Sacroiliac Disease

Definition

Sacroiliac disease is high-impact trauma to the sacroiliac joint that can cause death, or bone, and nerve damage.

Description

The sacroiliac joint is a strong, weight bearing synovial joint between the ilium and sacrum bones of the pelvis. The bones are held in place and allowed limited movements by a system of sacroiliac ligaments. Relaxation of this and other joints and ligaments is important during pregnancy and is accomplished by a special hormone called relaxin. Usually the sacroiliac is damaged by high-impact injuries. These injuries may be life threatening and mortality is approximately 20% if neighboring structures are also damaged. Injuries to this area often includes neurological deficits. Dislocation and nerve damage are frequently missed in the diagnosis.

Causes and symptoms

The primary cause of dislocations, fractures, and accompanying damage is usually a traumatic accident. Patients receiving such injuries require emergency medical attention. There may be severe blood loss due to breakage of large bones and resuscitative measures may be required for stabilization.

Diagnosis

The diagnosis can be difficult since nerve damage can mimic other conditions with similar symptoms (i.e., low back pain in persons with sciatica ). Additionally imaging studies and physical examination maneuvers will miss the diagnosis. The definitive method for diagnosing sacroiliac pathology would be injection of local anesthetic in the correct area of the affected sacroiliac joint. This procedure is usually performed using advance guidance systems (CT or fluoroscopic assisted guidance). If the pain is relieved by anesthetic injection, then the diagnosis is confirmed. There are three typical patterns of pain: pain directly over the joint, pain in the groin extending down the affected leg that can mimic the signs associated with a herniated lumbar disc, and pain widely dispersed in the affected leg.

Treatment

Treatment initially can include emergency interventions, but usually is conservative. Treatment includes physical therapy, manipulation, and medications for pain control. In some cases a sacroiliac belt can help with symptoms. In sacroiliac joint disease that has already progressed and is chronic and severe, corrective joint fusion may be indicated.

Prognosis

Outcome is variable and takes into account the extent of injuries, early diagnosis, and responsiveness to conservative treatment.

Prevention

There is no known prevention since the disease is secondary to an accident.

Resources

BOOKS

Goetz, Christopher G., et al, editors. Textbook of Clinical Neurology. 1st ed. W. B. Saunders Company, 1999.

Ruddy, Shaun, et al, editors. Kelly's Textbook of Rheumatology. 6th ed. W. B. Saunders Company, 2001.

OTHER

American Academy of Orthopaedic Surgeons. 〈http://www.aaos.org〉.

KEY TERMS

Herniated disk— A protrusion in a disk located in the spinal column.

Ligament— Fibrous tissue which connect bones.

Synovial joint— A joint that allows for bone movement.