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Sacroiliac Joint Dysfunction Cheat Sheet (DRAFT) by

- SI Joint dysfunction , Hx, PE, management

This is a draft cheat sheet. It is a work in progress and is not finished yet.

SI Joint ligaments


- Two Types:
Mechanical and arthritic
- Mechan­ical: Alteration of normal joint mechanics (hyper­/hy­pom­obi­lity, leg length inequa­lities, gait abnorm­ali­ties, lower extremity joint pain, pes planus, improper shoes, scoliosis, prior lx fusion, lp myofascial dsyfun­ction, repetitve strenuous activity and trauma, pregnancy)
- Arthritic: OA/ inflam­matory arthro­pathy (AS, psoriatic arthritis, entero­pathic arthritis, reiters arthritis)


- Patients place their index finger over PSIS (Fortin finger test)
- Pain in lower back, groin buttoc­k/t­high, sometimes in lower leg (chemical radicu­lopathy of the nearby L5-S1 NR)
- Referral depends on which part of SI joint is irritated (Upper 1/3 = region of PSIS)
Mid-se­ction = pain in mid gluts
Lowest = lower gluteal region
- Exacer­bated by weight bearing and arising from a seated position, long car rides, in and out of a vehicle, rolling from side to side in bed, flexing forward whilst standing
- Relieved by lying down or shifting weight off the affected side
- 2 of the 4 tests have a high predictive value: SI distra­ction, thigh thrust, SI compre­ssion and sacral thrust (+ve test = reprod­uction of symptoms unilat­erally and located near PSIS)
- Pain on Gaensl­en's, FABER
- Stiffn­ess­/ap­pre­hension in SI joint MP
- Check for TrPs, tightness, weakness in muscles
- Check for biomec­hanics of LS and LL
- SI stress tests can be +ve in discogenic patients
- Pain in SI joint is lumbar until proven otherwise
- NTT and neurol­ogical exam are unrema­rkable in SIJD


High sensit­ivity and specif­icity when patient scores >4 on:
- One finger test - 3 points
- Groin pain - 2 points
- Pain when sitting on a chair - 1 point
- SI shear test - 1 point
- Tenderness of PSIS - 1 point
- Tenderness of sacrot­uberous ligament - 1 point


- Inflam­matory Arthro­pathy
- Middle cluneal nerve entrapment
- LS referral (disco­genic)
- Hip DJD/pa­thology
- Myofascial pain (pirif­ormis syndrome, gluts)
- Sacral insuff­iciency f#
- Neoplasm
- Infection
- Viceos­omatic referral


- X-ray showing bilateral sacroi­litis (AS)
- SIJD usually diagnosed clinically
- Rule out other pathology
- MRI and CT more sensitive
- Erosions, sclerosis, joint space narrowing
- Changes does not correlate with symptoms


- Ice, NSAIDs
- Ultrasound
- EMT of SI joint
- CFM of tendons and ligaments (espec­ially long dorsal sacroiliac ligament
- Myofascial release of gluts, hamstr­ings, pirifo­rmis, TFL, QL, lumbar erectors, contra­lateral lats
- Streng­thening lumbop­elvic stability - transverse abdominus, abdominal obliques, lumbar erectors, gluteus, hip abductors and adductors
- Education on posture and ergonomic awareness
- Avoid prolonged standing, sitting and forced hip abduction
- Arch suppor­ts/­ort­hotics/ SI belt
- Surgery for failure to respond to conser­vative care with continued/ recurrent SIJ pain and +ve response to SI injection with >75% relief