Challenges in Diagnosing Sacroiliac Joint Pain: A Narrative Review

Abstract

Accurate diagnosis of sacroiliac joint (SIJ) pain is challenging. Diagnosis can be aided by pain referral patterns, historical features, physical examination maneuvers, and imaging. However, all of these diagnostic tools have limitations. The most reliable clinical tools may be a combination of three or more positive physical exam maneuvers, although the evidence is inconsistent even for this strategy. Intra‐articular diagnostic SIJ injections are often used as the reference standard for “true” sacroiliac pain. However, such injections do not consider extra‐articular sources of pain that may also exist as part of the sacroiliac joint complex. Research has established the posterior sacral ligaments as a possible source of pain, and the innervation of these ligaments has been anatomically defined. It is possible that by expanding our focus from the articular portion of the sacroiliac complex structure to both the joint and extra‐capsular ligaments, advancements in clinical diagnosis and treatment will be possible.

Evaluation of an Ultrasound-Assisted Longitudinal Axis Lateral Crest Approach to Radiofrequency Ablation of the Sacroiliac Joint

“…Our data would support this recommendation, which remains to be validated. 9,23 Other advantages of the L-SIJRFA technique are cost and less fluoroscopy time. The anatomically sound SIJ RFA techniques, like palisade, are multipolar techniques and require multiple RFA cannulae and probes (2-4 probes per side).…”

“…7,8 As such, inaccurate neural targeting and, in turn, incomplete denervation are a suspected cause of significantly lower success rates. 9,10 In the context of rising healthcare costs, providers are seeking cost-effective PSN RFA techniques that do not compromise accuracy or safety.…”

“…Although this may relate, in part to shortcoming in patient selection, including the diagnostic/prognostic block selection paradigm, recent studies have shown that many of the current SIJ RFA techniques incompletely target the intended PSN neural fibers 7,8 . As such, inaccurate neural targeting and, in turn, incomplete denervation are a suspected cause of significantly lower success rates 9,10 . In the context of rising healthcare costs, providers are seeking cost-effective PSN RFA techniques that do not compromise accuracy or safety.…”

Disfunción de articulación sacroiliaca

“…4 Como menciona Schneider y colaboradores, no hay patrones de dolor referido o datos claves en la historia del paciente que orienten directa y únicamente a afección de articulación sacroiliaca. 7 Sin embargo, esto se debe a la alta variabilidad de presentación de lesión de articulación sacroiliaca; el patrón más común que nos puede orientar a ello, sin ser patognomónico, es el dolor en nalga ipsilateral hasta el muslo posterolateral. También se ha visto correlación entre el dolor a 10 cm caudales y 3 cm laterales a la espina iliaca posterosuperior.…”

“…En cuanto a pruebas de provocación de dolor de articulación sacroiliaca, la prueba de cizallamiento posterior fue la más sensible con 74.4%, también referida como la más sensible por Schneider. 7 La prueba más específica fue el test de Patrick con 66.7%. Las pruebas de movimiento obtuvieron 0% de especificidad.…”