by my Rheumatologist with Fibromyalgia. I have had an emg done, no evidence of impinged nerve or nerve damage, disc L5 is herniated but per the neurosurgeon pain I have us not being caused by the herniated disc. I also have DDD & spinal stenosis. The pain in my hip is becoming more severe to the point it is very difficult for me to walk or stand. My neurosurgeon has referred me to a pain management specialist for the pain in my hip, although, I don't know that the pain I have is from the SIJ. I'm so frusterated.
  • What length of time are you referring to as far as improvement of pain?

  • This injection is the diagnostic "Litmus test." If Lidocaine is injected into the joint and symptoms temporarily resolve, this is confirmation of the SI joint as the source, or a source, of the patient’s low back pain (as multiple pain generators may co-exist). It is short term relief generally.
  • A comprehensive approach to SI joint evaluation might look like this:

    Recognize patient history of SI joint problems
    Perform physical examination:
    Provocative tests (minimum 3 out of 5 tests should be positive)
    Review or order imaging studies – for abnormalities / asymmetry
    Administer diagnostic injections (75% pain relief from one injection, or 50% pain relief from two injections to confirm SI joint diagnosis)
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    sleeprgirl said:
    Lost an amazing career and life.
    That should be the title of an entire thread!


    Spine-health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!

  • Thanks for the reply, the pain has become un-bearable to the point its getting more difficult to walk & sit, my job requires me to sit all day. My appt w pain specialist is not until next wk, so in the meantime, I scheduled an appt to see my PCP tomorrow for somthing stronger, Tramadol is not working. I think I am going to ask if I can have bone scan as I haven't had one done. Also waiting for the results of the lab work that my rheumatologist ordered last week.
  • Is there any other test then the shots? I can't keep getting my hopes up then dealing with the aweful pain of these types of shots just to have my hopes crushed when they don't work. I really just need something, anything that will say it's at least a good idea to try these shots again. I had them at L4 and I cried for days because they didn't work, not even a little. Please anything other then the shots again.
  • From purely a diagnostic standpoint...that being that your SI joint is truly your pain generator... then the si joint injection is the gold standard. It is not a therapeutic type injection with a long acting steroid that is designed for lasting pain relief(3-6 months). It is simply a diagnostic tool to help your physician decide if your si joint is causing your symptoms. It should be done under CT or fluoroscopic guidance and only a small amount of anesthetic is administered into the joint. The skin in typically "numbed up" prior to the injection.
  • I realize it is a diagnostic test very similar to the ones before RFA but they are excruciating. When you put your feet on the floor and realize there is absolutely no change with all the pain you just endured it's almost worse then then dealing with the chronic pain. I literally cried after I stood up with the L4 shots, not from the normal pain, but from the hope just being shot all to crap. Can't help any that the versed did next to nothing, not even removing partial memory of the shots. I was really just wanting to know if there is anything they can check to help suggest this shot. My PM wants to do this next and I'm not real hip on more extremely painful shots when it's all just a guessing game, ya know well I think it's this so lets try this shot and see. How many times can a person take this kind of pain and disappointment. I know it's the final answer all I really want is a particular stretch that should cause pain or a spot on an x-ray that makes it reasonable that it could be my SI before I subject myself to more pain. Obviously I'm depressed and I apologize. I'm not argueing just really, really, really don't want to do this again without any kind of result. This probably isn't even the right place to ask these questions.
  • I had appt w PM doc, I am scheduled to have an SI block injection, not thrilled because I hate needles, but if it gives the relief I need from the pain, its worth it. Rheumotologist confirmed no RA, which was a big relief for me. So now I just have to wait until my inject.
  • What confirmed my diagnosis for S.I. joint dysfunction was those anaesthetic shots with cortercosteroid into the joints. They were so painful (I was screaming in the operating theatre - so embarassing) and the pain can actually gets worse for a day or more after the injections - however the relief after a few days was, let me say, noticible? It did not remove all of my pain, but it was a decent step forward with my pain levels at that time.

    If you can manage to try it again, it may help - although everyone reacts differently.

    Waremest regards,
  • For me too what confirmed it was the cortisone injection. The first one was not too successful because the dye did not go very far in. The 2nd one they gave me the relaxant BEFORE the OR (what a concept!!) and I was very relaxed and don't remember anything and maybe that helped because more of the dye got in so more of the cortisone got in. And I have a reduction in pain. Not pain free but better. I have had so many years of unsuccessful cortisone shots that I was thrilled that maybe this one will work. I would definitely request a relaxant by IV.

    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
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