Sacroiliac Joint Pain : An Underdiagnosed Entity

A 55-year-old female walked into our chamber (Pain Clinic in Indirapuram) with complaints of pain in her right buttock radiating to her thigh and legs for 3 months. She was a bit obese and was limping while she entered. Her knees were a bit deformed due to osteoarthritis.

Her response after my question about her history was,” I am a known case of hypertension, diabetes, and hypothyroid, well-controlled on medications. This problem of pain in my buttocks and legs started insidiously and has been gradually become worse to a state that now I am unable to sit or walk. I don’t like to eat, and sleep is grossly disturbed. My family physician was giving pain medications which are unable to provide me any relief. I also consulted with a neurosurgeon and an orthopedic surgeon, who ordered a battery of tests including an MRI of the lumbar spine. But after all this, they were unable to even diagnose my problem and prescribed me antidepressants, thinking I am mad.”

After listening to her history, and examining her thoroughly,I found  severe tenderness in the right sacroiliac joint region with a positive FABER test. Her previous MRI of the lumbar spine was within normal limits. I explained that I was sure that her complaint is due to the degeneration of her sacroiliac joint, with obesity and knee deformity being the culprits. I advised wearing a pelvic brace, hot fomentation, along with Tab. Celecoxib and Tapendalol and advised her to consult after 3 days to tell about the relief. I also educated her about a small procedure ‘Intra-articular sacroiliac joint injection’ which may be required in her case for better relief.

After 3 days, she was satisfied, had decent relief, was able to sleep well, and had returned to her normal appetite, and was convinced for the procedure. The procedure went well and she had excellent relief with no medication. We followed her up after 3 months and were contented to find that she is doing much much better now.

Salient points about sacroiliac joint pain-

1. Sacroiliac joint pains also radiate in the lower limbs like sciatica. So many times physicians misinterpret it as lumbar disk disorder.
2. Sometimes patients with lumbar disk problems can have severe tenderness at the sacroiliac joint as both share a common nerve supply. So good physical examination and lumbosacral MRI are keys for correct diagnosis.
3. Obesity and knee deformities put excessive strain on the sacroiliac joint fastening its degeneration.
4. Sacroiliac Joint pains in young individuals are often due to spondyloarthritis. In such cases, physical exercise, NSAIDs and DMARDs, and sometimes biologics do help cure the problem
5. A sacroiliac joint steroid injections and many times prolotherapy and GFC therapy can help in the treatment of this disorder. 

So, Pain and Spine Clinic is always the right place to get all medical and interventional treatment to get rid of any type of pain. Here we correctly diagnose of cause the pain and advise the right treatment modalities for you. If any patient’s condition warrants surgery then, we guide the patient accordingly. So, Pain and Spine Clinic work in tandem with a lot of other specialties but more than 95% of patients will get relief here without surgery.

For more details mail us at www.painxtotal@gmail.com or WhatsApp Dr. Anurag Aggarwal @9958830005 or visit our clinic Aggarwals Gynae & Spine Pain Clinic, Indirapuram, website: www.painx.in