SI joint pain

SI joint pain

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  • dcwhisen
    Participant
    Post count: 1

    Dr. Corenman,

    I hope you had a fantastic holiday. Below is my information along with symptoms and what I’ve done to date. Thank you so much for your time.

    Age: 34
    Weight: 164
    Height: 5 10
    Deadlift: 345
    Squat: 275

    Symptoms
    • Sharp stabbing pain in what seems to be the right SI joint
    • Pain is only felt when taking a step and loading the leg however pistol squats do not cause pain
    • No radiating pain down the leg

    Active in yoga, power lifting, jiu-jitsu, and climbing
    First sign of pain was July/August 2017
    Pain can be with every step for a days and then disappear for weeks on end
    Cannot reproduce pain
    Extremely mobile/flexible
    Have been treating as if this was sacrolitis
    No added pain from overuse, lots of sitting, standing

    Have tried the following with no success
    • Took 6-8 weeks off of all physical activity and took 10mg of Mobic during May/June
    • Ice
    • Heat
    • Tens
    • Cupping
    • Massage
    • Chiropractic care
    • Strengthening regimen
    • Mobility work
    • Injections (helped for few weeks)
    • All physical activity stopped from August 1st until now except a little bit of climbing

    Sample time span for pain: pain on October 5th then no pain until November 11th followed by 4 days of pain with every step.

    My primary care physician wants me to do 6 months of intensive physical therapy.

    Below are the results from my MRI:

    Procedure: MRI lumbar spine w/o contrast
    Findings: There is normal alignment. There are no acute fractures. Intervertebral discs are unremarkable. The conus modullaris is unremarkable. There is a L5 vertebral body. There is a pseudoarthrosis on the left between L5 and S1 which can be a source of back pain. There is a 1.5 cm right-sided Tarlov cyst at S1/S2

    T12-L1: No significant neuroforaminal or spinal canal narrowing.

    L1-2: No significant neuroforaminal or spinal canal narrowing.

    L2-3: No significant neuroforaminal or spinal canal narrowing.

    L3-L4 Mild facet arthropathy. Small bilateral foraminal disc protrusions with mild bilateral foraminal stenosis.

    L4-L5: Mild bilateral facet arthropathy. Shallow disc bulge resulting in mild bilateral foraminal stenosis. No spinal canal stenosis.

    L5-S1: Mild facet arthropathy. No disc herniation, spinal canal stenosis, or foraminal stenosis.

    Conclusion: Mild degenerative changes throughout the lumbar spine with level by level details described above. No acute process. There is a transitional L5 vertebral body with a pseudoarthrosis on the left bet ween L5 and S1 which can be a source of back pain.

    I have x-rays and digital copies of the MRI if you’d like to see them. I’ve read about bertolotti’s syndrome but am not sure if that’s applicable since the “fusion” is on my left side while my pain is in my right SI joint.

    Thank you and have a fantastic weekend.

    Chris

    Donald Corenman, MD, DC
    Moderator
    Post count: 6700

    Generally, SI joint pain that is generated by the SI joint is rare, occurring in only 3-6% of all SI joint symptoms. Bertolotti’s syndrome is a condition that is also as infrequent as the SI joint pain cause and the pain generally occurs on the side of the pseudoarthrosis so we can rule that pain source out.

    Pain could be referred by the facet joint on the right as well as the disc. You could be developing instability which would be noted by flexion/extension X-rays. This instability could cause nerve root compression with athletic maneuvers (“Pain is only felt when taking a step and loading the leg however pistol squats do not cause pain”).

    I would consider a plan first of new motion X-rays. If abnormal motion is obvious, then that level should be investigated. If nothing is obvious, then a careful set of nerve/facet blocks should be considered to diagnostically look for the source of pain.

    See: https://neckandback.com/treatments/diagnostic-vs-therapeutic-injections/,
    https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/
    https://neckandback.com/treatments/facet-blocks-and-rhizotomies/
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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