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 tough part with SI joint pain is finding the people whose history and physical examination match true symptoms for sacroiliac pain, and then the true diagnosis may be established with a positive response to a joint anesthetic block
Quite often more than one block with positive response to each into the SI joint will be necessary to truly rule the joint as the pain generator. Once the joint is diagnosed, then the treatment options can begin. Sometimes patients will get relief in the joint for quite a while from the anesthetic block itself, or it may be short term. If the anesthetic block is inadequate, a radiofrequency denervation has shown effectiveness. Pain doctors debate the specific techniques that are best for the SI 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 injection efforts, additional therapies may include chiropractic, PT, Rehab, anti-inflammatory medication, and maybe acupuncture and massage. It may take a multitude of treatments including both traditional and alternative medicine to help the patient improve.
No great surgery option for SI pain exists. There is a new fusion procedure for the SI joint, but no long term data exists as to its success. Currently, it seems prudent to avoid fusion and treat the issue with outpatient treatments such as radiofrequency neurotomy.