The sacroiliac joint is a complex compound joint with an anterior synovial cavity and a posterior fibrous interosseous ligament complex. Its surface becomes increasingly irregular with age as interlocking ridges develop, progressively reducing motion. SIJ pain accounts for 15-25% of chronic low back pain with SI buttock pain, positive provocative tests (FABER, thigh thrust, Gaenslen), and diagnostic intra-articular injection confirming the diagnosis.
The SIJ pain referral pattern (buttock with possible posterior thigh radiation but rarely below the knee) must be distinguished from lumbar facet and discogenic pain. Three positive provocative tests increase the specificity to greater than 85%. Intra-articular fluoroscopy-guided injection with >75% relief confirms SIJ as the pain source. Cooled RF neurotomy of the lateral branch nerves (L4-L5 medial branch and S1-S3 lateral branches) provides lasting relief.
SIJ pain from joint degeneration or hypermobility producing buttock and thigh pain confirmed by provocative testing and managed with exercise, injection, and RF neurotomy.
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