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PAIN MEDICINE

Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment

Pain Management Divisions, Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD and Walter Reed Army Medical Center, Washington, DC

Address correspondence and reprint requests to Steven P. Cohen, MD, Johns Hopkins Hospital Pain Management Center 550 North Broadway, Suite 301 Baltimore, MD 21205. Address electronic mail to scohen40{at}jhmi.edu.

Sacroiliac (SI) joint pain is a challenging condition affecting 15% to 25% of patients with axial low back pain, for which there is no standard long-term treatment. Recent studies have demonstrated that historical and physical examination findings and radiological imaging are insufficient to diagnose SI joint pain. The most commonly used method to diagnose the SI joint as a pain generator is with small-volume local anesthetic blocks, although the validity of this practice remains unproven. In the present review I provide a comprehensive review of the anatomy, function, and mechanisms of injury of the SI joint, along with a systematic assessment of its diagnosis and treatment.

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