Buchanan Patrick, Vodapally Shashank, Lee David W, Hagedorn Jonathan M, Bovinet Christopher, Strand Natalie, Sayed Dawood, Deer Timothy
Department of Pain Medicine, Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA.
Department of Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA.
J Pain Res. 2021 Oct 8;14:3135-3143. doi: 10.2147/JPR.S327351. eCollection 2021.
Sacroiliac joint (SIJ) pain is one of the most common causes of low back pain, accounting for 15 to 30% of all cases. Although SIJ dysfunction accounts for a large portion of chronic low back pain prevalence, it is often overlooked or under diagnosed and subsequently under treated. The purpose of this review was to establish a best practices model to effectively diagnose SIJ pain through detailed history, physical exam, review of imaging, and diagnostic block.
A literature search was performed on the diagnosis of sacroiliac joint pain and sacroiliac joint dysfunction. The authors proposed diagnostic recommendations based upon the available literature and a detailed understanding of diagnosing SIJ pain.
The practitioner must focus on the history, location of pain, observed gait pattern, and perform key points of the physical exam including sacroiliac provocative maneuvers. If the patient exhibits at least three provocative maneuvers then the SIJ may be considered as a possible source of pain. Additionally, a thorough review of the imaging should be performed to rule out other etiologies of low back pain. In the absence of any pathognomonic tests or examination findings, diagnostic SIJ blocks have evolved as the diagnostic standard.
The diagnosis of SIJ pain is a multifaceted process that involves a careful assessment including differentiating other pain generators in the region. This involves careful history taking, appropriate physical examination including provocative maneuvers and diagnostic injections. Once the diagnosis is confirmed, long-term solutions may be considered, including recent advances in sacral lateral branch denervation and sacroiliac joint fusion.
骶髂关节（SIJ）疼痛是腰痛最常见的原因之一，占所有病例的15%至30%。尽管骶髂关节功能障碍在慢性腰痛患病率中占很大比例，但它常常被忽视或诊断不足，随后治疗也不足。本综述的目的是建立一个最佳实践模型，通过详细的病史、体格检查、影像学检查和诊断性阻滞来有效诊断骶髂关节疼痛。
对骶髂关节疼痛和骶髂关节功能障碍的诊断进行了文献检索。作者根据现有文献和对诊断骶髂关节疼痛的详细理解提出了诊断建议。
从业者必须关注病史、疼痛部位、观察到的步态模式，并进行体格检查的关键点，包括骶髂关节激发试验。如果患者至少表现出三种激发试验阳性，那么骶髂关节可被视为可能的疼痛来源。此外，应全面审查影像学检查以排除腰痛的其他病因。在没有任何特异性检查或检查结果的情况下，诊断性骶髂关节阻滞已成为诊断标准。
骶髂关节疼痛的诊断是一个多方面的过程，需要仔细评估，包括区分该区域的其他疼痛来源。这包括仔细询问病史、进行适当的体格检查，包括激发试验和诊断性注射。一旦确诊，可考虑长期解决方案，包括骶外侧支去神经术和骶髂关节融合术的最新进展。
