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Is SI joint Dysfunction over diagnosed or under diagnosed?
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marieh9 posted:
There is controversy in all the literature regarding SI joint Dysfunction.
Most articles, state that the tests used to diagnose are not specific and not accurate and vary from clinician to clinician and that the only reliable way to tell is SI joint injection with a steroid.

See poll below. However, I would like if you believe in SI Joint Dysfunction and why? If you do what is it based given the inaccuracy of the tests? Also, would you diagnose it as SI joint if the person has no major accident such as a car accident, no pelvic dislocation, no arthritis and non-pregnant and is middle aged? What is the basis of your answer? There seems to be a schism among the PT group, plus chiropractors and DO's versus all other doctors including GP's , pain doctors, surgeons etc.
I appreciate your input
MarieH

Take the Poll

How many of you believe in SI joint dysfunction?
  • yes or no overall
  • if yes SI problem caused by any type of injury
  • SI problem only caused by peliicdislocation, pregnancy, arthritis
  • Are you a physical therapist
  • what is your career
vote
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davedsel57 responded:
Hello.

Unfortunately, I find your poll extremely difficult to understand and impossible to answer.

I will say that I have had problems with my sacroiliac for many years and is one of the multiple degenerative spinal conditions I manage.
Blessings, -Dave
 
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bren_bren responded:
I know that I have been diagnosed with SI joint dysfunction via imaging that revealed inflammation, and a physical exam, by a very experienced sports ortho from the Mayo Clinic. I trust those results enough to know. Many doc's will throw that pain in that area into the category of "SI JOINT dysfunction". There are many variables and even the ligaments in that area could have more malfunction than the joint itself, resulting in horrific pain.

I would like to know what "articles" you have found stating it can only be determined by injections. Thanks, and yes, your post was very fuzzy, but I got the idea, B
 
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earlyretirement responded:
hello, I found your poll to be very confusing also but I have had SI-injections in the past with great relief but also have a multitude of degenerative spinal issues going on for the past twenty years, but in general is based on physical findings on exam and pain location that directs my Pain specialist physician to recommend and give me these injections-hope this helped you some. So yes I do believe in SI joint Problems and I am a retired/disabled Critical Care Nurse.
 
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marieh9 replied to davedsel57's response:
Davidsel57,
Yes it is and I'm sorry I messed up.It was my first making a poll. I have asked how to correct it and haven't received an answer yet.
Thanks for you input and sorry you have SI problems.
MarieH
 
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marieh9 replied to bren_bren's response:
Yes I apologize to everyone that I messed up. I'm sure I'll hear lots of that. I have asked how to fix it and haven't heard back. So I can't help it sorry.
Yes I'll have to go back and search PubMed for the specific articles you have asked for but it is all over the PubMed or Medline peer reviewed articles state that SI joint tests are not specific or accurate and vary from clinician to clinician. There are several articles that state either in a retrospective study or in blinded studies that the SI joint block or steroid injection is the best most accurate way to determine if you have an SI joint problem, however that is not 100% or even 90 accurate either due to leakage. I agree with you that alot may be due to the ligaments in the area rather than hypermobilization (unless due to certain problems or pregancy). It isn't something I made up it is a concern I have because I'm trying to get diagnosed myself and don't know who to believe. There is also a book by Dr. Scott Fishman, pain doctor at UC Davis who states that contrary to popular believe the SI joint doesn't just go out of whack it is very stable especially in your 40's. The books is called the War on Pain. I have been diagnosed by two PT's with SI joint dysfunction and all the doctors say it is muskulo skeletal problem. So I dont know where to go next , 2/3 PT's injured me further and much worse than when I started so I'm not too happy.
thanks
MarieH
 
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marieh9 replied to earlyretirement's response:
Thanks for your response. Did you find the SI joint block very painful?
thanks,
MarieH
 
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marieh9 responded:
Sorry to everyone about the confusing poll. I can't fix it and I think I may understand next time how to ask the questions. I am new and didn't get it right. At least I tried.
Marie H
 
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bj1208 replied to marieh9's response:
hi marieh9 - welcome to the board -

first of all - PT's are not doctors and cannot diagnose any conditions - they can speculate what they believe is wrong - the only way to get an accurate diagnosis is to be checked out by either an orthopedic spine specialist; neurosurgeon spine specialist; or pain management specialist

so what type of doctors diagnosed this as muscular skeletal problems?

I would take all your results and see an orthopedic spine specialist - if some results are more than 6 months old he/she may order new ones - not saying you need surgery but ortho spine specialist and neurosurgeon spine specialist are the best at reading the results. once that is done then they can direct you in the right treatment path.

I have SI joint problems along with piriformas problems - nerve damage in both legs (worse on left leg) and tenderness in my lower back at the L5 area - so tender no one can touch it - my surgery was 2 1/2 years ago and I'm worse now than before - before and after my surgery I've had all injections; nerve ablation; trial spinal stimulator implant - nothing has worked - and just recently found out i have a reaction to steroids - now i'm faced with either taking pain meds orally the rest of my life or getting the pain pump implant - which is a big step to decide -

take care and let us know how you are doing - Joy~~
 
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earlyretirement replied to marieh9's response:
not really, he uses a local anesthetic initially and then injects the si joint under x-ray( flouroscopy) and I get immediate relief.
 
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marieh9 replied to bj1208's response:
bj1208,
Thanks for your info. I saw an orthopedic surgeon and he said my injury was not spinal, the pelivis, was in alignment and it was "dynamic" not structural. The MRI has looked great on two occasions. I am due for a Hip MRI to make sure there is nothing wrong there. I may be another more recent lumar MRI though to be sure since it has been a while. I saw a pain doctor and said it was chronic myofascial even though the first time I had the injury was 4 years ago and was pain free and doing all activiites for 1 1/2 years. I did yoga and go pain in the same place. It is a focal spot near the SI joint. I have had leg tightening down the back of my leg, and sometimes the calf gets tight. My foot also has heel problems mostly at night. I think it is plantars fasciitis from the achilles being too tight. It could also be some nerve pain radiating but I'm sure about that. My family practise doc thinks it is muskuloskeltal too like the ortho surgeon. Two PT's said it was SI joint but none of the doctors agree with that. So, I'm thinking of seeing a physiatrist (rehab/physical med doc) because after my last major injury I can't cross my leg right to put my pants on and it hurts to wash the privates. I can't bend either. I seem to pull it every two weeks. I don't know if it is a muscle pull or SI joint going out. In between I sit too much as it hurts but I walk about 30 minutes in the morning and 10 min. in the afternoon. I don't want the doc to hurt me though and I'm very worried about that. I wish I could go to the PT that helped me get out of this last time but I'm too weak now to do the exercises he had me do. Whatever the diagnosis is don't you think if the pain is in the same exact spot as before that I should be able to get out of this again if I can get strong enough? Can one walk their way out of atrophy? I know as I do more exercise I feel less pain but then I pull it again and back to square one. I think also that I didn't "reinjure or pull a muscle or pull it out " until I started going down on neurontin. But neurontin didin't help the pain. So, maybe it is nerve related.
MarieH9
 
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marieh9 replied to earlyretirement's response:
That is good to know as I heard some say the injection was extremely painful and only lasted 4 weeks. I think it would help with diagnosis. I wish I had a good pain doc here. The one I went to was awful. How long does your pain relief last?
thanks, in advance
Marieh9
 
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marieh9 replied to bren_bren's response:
http://emedicine.medscape.com/article/95444-overview
I can get many other articles off of medline or pubmed. This is a really good article for anyone I am still reading. If you really want me to search pubmed I will but everywhere you read they say that the general thing about SI joint diagnosis is controversial and varies from clinician to clinician and that the tests used are inaccurate and non specific. I shouldn't have I said only diagnosed by injection but rather it is the most specific or accurate way and that it isn't that accurate either. If I said only that is not correct. Sorry again about the poll. But I have read a lot about this as I am still trying to get diagnosis and haven't been happy about what I have found in the publications.
regards,
Marieh9
 
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marieh9 replied to bj1208's response:
hi bj1208,
You are so right. Pt's shouldn't be diagnosing. My doctor gave them specific instructions and said go to him he's the man! So I did and he didn't want to follow the doc's orders. I probably should have caled the doc then. Anyway, I saw an ortho surgeon and he said the MRI and bone scan were negative and looked great but I have a "dynamic" problem not spinal. I guess meaning from movement. I did see a pain doc but was so fearful I didn't let him do the exam. He questioned me for a while and said I have chronic myofascial. I am thinking of going to a physiatrist (rehab/physical medicine doc) because I can't dress myself and wash below the waist due to pain. I think she might be good diagnositcally and if I get more PT I would think they would be more gentle. Have you seen one? The PT that I went to said to get a Hip MRI to make sure. So, I am confused. As for your drug question. My sister in law had a morphine pump and it worked for a while but then it leaked spinal fluid (this isn't the first time I have heard of this) the ER took it out and sent her home. She went into major pain and withdrawal (even though they said she wouldn't go into withdrawal). She went to a drug rehab center and they watched her carefully and gave her certain drugs for nerve problems and now she got married and is out of bed and working again. She still has good and bad days but so much better. Think about things like lamictal plus antidepressants and probably a third drug if that doesn't help. I may do the same to lower my pain. What do you think? How did they diagnose the SI problem (which doctor and tests). Have you had an SI joint injection and was it painful? I know you can't take steroids now I am just asking for diagnosis is it very painful and worth it?
Thanks, and let me know how you are doing too.
Marieh9
 
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earlyretirement replied to marieh9's response:
hello, sorry it has taken a little while to respond back to you, my computer is acting up and I've had a hard time getting on this exchange, anyhow I am under the care of a Neurosurgeon and Pain Management specialist along with several other consults that follow my progression or should I say degenerative process. That last SI injection that I had back in 2008 ( for a total of 5 thus far) has lasted this long and haven't required any more at this time or at least it's not been bothering me anymore. I will have to say that my Pain MD is highly specialized and I am so thankful for that and hope you can find the same! The others have also given you some good advice to go by and you do really have to be your own advocate if something persists given you a problem.


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