Challenges in Diagnosing Sacroiliac Joint Pain: A Narrative Review

Area of Science:

• Pain Management
• Anatomy
• Diagnostic Imaging

Background:

• Accurate diagnosis of sacroiliac joint (SIJ) pain presents significant clinical challenges.
• Current diagnostic modalities including pain referral, history, physical examination, and imaging each have inherent limitations.
• Intra-articular injections are considered a reference standard but may overlook extra-articular pain sources.

Purpose of the Study:

• To review the diagnostic challenges associated with sacroiliac joint (SIJ) pain.
• To explore the potential of including extra-articular structures, specifically posterior sacral ligaments, in the diagnostic approach.
• To suggest advancements in clinical diagnosis and treatment by broadening the focus beyond the articular SIJ.

Main Methods:

• Literature review of diagnostic tools for SIJ pain.
• Analysis of anatomical studies on posterior sacral ligament innervation.
• Evaluation of the limitations of current diagnostic strategies.

Main Results:

• No single diagnostic tool for SIJ pain is consistently reliable.
• Physical examination maneuvers, while helpful, lack consistent evidence for efficacy.
• Posterior sacral ligaments are identified as potential extra-articular pain generators with defined innervation.

Conclusions:

• Current diagnostic methods for SIJ pain are limited.
• Considering both intra-articular and extra-articular structures, like the posterior sacral ligaments, is crucial for comprehensive diagnosis.
• Expanding the diagnostic scope may lead to improved clinical outcomes for patients with SIJ pain.