Stemcelldoc's Weblog

August 12, 2011

Sacroiliac Joint Pain: Not limited to Back and Buttock

The sacroiliac joint (SI) is the joint between the sacrum, the base of the spine, and the ilium of the pelvis. 

Frequently it is a cause of pain in patients who have undergone lumbar fusions and traumatic injuries.

ST is 47 y/o active patient with 4 year history of left buttock pain which was constant in duration, progressive in nature with radiations into the left lateral thigh extending down calf and into the fourth and fifth digits of left foot.  Buttock pain was aching and throbbing whereas  the leg pain is ‘nerve’ like with intermittent sharp electrical sensations. Patient is active in volleyball and cycling.  Physical examination was significant for positive  Fortin test and patrick test.

ST was surprised of by the diagnosis of SI joint dysfunction.  Surely this was irritation of the nerve root caused by a protruding lumbar disc.

Can SI joint be responsible for lower extremity pain?

Yes !

Slipman demonstrated that SI joint pain is not limited to the lumbar region and buttock.  50 patients were evaluated who had confirmed Si joint dysfunction. 94 % of patient described buttock pain whereas 50% of patients had lower extremity pain, 28% had leg pain distal to the knee and 14% reported foot pain.

Not all lower back, buttock and leg pain arises from disc disease.

At the Centeno-Schultz Clinic we are committed to making the correct diagnosis.  Treatment options for sacroiliac joint dysfunction includes prolotherapy, PRP and bone marrrow derived stem cells.

July 7, 2011

Buttock Pain After Lumbar Fusion

Fusion of the lumbar spine is commonly performed for low back and leg pain. Pain relief varies from minor to moderate.  Unfortunately  fusion of the lumbar spine can result in complications or the development of a new type of pain.

 EB is a case in point.  EB is a 50y/o patient who underwent two level fusion for severe lower back and leg pain which was refractory to conservative therapy.  While her leg pain improved her lower back pain remained unchanged and she developed new buttock pain which was constant in duration, progressive in nature, localized deep in her buttock with radiations into the posterior thigh.  Physical examination was significant for tenderness over the PSIS and a  positive Patrick’s test. EB  had developed sacroiliac joint dysfunction as a result of her lumbar fusion.

The sacroiliac Joint (SI) is the joint in the bony pelvis between the sacrum and the ilium.  It functions as a major shock absorpter for the spine.  Removal of some of the shock absorbers of the spine puts additional forces and strain on the SI jont leading to pain and dysfunction.

The SI joint, its anatomy, physiology and clinical significance is well documented.

Symptoms: Unilateral pain which if severe enought can refer into hip, groin and down the posterior thigh.

Engineeers have demonstrated increased stresses and motion in SI joint following lumbar fusion.

Katz demonstrated that SI joint dysfunction was a cause of pain in 32% of patients with low back pain after lumbar fusion.

At the Centeno-Schultz Clinic EB underwent x-ray guided injections of the prolotherapy into the joint and supporting ligaments with greater than 75% benefit.   Patients unresponsive to prolotherapy have undergone SI injections with Regenexx SCP, Regenexx SD and Regenexx PL with good success.

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