Sacroiliitis: Often Missed Diagnosed as Back Pain

South Carolina Woman Magazine (SC) Febuary 2009

More than 80 percent of Americans have back pain at some point in their lives. Most are the results of a past injury when the patient thought they were not hurt but really were. For some, the pain is caused by inflammation of the sacroiliac (SI) joint that attaches the sacrum (the lowest part of the spine) to the pelvis. Very often this condition is missed or inappropriately treated.

The disease is called sacroiliitis. In people under age 50, an underlying medical condition is often present if there has been no injury. These include inflammatory bowel disease (ulcerative colitis and Crohn's disease), psoriasis and a condition called ankylosing spondylitis. For others, it is the result of a physical injury i.e. slip and fall, childbirth, and more recently I have been finding it after car crashes where the seat belt caused the injury. Now, do not stop wearing your seat belt because it is the law and it is better to be injured than dead!

Sacroiliitis can occur but rarely, as a complication of infections in the joint, skin, heart or muscle. It can also follow an injury to the back. This form of back pain is also a frequent complication of pregnancy as the pelvis stretches to accommodate childbirth. In older people a major cause is osteoarthritis and is similar to pain and dysfunction in many other joints.

In a typical patient, the symptoms can develop very suddenly with pain that is usually localized to one side of the back. The pain can be excruciating!. Also, any form of movement of the spine becomes very uncomfortable and painful. The SI joint is the largest joint in the body and carries the weight of the entire body. It is a major joint that is often overlooked by patients and doctors alike.

Sometimes the pain is felt in the thigh and in the buttock. Pain in the joint leads to spasm of the muscles surrounding the joint that then, in turn, can cause compression of the sciatic nerve leading to pain that radiates down into the leg and on occasion numbness in the foot or leg. This can also lead to limping. This is called Sciatica, but the cause can be a dysfunctional SI joint.

The most severe forms of sacroiliitis are associated with the medical conditions listed above. There can be fever, eye inflammation, evidence of psoriasis (with an obvious skin rash) or inflammatory bowel disease that manifests with abdominal pain and diarrhea containing blood and mucus. If these conditions exist then you may need more than one type of doctor.

In the older patient, the pain can be quite severe, but is more often chronic, presenting with back pain that could have been present for weeks, months and even years. A unique feature of the pain is that it is made worse by sitting or lying down and is made better by standing up.

Quite frequently sacroiliac pain is mistaken for another cause of low back pain, such as a ruptured disk, collapsed vertebra, spinal stenosis or osteoarthritis of the joints in the spinal cord. Unless your doctor closely examines your back he may totally overlook the diagnosis. After a physical exam, the next step in order to make a diagnosis is an X-ray or MRI of the lower back. To proper diagnosis a dysfunctional SI joint, the X-ray needs to be taken while standing up and the doctor evaluates for function of the joint after he evaluates for pathology. Otherwise SI joint dysfunction will be missed.

With patients over 50, abnormalities of the spine are very common, and therefore it is not surprising that the pain is ascribed to the wrong cause. Even if the sacroiliac joint is visualized, the X-ray is often normal (especially if the X-Ray is taken while lying down). On occasion, surgery is done that, of course, will not be successful.

Because this condition is so frequently misdiagnosed, an empowered patient like yourself, should always be aware of the sacroiliac joint as a cause of pain. A good way to pinpoint sacroiliac pain is to sit down and if the pain is on the right side of your back, place the ankle of your right leg on the thigh of your left leg. Then push your right knee downward. If this elicits pain the likely cause is the sacroiliac joint. Your doctor should also closely examine your back and press on the affected joint, which of course will lead to pain, and then, an accurate diagnosis.

Another way to self test for dysfunctional SI joints is to lay down across the bed, with shoes on, leaving feet off the bed about a foot, and check for leg length discrepancy. Anything more than a quarter of an inch should be suspect. If this is found, then the spouse should take their thumb and press hard at the center of the thigh where the short leg connects to the buttock. Quickly check the legs lengths again. If the legs even and then begin to shorten again in a few seconds, then this is a good indicator that there is SI dysfunction or Sacroiliitis.

To further complicate an already complicated disease process, if SI dysfunction is left long term it will usually lead to hip, knee and ankle issues. I often use the example of a car front end. If the front end is out of alignment, it will wear the tires and rods out. This is not the only cause of these conditions but it causes more than most doctors realize. That is why diagnosing SI dysfunction correctly and quickly along with correct treatment is so important in the cause and prevention of so many degenerative problems.

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