What Triggers Sacroiliitis and How does It Present?
Q: Good evening sir, I am a 46 years old male from India. I have had very severe pain in the left hip and buttock region since past 6 months. I got an MRI done which indicated that my L2-L3, L3-L4 disks have a mild bulge encroaching on the sciatic nerve. Also, the L5 is sacralized and fused with the S1. This however, has been seen to be mild. In addition, my neurosurgeon has seen sacralization present. He asked me to take a few steroid injections and medicines to rule out sacroiliitis as the pain source. The medicines and injections didn’t help in relieving the pain and hence the specialist has ruled out sacroiliatis. My symptoms are very marked. I feel pain while climbing and getting down stairs. It hurts a lot while standing or sitting for periods beyond 10 minutes. It doesn’t hurt while I walk on a plain surface. The pain is generally in the left buttock that is felt even while touching, especially in the dimpled area. I have checked the symptoms online and it appears to be a case of Piriformis Syndrome. My doctors have however dismissed it, saying it’s a rare disorder and is unlikely. As a background, I would like to inform that I had slipped and fell in the bathroom around 6 -7 months ago and had fallen flat on my buttocks. I didn’t feel any pain then. Presently I am treating my pain with stretch exercises and at times with pain killers. I need your expert advice on the following:
- Are there any tests to check what exactly is the cause of pain?
- If it is piriformis, can it be documented somehow by way of any imaging test like MRI etc.
- Are there any specific medications which may help in relieving the pain, since it’s greatly affecting my routine life style.
Thanking you in anticipation,
Yours faithfully,
Mahesh Paranjpe
Reply:
It doesn’t appear to be Piriformis Syndrome.
Your symptoms have started after you sustained the fall. So, this trauma is very likely to be related to your condition.
Though you have mentioned that your doctor has ruled out sacroiliitis, there are still pretty good chances that it may be the underlying cause of your symptoms.
Symptoms and Presentation
This term simply means an inflammation of the sacro-iliac joint of one or both sides. The typical symptoms are-
- Pain while climbing stairs
- Pain on prolonged sitting or standing
- Pain on bearing weight
Basically, any activity involving the movement of these joints would give pain. Did the reports show any signs of inflammation at this joint?
Causative Factors
Sacroiliitis can get triggered by many causes including trauma, arthritis or infections.
Diagnosis and Treatment
Have you adequately tried medications for this condition? If not, you may give it a trial again.
Investigations may only point towards the condition. Diagnosis is confirmed only when the medications respond.
The specific medications for the condition include the range of anti-inflammatory drugs like steroids etc.
Take Care,
Buddy M.D.
Dear Sir, thank you for your prompt and detailed reply. My MRI was for the spinal issue. Though the sacroiliac joints were visible in the lower end of the MRI image, it wasn’t very clear. But the surgical specialist did point out certain inflammation like indication in the MRI but wasn’t sure since it was on the edge of the MRI image.
That is why he tried the medication, including steroid injections, for 2 weeks. They didn’t help reduce the pain at all. But with the similar symptoms as pointed out by you, I am fairly sure now that it is more likely a sacroiliitis. I shall have another MRI done specifically for the Sacrum joints this time.
Do let me know sir, if there is any specific medication to test the above and if confirmed, what is the best way of treating it. Thank you again for you reply.
Sacroiliitis is the inflammation of joints forming the hip girdle. Mainly, two bones, sacrum and ilium form this girdle.
Your doctor would press at certain points in the area to conclude where exactly the pain is, that is, the epicenter of pain. He may move your leg gently and make an assessment about the exact location.
MRI would be able to give a clearer picture. It would also reveal if this inflammatory swelling is pressing upon any nerve!
Treatment of sacroiliitis aims at reducing the inflammation of the affected joint. This is done by a combination of medicines including steroids, anti inflammatory drugs and muscle relaxants. Also, you are required to take rest. Once you are out of the painful phase, physiotherapy is advised.