SI joint area pain may or may not be actually coming from the SI joint. It may be strictly situated in this area (the buttock) or it may radiate down the leg somewhat. It may be confused with myofascial type pain in the paraspinal muscles, piriformis, or gluteal muscles. Other patient problems that can mimic SI joint pain include intervertebral discs that have tears in the outer portion (annulus), or potentially arthritic and painful facet joints that have pain that radiates into the buttock region.

All of these issues may lead to pain in the same region, therefore, delineating the exact pain cause may take some significant mental consideration. A thorough history and exam of the patient is critical to ruling in or out some of the potential diagnostic sources.

The difficulty with SI pain is finding the individuals whose exam and history match true SI joint symptoms, and then the diagnosis can be confirmed by a positive response to an anesthetic block inside the joint.

A significant amount of time more than one anesthetic block will be necessary into the SI joint to definitely rule int the joint as the pain generator. Once this diagnosis occurs, the additional treatment options may begin. At times patients will obtain relief for a while from the anesthetic blocks themselves, or it could just be short term. Should the pain block not work after a while, a radiofrequency neurotomy has been shown to work well. Pain physicians typically debate the exact techniques that are best for the joint.

The SI joint is not the easiest joint to get into for interventional techniques. Fluoroscopic assistance is crucial, as the joint is jagged and irregular. The entry into it may take an unusual angle. Knowing the exact entry point with the real time x-ray can make the difference between a successful procedure with a happy patient versus a missed joint and a patient remaining in pain.

Along with the interventional pain efforts, additional treatment options include physical therapy, anti-inflammatory medication, chiropractic treatment, and potentially acupuncture and massage. It may take a combination of efforts including both traditional and alternative medicine to help the patient improve.

There really is no great surgical option for SI joint pain. There is a new procedure for fusing the joint, but no long term data is available yet regarding its effectiveness. For the time being, it’s best to avoid operative intervention and treat the problem with outpatient techniques such as the radiofrequency technique mentioned.

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