What is it: Altered structural or positional relationship of the sacrum on a normally positioned ilium causing pain or discomfort.
How does it present: Patients may present with dull, aching, gluteal pain, especially with weight bearing and with lumbosacral flexion/extension maneuvers. They usually do not have associated true radicular symptoms although there may be some local radiation of the discomfort.
Common exam findings: Patients may demonstrate an antalgic gait and favor the painful sacroiliac joint while sitting. Palpation may reveal tenderness of the sacroiliac joint line and surrounding soft tissue. Common examinations for sacroiliac testing include the Standing Flexion Test, Seated Flexion Test, and Faber (Patrick) Test.
Tests and treatment: Plain radiographs of the pelvis and sacroiliac joint may be ordered to evaluate for the evidence of arthritis. Treatment is often conservative, limiting or avoiding aggravating pain medications, ice or heat, pelvic stabilization exercises and/or sacral manipulative or physical therapy. Intra-articular sacroiliac joint injections performed under fluoroscopic guidance can be used for diagnostic and therapeutic purposes.