Understanding Sacroiliac Joint Syndrome Insights from a Clinical Audit

Sacroiliac joint syndrome (SIJS) is a common but often overlooked cause of lower back pain. Despite its prevalence, diagnosing this condition remains a challenge for many healthcare providers. A clinical audit conducted by Sanders B in 1997 at the AECC and a private chiropractic clinic sheds light on the diagnostic procedures used for SIJS and highlights areas for improvement. This post explores key findings from that audit and offers practical insights for patients and practitioners dealing with sacroiliac joint syndrome.

What Is Sacroiliac Joint Syndrome?

The sacroiliac joints connect the lower spine to the pelvis. These joints bear the weight of the upper body and help absorb impact during movement. When these joints become inflamed or dysfunctional, they can cause pain in the lower back, buttocks, and sometimes the legs. Symptoms often mimic other conditions like lumbar disc problems, making diagnosis tricky.

SIJS is estimated to cause 15-30% of chronic lower back pain cases. Despite this, many patients go undiagnosed or receive delayed treatment due to the complexity of identifying the syndrome accurately.

Challenges in Diagnosing Sacroiliac Joint Syndrome

Sanders’ clinical audit reviewed diagnostic methods used at the AECC and a private chiropractic clinic. The audit revealed several challenges:

• Lack of a single definitive test: No single clinical or imaging test can confirm SIJS with certainty.

• Overlap of symptoms: SIJS symptoms often resemble those of other spinal or hip conditions.

• Variable diagnostic approaches: Different practitioners use varying combinations of physical tests, patient history, and imaging, leading to inconsistent diagnoses.

  
  

The audit emphasized the importance of combining multiple diagnostic tools rather than relying on one method alone.

Diagnostic Procedures Reviewed in the Audit

The audit examined several common diagnostic procedures:

1. Patient History and Symptom Assessment

A detailed patient history remains the foundation of diagnosis. Patients typically report:

• Pain localized near the sacroiliac joint

• Pain aggravated by standing, walking, or climbing stairs

• Relief when lying down or resting

  
  

Understanding the pain pattern helps narrow down the cause but cannot confirm SIJS alone.

2. Physical Provocation Tests

Several physical tests aim to reproduce pain by stressing the sacroiliac joint. The audit highlighted the following:

• FABER test (Flexion, Abduction, External Rotation): Stresses the joint to elicit pain.

• Compression test: Applies pressure to the pelvis to provoke symptoms.

• Thigh thrust test: Applies force through the femur to stress the joint.

  
  

The audit found that no single test was reliable on its own. Instead, a combination of at least three positive provocation tests increased diagnostic accuracy.

3. Imaging Techniques

X-rays, CT scans, and MRIs are often used to rule out other causes of pain. However, the audit noted:

• Imaging rarely shows definitive signs of SIJS.

• Changes seen on imaging may not correlate with symptoms.

• Imaging is more useful to exclude fractures, tumors, or infections.

  
  

4. Diagnostic Injections

Injection of local anesthetic into the sacroiliac joint under imaging guidance can help confirm the diagnosis if pain relief occurs. The audit recognized this as one of the most reliable diagnostic tools but noted it is invasive and not always available.

Practical Takeaways for Patients and Practitioners

Based on the audit findings, here are some practical points for managing sacroiliac joint syndrome:

• Use a combination of diagnostic methods. Relying on patient history, multiple provocation tests, and selective imaging improves accuracy.

• Consider diagnostic injections when possible. These provide strong confirmation but should be used judiciously.

• Be aware of symptom overlap. Rule out other causes of lower back pain before concluding SIJS.

• Tailor treatment to confirmed diagnosis. Effective management depends on accurate identification of the syndrome.

  
  

Moving Forward with Better Diagnosis

The clinical audit by Sanders B highlights the complexity of diagnosing sacroiliac joint syndrome and the need for a structured approach. For patients experiencing persistent lower back pain, seeking evaluation from practitioners familiar with SIJS and its diagnostic challenges is crucial.

Practitioners should adopt a systematic process combining history, physical tests, imaging, and injections when appropriate. This approach reduces misdiagnosis and leads to better patient outcomes.

Understanding sacroiliac joint syndrome through audits like this one helps improve care quality and patient satisfaction. If you suspect SIJS, discuss these diagnostic options with your healthcare provider to ensure a thorough evaluation.

Sanders B, "Sacroiliac joint syndrome: A clinical audit to diagnostic procedures at the AECC and a private chiropractic clinic", AECC Project List 1997