Author Archives: Tigran Garabekyan, M.D.

In order to accurately diagnose a dysfunctional sacroiliac (SI) joint and prescribe the correct treatment, the doctor will likely need the patient’s medical history, including symptoms, a physical exam which will include the SI joint, provocative maneuvers, and imaging studies.

Additionally, the provider will need to eliminate other sources of low back pain, such as the spine or hip, so there is a lower possibility of misdiagnosis.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery as well as non-surgical treatments to patients in Los Angeles, Century City, CA, and surrounding locations.

SI Joint Pain Tests

SI joint dysfunction tests include discussing the patient’s history and pain experience, a physical exam, tests to eliminate other sources of pain, such as hip pain and lumbar spine pain, and these commonly accepted techniques:

• Provocative tests
• Diagnostic imaging (X-ray, CT, MRI)
• Diagnostic SI joint injections of the SI joint

Provocative SI Joint Tests

The doctor may undertake a series of provocative examinations or tests to manipulate the joints or feel tenderness over their SI joint. All of these methods can help diagnose the condition. Tests for provocative SI joints include:

• Distraction
• Thigh thrust
• Compression
• FABER
• Gaenslen

The doctor will apply pressure to the hips, knees, and other areas to see which position may lead to pain or discomfort in five different positions.

Diagnostic Imaging

Additionally, a CT scan, X-rays, or MRI may be helpful in diagnosis. It is also vital to understand that more than one condition (such as a hip or disc problem) can occur along with SI joint issues and the doctor should evaluate other factors that may be causing symptoms.

Get the Right Diagnostic Test

The correct diagnostic tests are very important to establish whether the patient has a sacroiliac (SI) joint dysfunction. Below are the most common techniques to diagnose SI joint dysfunction.

Diagnostic Injections of the SI Joint

The most common technique to correctly determine the reason for SI joint pain is to inject the SI joint with pain drugs.

Fluoroscopic-guided SI joint injection with:

• local anesthetic
• contrast medium

Post-injection pain reduction:

• ≥ 50% SIJ is the probable source of pain
• < 50% Should consider other sources of pain, but SIJ may be a factor

The SI joint injection procedure involves administering a tiny amount of numbing medication (a local anesthetic such as lidocaine) into the SI joint under CT guidance or fluoroscopic guidance.

In case there is significant relief in the SI joint pain (over 50 percent pain relief) following the injection for one or two hours, then it is thought to be a confirmatory or positive diagnostic injection, which means that the SI joint is the most likely reason for the pain.

The SI joint is less likely to be the primary reason for the pain if the level of pain is unchanged after the injection.

Know What to Share with the Doctor

To enhance the chances of an accurate diagnosis and treatment, the patient should follow the below mentioned steps:

• Understand when the pain occurs and how intensely they feel it in multiple locations, including the buttocks, lower back, and legs
• Tell the doctor the exact location of the pain and the level of functionality, and share the pain journal with them.
• Inform the doctor about any previous injury that may have either directly impacted the pelvis, or caused the patient to walk asymmetrically, or may relate in any manner to functionality
• Ask if the doctor is trained specially in SI joint dysfunction. If they are not, the patient should reconsider their choice of doctor.

A medical professional trained in SI joint pain diagnosis will assess all the information the patient provides, including their history of injury, failed lumbar fusion or other surgery, location of the pain, or problems sleeping or standing.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery and other procedures.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

The sacroiliac (SI) joint is located in the pelvis, and it connects the iliac bone (pelvis) to the sacrum (the lowest portion of the spine above the tailbone).

This joint transfers forces and weight between the legs and upper body. It is an important component for energy transfer between the torso and legs.

When the doctor asks the patient to point to their pain, they are trying to identify whether the SI joint might be the cause for the pain. Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery as well as non-surgical treatments to patients in Los Angeles, Century City, CA, and surrounding communities.

SI Joint Anatomy and Function: Does it Move?

A network of muscles and ligaments stabilizes the SI joint, which also restricts motion. The normal SI joint has a small amount of normal motion of around two to four mm movement in any direction. Therefore, it moves only a little.

The SI ligaments in females are less stiff in comparison to males, which enables the mobility necessary for childbirth. Motion, mainly rotation, reduces with aging, and increased motion is related to pregnancy.

SI Joint Shape, Size, and Texture: It’s a Real Joint

The SI joint is a true diarthrodial joint, which means that it is the most common and moveable joint in the body. The articular surfaces are shaped like an ear, containing uneven ridges and depressions. The concave sacral surface of the joint is covered with thick hyaline cartilage, and the convex iliac surface is lined with thin fibrocartilage.

In the upper part of the SI joint, the ilium and sacrum are not in contact but are instead connected with robust posterior, inter-osseous, and anterior ligaments. The lower half of the joint and anterior is a typical synovial joint with hyaline cartilage on the joint surfaces.

The SI joint is an axial joint with an estimated surface of 17.5 square cm. The surface of the joint is smooth in juveniles and becomes uneven over time.

SI Joint Strain, Injury, and Instability

Upon understanding the location of the SI joint and what it is, it is more convenient to comprehend how it can be injured and degenerate over time and lead to low back or spine, leg, pelvic, or buttock pain.

Common Causes of SI Joint Dysfunction and Pain

The injury and mechanical strain to the SI joint are produced by falls on the backside or a combination of vertical compression and rapid rotation (i.e., lifting a heavy object and twisting). These types of injuries can create ligamentous laxity and allow painful abnormal motion, meaning SI joint pain.

SI joint instability can also initiate from lumbar spine surgery, which involves injury to a large part of the ilio-lumbar ligament. SI joint pain can also occur due to leg length discrepancy, gait irregularities, extended, vigorous exercise, traumatic birth, trauma, and long scoliosis fusions to the sacrum.

Painful SI joint arthritis can also initiate from autoimmune diseases, such as juvenile rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Reiter’s Syndrome, and infections including TB, staphylococcus, and gonorrhea.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery and other procedures.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/

For over a century, Sacroiliac (SI) joint disorders and related symptoms have been well-known. Scientific data indicates that it is common from pain from SI joint to feel similar to discogenic or low back pain.

SI joint disorders should be considered in low back pain diagnosis to avoid unnecessary lumbar spine surgery.

Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery as well as non-surgical treatments to patients in Los Angeles, Century City, CA, and surrounding locations.

A Properly Functioning SI Joint

An SI joint which is functioning correctly has a limited amount of motion SI joint and the motion occurs in multiple planes. The sacrum translates (glides between the two ilea), the sacrum nutates (rocks forward and backward) as well as pivots on a diagonal axis simultaneously.

These motions are quite small with the gliding motion being around 1.6 mm and with one to two degrees of sacral rocking motion in men, and three to four degrees of sacral rocking motion in women.

The Three Components of a Normal SI Joint

For optimal SI function, there are three components that are necessary. These are:

• Form closure: passive forces
• Force closure: dynamic forces
• Motor control: the coordination between the nervous system and the muscles that stabilize the pelvic area and lower back

The SI joint works to transfer weight and forces due to motion from the upper body through the pelvis to the legs and vice-versa. The SI joint is an important component for shock absorption to prevent the impact of forces from reaching the spine during movement.

The main role of the SI joint is to offer stability to the pelvis and to bear the weight of the upper body.

SI Joint Instability

SI joint dysfunction may develop when any or all components that are necessary for the stability of the SI joint are not functioning appropriately due to giving birth, trauma, arthritis, degeneration, or other conditions. SI joint dysfunction may or may not cause pain in the SI joint itself.

SI joint dysfunction may cause pain in the soft tissues surrounding the SI joint and/or in other body areas that may be affected in a secondary manner.

Testing for SI Joint Instability

SI joint pain refers to the situation when there is pain emanating from the joint itself. Patients experiencing SI joint pain usually have discomfort at the time of provocative testing. The provocative tests refer to physical exam tests that stress the SI joint(s) in several directions.

Studies indicate that if the patient has three or more positive tests on a cluster of five specific provocative tests, it is quite probable that the patient has pain initiating in the SI joint.

SI Joint Dysfunction Pain and Treatment

SI joint dysfunction pain can be experienced anywhere in the low back, legs, or buttocks. Chronic SI joint pain symptoms can make it challenging to perform common daily tasks, and can impact many facets of the patient’s life.  

Fortunately, there are thousands of physicians around the world who are trained in SI joint pain treatment, from conservative treatments to minimally invasive SI joint fusion surgery.

Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery and other procedures.

Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:

Century City / Los Angeles: 310.595.1030

Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.

Also visit http://www.drgorthopedics.com/