The sacroiliac (SI) joint is the place where two bones — the sacrum and the ilium — come together in your pelvis, forming one SI joint on each side.
Typical sacroiliac joint pain pattern
Typical pain pattern demonstrated by people suffering from sacroiliac joint issues.
Medical professionals from a wide range of specialties work together at the Sacroiliac Joint Clinic at Mayo Clinic's campus in Rochester, Minnesota. Having expertise from a large pool of specialists helps ensure that you receive exactly the right treatment for you.
The sacroiliac (SI) joint is the place where the wing-shaped top of your pelvis, a bone called the ilium, attaches to the lower part of your spine (sacrum). You have two SI joints, one on each side of your pelvis. A very strong and complex set of ligaments holds the two bones snugly together.
SI joint problems can be caused by:
- Congenital problems. People born with an abnormal curvature in their spines or who have one leg shorter than the other are at higher risk of SI joint pain.
- Trauma. The SI joint can be injured in car crashes or from falls.
- Spine surgeries. Fusing vertebrae together alters the spine's flexibility, which can place more stress on the SI joint.
- Postpartum issues. Looseness in the pelvic joints after childbirth can cause long-lasting pain.
- Inflammatory conditions. People who have systemic inflammatory conditions may be prone to SI joint degeneration.
- Infection. Some people develop infections in the SI joint that can lead to rapid degeneration.
- Idiopathic. In some cases, it's not possible to find out exactly what causes SI joint pain.
It can be difficult to diagnose problems arising from the sacroiliac joint because so many other conditions can cause similar symptoms. Doctors must rule out disorders affecting nearby structures, ranging from pinched spinal nerves to abdominal hernias.
Within the Sacroiliac Joint Clinic, expert clinical evaluations of the SI joint may include:
- Specialized X-rays to detect subtle instability in the SI joint
- A computerized tomography (CT) scan that features unique reconstructions to highlight the SI joint
- A comprehensive physical exam and history
Types of specialists involved
Mayo Clinic prides itself on its team approach to patient care. Specialists involved with SI joint care include:
- Orthopedic surgery. Specialists in spinal and pelvic surgeries see hundreds of people with SI joint problems each year at Mayo Clinic.
- Radiology and pain medicine specialists. Fluoroscopy can be used during injection procedures to ensure that the steroid and numbing medications are placed precisely in the SI joint. This is one of the most important components of the evaluation and must be done with precision.
- Endocrinology. In certain situations, endocrinologists may suggest medications that can help the bones heal together after surgical fusions of the SI joint.
- Physical medicine and rehabilitation. Mayo Clinic has a team of physical therapists and occupational therapists who have specialized training in the management of SI joint dysfunction.
Mayo Clinic offers a wide variety of treatment options for SI joint problems. Examples include:
- Steroid shots. Injecting a mixture of cortisone and a numbing medication into the SI joint can sometimes provide months of pain relief. At Mayo Clinic, these injections are performed with fluoroscopy guidance, so the medicine ends up in exactly the right place.
- Radiofrequency neurotomy. Heat generated by radio waves is used to target specific nerves near the SI joint and temporarily interfere with their ability to transmit pain signals. The radio waves are delivered to the nerves via needles inserted through the skin.
- Fusion surgery. Eliminating the SI joint's motion by fixing the two bones together with metal hardware is a more permanent solution. At Mayo Clinic, this surgery can be done through minimally invasive techniques with either same-day or overnight surgery. In some cases, a larger fusion surgery may be recommended.
- Nonoperative management. At Mayo Clinic, integrated teams supply a comprehensive approach to SI joint mediated pain on a single campus. These teams include experts in physical medicine and rehabilitation, pain medicine, radiology, orthopedic surgery and complementary medicine. Often, after an initial visit, patients are encouraged to maintain nonoperative management and exhaust all options prior to proceeding with surgery.
June 25, 2021