The sacroiliac joint is one of the most stable joints in the body, transmitting the entire body weight from the spine to the pelvis through its irregular interlocking auricular surfaces reinforced by the strongest ligament complex in the body (interosseous SI ligaments). Despite its minute range of motion, SI joint dysfunction is a significant cause of low back and buttock pain, accounting for 15 to 25 percent of chronic low back pain presentations.
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SI joint dysfunction produces unilateral buttock pain that may radiate into the posterior thigh and groin, rarely below the knee. Cluster tests (FABER, Gaenslen, posterior shear, active SLR, thigh thrust) improve diagnostic accuracy when three or more are positive. Image-guided injection into the synovial part of the joint, the anteroinferior portion, is both diagnostic and therapeutic. In pregnancy, hormone-related ligament laxity increases SI joint movement and is a common cause of pelvic girdle pain. SI joint fusion is performed for refractory cases using minimally invasive implants.
Abnormal sacroiliac joint mechanics producing unilateral buttock pain with positive cluster provocation tests, managed with manual therapy, targeted exercise, and joint injection.
Posterior pelvic ring instability from SI joint diastasis in high-energy pelvic fractures requiring percutaneous screw fixation.
Inflammation of the sacroiliac joint, typically in axial spondyloarthritis, causing inflammatory buttock and low back pain with morning stiffness; seen early as bone marrow oedema on MRI.
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