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/
