I saw your post to Dr. Corenman regarding the ER diagnosis of SI Joint Dysfunction, and wanted to briefly offer my personal experience with this disorder.
The Sacroiliac Joints themselves aren’t what we typically understand to be garden variety synovial / hinged joints. It’s simply the junction at which the upper pelvic crest (Ilium) meets the Sacrum (the large plate at the end of the lumbar spine). At most, and simply due to design, our SI joints will only shift or move about 4 degrees as opposed to something like an elbow — 130 degrees or more.
I was diagnosed in October 2012 with Severe Bilateral SI Joint Dysfunction, but as Dr. Corenman indicated, this isn’t a disorder that’s common, nor is it an easily diagnosed condition. Bulges, large “knots” or masses, and severe leg pain aren’t the usual warning signs and symptoms of SIJD. In fact, the SI joints aren’t “capable” of producing any kind of large lump under the skin, or knots within the overlying muscle tissue.
A confident, definitive, accurate diagnosis of SIJD is typically made by process of elimination, and by performing two series of diagnostic tests. The first tests require a physical examination conducted by an alert orthopedic surgeon who has more than just a basic knowledge base of SI Joint disorders.
First, there are 5 very specific manipulative maneuvers of the patient’s pelvic region that will indicate a somewhat conclusive diagnosis. Limited tolerance or outright intolerance of these 5 manipulative maneuvers will tell the physician that he or she is on the right track. Second, the orthopedic specialist will order an anesthetic injection (Lidocaine or similar solution) to be introduced directly into the joint(s)… if the patient experiences 90% or more relief within 10 minutes, that’s usually the diagnostic indicator.
The etiology of SIJD is still under study, however a few causative variables are its manifestation in women more so than men, age (over 40), with an extensive history of severe spine problems. The most significant origin of this condition lies in the patient’s history of spine surgeries.. individuals who’ve undergone several bi-level lumbar fusions are particularly at risk (at the time of my diagnosis, I had undergone 10 spine surgeries). When the spine has been rendered completely (more or less) immovable or static, the load we experience from walking, sneezing, straining, and lifting has to be dispersed somewhere — so, that kinetic energy and load is transferred downward and outward through the SI region. The SI junction is an extremely solid and durable region, however it can wear out just as any traditional joint space.
The pain “pattern” experienced with SI issues is different than that from discogenic or nerve compression pain. Mine began as severe spasm-like shocks across the upper buttock area (below the waist of my jeans, but above the glutes). I also had severe neurogenic claudication, meaning that walking and taking normal strides were extremely painful. Another tell-tale symptom is the patient’s inability to roll over in bed… I felt “locked up” and unable to roll onto my sides from a supine position. In standard x-ray films, my SI joints exhibited gas formation and significant deterioration. I had both SI joints fused between Oct. 2012 and Feb. 2013, yet this procedure is only undertaken as a last resort to preserve the patient’s quality of life. My surgeon was incredible, and had a high success rate in treating this condition through the iFuse MIS procedure.
I hope this information helps. Good luck to you.