Introduction

SI joint pain is often overlooked. Many doctors have not been trained to consider it. Many are still reluctant to believe a joint that has so little movement can cause back pain.

Causes

Many problems can lead to degenerative arthritis of the SI Joints . It is often hard to determine exactly what caused the wear and tear to the joints.

One of the most common causes of problems at the SI joint is an injury. The injury can come from a direct fall on the buttocks, a motor vehicle accident, or even a blow to the side of your pelvis. The force from these injuries can strain the ligaments around the joint. Ligaments are the tough bands of connective tissue that hold joints together. Tearing of these ligaments can lead to too much motion in the joint. The excessive motion can eventually lead to wear and tear of the joint and pain from degenerative arthritis.

Injuries can also cause direct injury of the articular cartilage lining the joint. This too, over time will lead to degenerative arthritis in the joint.

Pain in your SI joint can also be caused by an abnormality of the sacrum bone.
Women are at risk for developing SI joint problems later in life due to childbirth. Female hormones are released during pregnancy that allow the connective tissues in the body to relax. The relaxation is necessary so that during delivery, the female pelvis can stretch enough to allow birth. This stretching results in changes to the SI joints, making them hypermobile (extra or overly mobile). Over a period of years these changes can eventually lead to wear-and-tear arthritis. During pregnancy, the SI joints can cause discomfort both from the effects of the hormones that loosen them and from the stress of carrying a growing baby in the pelvis. The more pregnancies a woman has, the higher her chances of developing SI joint problems.

Symptoms

Symptoms of SI joint syndrome are often difficult to distinguish from other types of low back pain. In most cases, there is a confusing pattern of back and pelvic pain that mimic each other, making diagnosis of SI joint syndrome very difficult.

Diagnosis

Clinical tests
X-rays may be recommended to determine whether there are abnormalities in your SI joint.
CT scan can sometimes show more detail about the joint surfaces and the surrounding bone. If the X-rays suggest something may be affecting your SI joints, your doctor may recommend a CT scan to get a better look.

A bone scan can be useful in determining whether your SI joint is inflamed. An inflamed SI joint usually shows up as a hot spot on a bone scan of your pelvis.

SI Joint Injection

Your doctor may also recommend that you undergo a fluoroscopic injection into your SI joint. During this test, a local anesthetic is injected into the joint. The doctor uses a fluoroscope to make sure the needle is actually in the joint before injecting the medication.Once the needle is in the right place, anesthetic is injected to numb your joint. If the pain goes away, your doctor can be relatively sure that the problem is coming from your SI joint and not somewhere else in your spine. The doctor may also add a dose of cortisone to the injection to help ease the

pain. Cortisone is a powerful anti-inflammatory medication that calms the arthritis inside the joint and reduces pain. The effect is usually temporary, but it may last up to several months.

Treatment Options

Conservative Treatment
Medications to ease pain.

Patients commonly receive physical therapy treatment for SI joint problems. Treatment choices depend on whether the SI joint is stiff or loose. A stiff or "locked" joint responds best to mobilization, a form of stretching used to improve joint movement. Along with hands-on techniques used by the therapist, mobilization includes specific exercises to improve SI joint mobility. For conditions where the joint is too loose, such as arthritis or SI ligament injuries, stabilization treatments are chosen to hold the joint in correct alignment. Stabilization exercises involve posture and muscle training. Therapy sessions may be scheduled two to three times each week for up to six weeks.

Your doctor may also recommend a sacroiliac belt to help stabilize a loose and painful SI joint. The belt wraps around your hips to squeeze and hold your SI joints together. This supports and stabilizes your pelvis and your SI joints.

SI Joint Injection
An injection into your SI joint using cortisone can be helpful for calming pain and inflammation. The injection usually gives temporary relief for several weeks or months.

Radiofrequency ablation
It gives long term pain relief.
Surgical Treatment

Surgery may become an option if all conservative methods of treatment fail. Surgery on the SI joint usually consists of a fusion of the joint.

Costotransverse and Costovertebral Joint Costo –