Clinical History
We review where the pain starts, where it travels, how long it has persisted, and what makes it worse.
Diagnosis
Separating SI joint pain from other causes.
Diagnosis requires more than a scan alone. SI joint pain is identified through symptom pattern, physical examination, imaging context, and diagnostic testing when needed.
Physical Examination
Provocation maneuvers help determine whether the sacroiliac joint is likely contributing to symptoms.
Imaging Review
X-rays, CT, and MRI help clarify anatomy but are always interpreted alongside the broader clinical picture.
Diagnostic Injections
Image-guided injections can help confirm the SI joint as the pain generator in selected patients.
Provocative Tests
Commonly Used Exam Maneuvers
Distraction, compression, thigh thrust, FABER, and Gaenslen's testing are commonly used provocative maneuvers when SI joint pain is suspected.
Injection Role
Diagnostic Blocks
When examination findings point toward the SI joint but the picture is still mixed, image-guided injections can help clarify whether the joint is actually the pain generator.
Hard To Diagnose
Why Is It Hard To Diagnose?
SI joint dysfunction can be difficult to diagnose because symptoms overlap with lumbar, hip, and pelvic disorders, and no single test works in isolation.
Common Diagnostic Dilemmas
Overlap With Spine And Hip Pain
Disc problems, facet pain, hip disease, piriformis syndrome, and post-surgical back pain can all mimic SI joint dysfunction.
Pattern Recognition
What Raises Suspicion?
One-sided buttock pain, pain with standing transitions, and tenderness around the posterior pelvis often increase suspicion for SI involvement.
Decision-Making
Why Multiple Clues Matter
No single test is perfect, so confidence improves when history, examination, imaging, and response to injections point in the same direction.