Sacroiliac Joint Pain

Pascal Vanelderen, Karolina Szadek, Steven P. Cohen, Jan De Witte, Arno Lataster, Jacob Patijn, Nagy Mekhail, Maarten van Kleef, Jan Van Zundert

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The sacroiliac joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the sacroiliac joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower limb(s). Because sacroiliac joint pain is difficult to distinguish from other forms of low back pain based on history, different provocative maneuvers have been advocated. Individually, they have weak predictive value, but combined batteries of tests can help ascertain a diagnosis. Radiological imaging is important to exclude "red flags" but contributes little in the diagnosis. Diagnostic blocks are the diagnostic gold standard but must be interpreted with caution, because false-positive as well as false-negative results occur frequently. Treatment of sacroiliac joint pain is best performed in the context of a multidisciplinary approach. Conservative treatments address the underlying causes (posture and gait disturbances) and consist of exercise therapy and manipulation. Intra-articular sacroiliac joint infiltrations with local anesthetic and corticosteroids hold the highest evidence rating (1 B+). If the latter fail or produce only short-term effects, cooled radiofrequency treatment of the lateral branches of S1 to S3 (S4) is recommended (2 B+) if available. When this procedure cannot be used, (pulsed) radiofrequency procedures targeted at L5 dorsal ramus and lateral branches of S1 to S3 may be considered (2 C+).

Original languageEnglish (US)
Title of host publicationEvidence-Based Interventional Pain Medicine
Subtitle of host publicationAccording to Clinical Diagnoses
PublisherWiley-Blackwell
Pages96-102
Number of pages7
ISBN (Print)9780470671306
DOIs
StatePublished - Nov 1 2011

Keywords

  • Cooled radiofrequency treatment
  • Evidence-based medicine
  • Low back pain
  • Radiofrequency
  • Sacroiliac joint

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Vanelderen, P., Szadek, K., Cohen, S. P., De Witte, J., Lataster, A., Patijn, J., Mekhail, N., van Kleef, M., & Van Zundert, J. (2011). Sacroiliac Joint Pain. In Evidence-Based Interventional Pain Medicine: According to Clinical Diagnoses (pp. 96-102). Wiley-Blackwell. https://doi.org/10.1002/9781119968375.ch13