The sacroiliac joint has a very low amount of motion, but does move. Any deviation from the normal amount of movement – either too much or too little movement – is a dysfunction of the sacroiliac joint. This video explains the causes of sacroiliac joint dysfunction, typical symptoms for this condition, and the diagnostic procedure to identify sacroiliitis.
Video presented by Zinovy Meyler, DO
In This Article:
Sacroiliac joint dysfunction really denotes mobility at the joint itself. Now, one thing to note is that there is very little motion at this joint; different literature cites different numbers for this motion, but it is anywhere between 1 millimeter to 3 millimeters, obviously varying from person to person.
Sacroiliac joint dysfunction denotes either hypomobility - which is decreased motion or lack of motion - or hypermobility - which is increased motion. Now, either one of these can really aggravate the sacroiliac joint itself and that will cause sacroiliitis - or in other words, inflammation of the sacroiliac joint.
The sacroiliac joint mobility can be affected by the intrinsic joint itself, by the laxity of the ligaments that support the joint, it can be restricted by the tightness of those ligaments. Now, loose ligaments can be part of the physiological process, such as pregnancy where the ligaments loosen up and there is more motion in the whole pelvis altogether or in other diseases of connective tissues, such as Ehlers-Danlos or other connective tissue disorders that loosens the connective tissue of all the joints and of course the sacroiliac joint as well.
The other causes of that dysfunction really come from the surrounding joints. So, if you take a look at the sacroiliac joint, it is positioned in the pelvis. It is part of the pelvis, so it can be influenced by the facet joints - which are hinge-like joints of the spine - it can be affected by the hip joint and can actually also be affected by the knee joint as well. Any of these joints, if moving abnormally or if there is any pain associated with these joints can cause a change in the whole biomechanical chain, altering the forces going through the sacroiliac joint. That in itself can compress it and limit its motion or it can increase the motion because the body needs to compensate for lack of motion elsewhere. So, in diagnosing sacroiliac joint dysfunction, it is very important to remember it doesn't exist in isolation - the whole biomechanical chain has to be looked at and all the joints in the continuum have to be evaluated because if you just treat the joint itself, you may be missing the actual source of the problem and, in such, this dysfunction is likely to come back.
Some of the symptoms of sacroiliac joint dysfunction really correspond to all of the areas surrounding the sacroiliac joint. People can present with pain or discomfort around the sacroiliac joint unless there is sacroiliitis - where there is inflammation in that joint whereas the pain is a little more identifiable to the region of the sacroiliac joint. There is also usually muscle spasms surrounding the sacroiliac joint area and that can present with tightness in the hips, tightness in the buttocks, tightness in the lumbar spine. It can also present with hip pain and most certainly lumbar spine pain. It is very common for the sacroiliac joint dysfunction to alter the way the body supports its weight, placing undue stress on other structures and, of course, the spine is one of them.
Diagnosing sacroliitis is actually one of the easier things we do on almost an everyday basis. That being said, it is also one of the more frustrating things to diagnose, and here's the reason why. The reason it is so difficult is because one of the mainstays of diagnosis for physicians in pretty much any specialty is history and physical examination. History - or in other words, patient describing what they're feeling, how long they've been feeling it, what exacerbates, what alleviates the symptoms - really tends to raise our suspicion for that being the source of the pain. It also serves to eliminate other sources of the pain, but that’s as far as we can get. An extremely important point, but not quite a definitive diagnosis. In the physical examination, we can aggravate the pain and we can pinpoint pain generators by aggravating the motion - by forcing that joint into compression or distraction and provoke that pain - but, once again, that points us in that direction, but because there are so many overlapping structures in that region, it is very difficult to definitively eliminate some of the structures and, most certainly, definitively say that that is the pain generator.
In terms of the other tools we have at our disposal, radiography of course is a very important tool. So, x-rays, MRIs, CAT scans are very important, but once again there isn't a single finding on these films that can pinpoint to that as the source of the pain. It is important to exclude fractures, it is important to exclude soft tissue injury and nerve compressions and so on and so forth - everything that we can definitely see on these diagnostic studies, but that once again gets us closer to the diagnosis and gets our suspicion really up to where we need it to be for that being the source of the pain, but that doesn't give us the ability to definitively diagnose.
So, how do we diagnose definitively the sacroiliac joint pain? The reason that it’s so simple is because under controlled conditions, what we can do is place a small amount of medication into the sacroiliac joint with the guidance of x-ray or fluoroscopy and outline it with contrast to know that the medication is actually going to spread through the sacroiliac joint and not in the surrounding tissues. As we know through research, there are a lot of false injections that don’t actually go into the joint itself, so with that guidance, we know with certainty that the medication is going to be maintained in that joint. And then we place an anesthetic into that joint. If the pain is alleviated with that intervention, then we know that's the pain generator.