Management of Sacroiliac Joint Pain

J Am Acad Orthop Surg. 2018 Sep 1;26(17):610-616. doi: 10.5435/JAAOS-D-15-00063.


Sacroiliac joint (SIJ)-based pain can be difficult to diagnose definitively through physical examination and conventional radiography. A fluoroscopically guided injection into the SIJ can be both diagnostic and therapeutic. The initial phase of treatment involves nonsurgical modalities such as activity modification, use of a sacroiliac (SI) belt, NSAIDs, and physical therapy. Prolotherapy and radiofrequency ablation may offer a potential benefit as therapeutic modalities, although limited data support their use as a primary treatment modality. Surgical treatment is indicated for patients with a positive response to an SI injection with >75% relief, failure of nonsurgical treatment, and continued or recurrent SIJ pain. Percutaneous SI arthrodesis may be recommended as a first-line surgical treatment because of its improved safety profile compared with open arthrodesis; however, in the case of revision surgery, nonunion, and aberrant anatomy, open arthrodesis should be performed.

Publication types

  • Review

MeSH terms

  • Arthralgia / diagnosis*
  • Arthralgia / therapy*
  • Arthrodesis / methods
  • Disease Management*
  • Fluoroscopy / methods
  • Humans
  • Injections, Intra-Articular
  • Physical Therapy Modalities
  • Prolotherapy / methods
  • Radiofrequency Ablation / methods
  • Sacroiliac Joint*