Diagnosis of Sacroiliac Arthropathy

The diagnosis of sacroiliac arthropathy can be a challenging process, but it’s necessary for healing. Learn more here.

Table of Contents

What Is Sacroiliac Arthropathy?

The diagnosis of sacroiliac arthropathy, also known as sacroiliitis, is a condition that affects the sacroiliac joint. This joint connects the sacrum (bone at the bottom of the spine) to the ilium (pelvis bone).1


Sacroiliac arthropathy involves inflammation and damage to the sacroiliac joint. This can result in pain and stiffness in the lower back, buttocks, and legs. The pain can increase with prolonged sitting or standing.

Factors that Can Cause Sacroiliac Arthropathy

A variety of factors cause sacroiliac arthropathy, such as:2

  • Trauma
  • Infection
  • Pregnancy
  • Certain types of arthritis

What Are the Diagnostic Criteria for Sacroiliac Arthropathy?

As there is no single definitive test, the diagnosis of sacroiliac arthropathy involves a combination of methods. As a result, the diagnosis comes from a combination of findings.


Here are some criteria and methods used for the diagnosis of sacroiliac arthropathy:3

  • Medical history
  • Physical examination
  • Diagnostic injections
  • Imaging studies
  • Blood tests

The diagnosis of sacroiliac arthropathy can be challenging, as the symptoms can overlap with other conditions. It’s crucial to consult with a health care provider for an accurate diagnosis.

Are There Any Specific Physical Symptoms Used to Identify Sacroiliac Arthropathy?

Sacroiliac arthropathy can present with a variety of physical symptoms. These affect the lower back, buttocks, and hips. 


Symptoms may vary among individuals, but common physical manifestations of sacroiliac arthropathy include:

  • Lower back pain
  • Buttock pain
  • Hip pain
  • Pain with movement
  • Pain with weight-bearing
  • Stiffness
  • Limited range of motion
  • Instability

Remember, these symptoms can also occur with other conditions. Testing is often needed to rule out other disorders that may cause similar symptoms. 

How Is Sacroiliac Arthropathy Differentiated From Other Causes of Pain?

Telling the difference between sacroiliac pain and other pain can be difficult due to overlapping symptoms. 


Several factors can help in the differentiation process, including:

  • Patient symptoms
  • Medical history
  • Physical examination findings
  • Imaging studies

Consulting with a health care provider is essential. This allows for an accurate diagnosis of sacroiliac arthropathy.


Here are some common considerations for a diagnosis of sacroiliac arthropathy:

Location of Pain

Sacroiliac arthropathy causes pain in the lower back, buttocks, and hips. While the pain can affect both sides of the body, it is often localized to one side. Other causes of lower back and pelvic pain may have different patterns of pain.


For example, pain from a herniated disc may radiate down the lower back and buttocks, and pain from kidney stones may manifest in the flank area.

Pain Radiation

Sacroiliac arthropathy may cause pain that radiates down the back of the thigh or into the groin area. Radiating pain that extends below the knee may suggest a nerve-related issue, such as sciatica.

Aggravating Factors

Activities or movements that worsen the pain can provide clues. In sacroiliac arthropathy, pain may worsen with prolonged standing, walking, or climbing stairs. Movements that stress the sacroiliac joint may also exacerbate the pain.


Other causes of lower back and pelvic pain may have different aggravating factors. For example, disc-related pain may worsen with sitting or forward bending.

Response to Interventions

The response to specific interventions or treatments can provide more insights. For instance, certain movements or positions may influence the pain in sacroiliac arthropathy. Diagnostic injections can help confirm or rule out sacroiliac joint involvement.

Physical Examination Findings

A physical examination can aid in identifying specific signs associated with sacroiliac arthropathy. Health care providers may perform various tests and maneuvers to assess the sacroiliac joint. 


This includes applying pressure to specific areas or performing specific movements. Positive findings on these tests can suggest sacroiliac joint involvement.

Imaging Studies

Imaging studies play an important role in the diagnosis of sacroiliac arthropathy. There is no single imaging test that can confirm sacroiliac arthropathy. But, different imaging modalities can support the diagnosis of sacroiliac arthropathy. 


These imaging studies include:

  • X-rays
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) scans
  • Bone scans

What Impacts the Choice of Imaging Modality?

The choice of imaging modality depends on various factors, such as:

  • The severity of symptoms
  • Clinical presentation
  • Initial findings from X-rays or other imaging studies

Health care providers should treat the diagnosis of sacroiliac arthropathy on a case-by-case basis. From here, they’re able to determine the right approach to diagnose sacroiliac arthropathy.

What Role Do Symptoms and History Play in the Diagnosis of Sacroiliac Arthropathy?

Patient symptoms and medical history play a large role in the diagnosis of sacroiliac arthropathy. They provide essential information that helps health care providers differentiate from other potential causes of lower back and pelvic pain. 

Pain Symptoms

The hallmark symptom of sacroiliac arthropathy is pain, typically felt in the:
  • Lower back
  • Buttocks
  • Hips
  • Occasionally radiating down the legs
The pain is often localized to one side, although it can affect both sides in some cases. Activities such as standing up from a seated position, walking, or climbing stairs may exacerbate the pain.

Stiffness Symptoms

Patients with sacroiliac arthropathy may experience stiffness and limited range in the lower back or hip area. This can lead to difficulty performing activities that involve bending, twisting, or lifting.

Sensations Symptoms

Some individuals may report sensations such as dullness, burning, or numbness in the affected area, but it can also be sharp or stabbing. 

Altered Gait Symptoms

Due to pain and stiffness, patients may develop an altered gait pattern. This can include limping, walking with a tilt or lean to one side, or avoiding weight-bearing on the affected leg.

Medical History

The health care provider will inquire about the patient’s medical history, including any previous injuries or conditions that can damage the sacroiliac joint. 


The following can increase the risk of developing sacroiliac arthropathy:

  • Previous injuries
  • Infections
  • Underlying conditions such as arthritis
  • Previous surgeries, such as spinal fusion or hip replacement

History of Symptom Onset and Duration

The health care provider will ask about the onset and duration of symptoms to understand the progression and chronicity of the condition. 


Sacroiliac arthropathy can develop gradually over time or occur suddenly. The duration of symptoms can vary from weeks to months or even years.

History of Aggravating and Relieving Factors

Identifying activities or movements that aggravate or alleviate the symptoms is important in diagnosing sacroiliac arthropathy. 


Patients may find that certain positions or movements worsen the pain, such as sitting or bending forward. 

Previous Treatment History

The health care provider will inquire about any previous treatments or interventions the patient has undergone to manage their symptoms. 


This includes: 

  • Medications
  • Physical therapy
  • Chiropractic manipulation
  • Corticosteroid injections

Understanding the response to previous treatments can provide valuable information for diagnosis and management.

Are There Any Limitations to Diagnosing Sacroiliac Arthropathy

Yes, there are certain limitations when seeking an accurate diagnosis of sacroiliac arthropathy. These limitations of diagnosing sacroiliac arthropathy include:

Overlapping Symptoms

The symptoms of sacroiliac arthropathy can overlap with other conditions. This is especially true of conditions that cause lower back and pelvic pain. 


Overlapping symptoms can make it difficult to distinguish sacroiliac arthropathy from other causes. As a result, a diagnosis of sacroiliac arthropathy is rarely based on symptoms alone.

Lack of Specific Diagnostic Tests

There is no single definitive test to diagnose sacroiliac arthropathy. Tests like X-rays, MRIs, or CT scans can provide valuable information. 


But, they may not always show abnormalities in the sacroiliac joint. The interpretation of imaging findings can also be subjective.

Diagnostic Injections

Diagnostic injections can be helpful when confirming a diagnosis of sacroiliac arthropathy. Yet, while they’re beneficial, they’re not perfect. 


Diagnostic injections involve the injection of a local anesthetic or a combination of anesthetic and corticosteroid into the sacroiliac joint or its surrounding structures. 

Potential Limitations of Diagnostic Injections

Some limitations of these injections include:
  • Patients can experience a placebo effect or temporary pain relief from the injection.
  • The injection missed the target area, or the medication spread incorrectly within the joint. 
  • Variations in joint shape, size, and orientation can affect the success and reliability of the injection technique.

Lack of Specific Biomarkers

Currently, no specific tests or biomarkers are available to diagnose sacroiliac arthropathy. Blood tests may help rule out other potential causes of pain, which can be beneficial. But, it cannot lead to a diagnosis of sacroiliac arthropathy on its own.

Subjectivity of Physical Examination

The physical examination findings for sacroiliac arthropathy can be subjective. This means they may vary among health care providers.


Different practitioners may have different interpretations of the same examination maneuvers, impacting the diagnostic process.

Coexisting Conditions

Sacroiliac arthropathy can often coexist with other conditions, such as lumbar disc herniation or hip joint pathology. These can complicate the diagnostic process.


These coexisting conditions can contribute to overlapping symptoms. These make it challenging to attribute the symptoms to sacroiliac arthropathy.

How Can Limitations Be Overcome?

Health care providers can use various strategies to overcome these challenges. Here are some approaches:

Comprehensive Evaluation

An accurate diagnosis of sacroiliac arthropathy begins with a thorough evaluation. An experienced health care provider should be the one to oversee this evaluation.


They should conduct an evaluation that considers a combination of factors. This includes:

  • Patient symptoms
  • Medical history
  • Physical examination findings
  • Imaging studies

Using information gathered through various tests can provide a comprehensive picture. This allows a more accurate diagnosis of sacroiliac arthropathy. 

Collaboration and Expertise

In complex cases, health care providers may seek collaboration with specialists such as:

  • Rheumatologists
  • Orthopedic surgeons
  • Pain management specialists

These specialists have expertise in diagnosing and managing musculoskeletal conditions. Utilizing their specialized knowledge can enhance the accuracy of the diagnosis.

Advanced Imaging Techniques

Conventional imaging tests like X-rays, MRIs, or CT scans may not always show abnormalities in the sacroiliac joint. Newer imaging techniques, though, may provide more insights.4


For example, specialized MRI sequences can improve the visualization of the sacroiliac joint. With this, professionals can see inflammation and swelling. This can be beneficial when trying to achieve a diagnosis of sacroiliac arthropathy.

Diagnostic Injections With Guidance

Diagnostic injections include those such as sacroiliac joint injections or provocative tests. These diagnostic tests can help confirm or rule out sacroiliac joint involvement.


Utilizing imaging guidance during the injection procedure can enhance accuracy, increasing the likelihood of a successful diagnostic outcome. Examples of imaging guides include fluoroscopy or ultrasound. 

Longitudinal Assessment

In some cases, a diagnosis of sacroiliac arthropathy may need a longitudinal assessment. A longitudinal assessment involves the repetition of observations. In other words, the health care provider will conduct the same tests and evaluations multiple times to ensure accuracy. 


This assessment also includes monitoring the response to treatment, which can provide further evidence to support the diagnosis. 


This may involve:

  • Follow-up evaluations
  • Repeated imaging studies
  • Observing the response to various therapeutic interventions

Clinical Judgment and Experience

Experienced professionals who have experience with sacroiliac arthropathy can develop a keen judgment. 


Years in the medical field and working with the sacroiliac joint can help develop this experience. This allows them to take into account subtle nuances and individual variations. 


Experience and expertise play a vital role in navigating diagnostic challenges. Both factors play a large role in arriving at an accurate diagnosis.

Diagnosis of Sacroiliac Arthropathy

Learn More About the Diagnosis of Sacroiliac Arthropathy With J. Flowers Health Institute

Are you tired of living with persistent lower back and pelvic pain? At J. Flowers Health Institute, we recognize the challenges of a sacroiliac arthropathy diagnosis and understand that persistent pain can significantly impact your quality of life. 


That’s why our team of healthcare providers is here to help.

With our expertise in musculoskeletal conditions, we are committed to diagnosing and treating your pain. 


Our team of board-certified experts utilizes comprehensive diagnostic tools and methods that ensure an accurate diagnosis of sacroiliac arthropathy. 

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Our Bespoke Diagnostic Evaluations aim to identify the underlying cause of your medical condition and provide guidance toward the most effective treatment options.


At J. Flowers Health Institute, we focus on healing the mind, body, and soul to treat the whole person. Our treatment approach combines various factors and techniques to best understand and treat your condition. 

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Take control of your life and reclaim your comfort. Schedule a consultation with J. Flowers Health Institute today. Discover the expertise and compassionate care that can make a difference. 


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