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Negative Lumbar Exam
Negative Hip Exam
Provocation Testing
Intra-articular Sacroiliac Joint Injection
Radiographic Imaging
Causes for Sacroiliac Joint Injury
Sacroiliac Joint Arthritis
Sciatica and the Sacroiliac Joint: A Forgotten Concept
Questions & Answers With Dr. Amish Patel
Low Back Pain's Missing Piece
Sacroiliac Joint Fusion

Diagnosis of Sacroiliac Joint Pain


When diagnosing most musculoskeletal conditions, the workup includes a history and physical examination, imaging studies, and possibly a selective injection. The gold standard for diagnosis of Sacroiliac pathology is an image-guided intra-articular injection of local anesthetic, though some additional diagnostic components should be determined before proceeding with a diagnostic injection:

  • Positive history
  • Negative lumbar and hip examinations, and
  • Positive provocation testing

Sacroiliac Joint Diagnosis: Patient History

Mechanism of Injury

Traumatic onset is the most common etiology of sacroiliac joint injury, such as:

  • Slip and fall onto one buttock
  • Motor vehicle accident
  • Lift and twist motion
  • Childbirth

Sacroiliac joint pain can also have a gradual onset as a result of:

  • Lumbar or lumbosacral spinal fusion
  • Sustained abnormal biomechanics, e.g., muscle imbalance
  • Structural abnormality, e.g., scoliosis
  • Pregnancy
  • Infection
  • Degenerative or inflammatory arthritis

Aggravating Factors

Activities that exacerbate the complaint of pain can include:

  • Prolonged sitting or standing
  • Single leg weight bearing: donning socks, stairs
  • Transitional motions: walking, sit-to-stand motion, rolling over in bed
  • Sexual intercourse

Pain Location

The location of pain can also be indicative of an sacroiliac joint problem. The primary pain referral patterns for the sacroiliac joint are below L5 and over the ipsilateral posterior superior iliac spine (PSIS); pain will typically not be midline or superior to the sacrum. The Fortin Finger test can be an accurate diagnostic indicator of pain generated by the sacroiliac joint. A positive Fortin test is demonstrated if the patient can localize the pain with one finger, the area pointed to is immediately inferomedial to the PSIS within one cm, and the patient consistently points to the same area over at least two trials.1  

Pain Location
Pain Location

Secondary referral patterns are to the hip, groin, posterior-lateral thigh, and occasionally the posterior-lateral calf.2 In general, the distribution of sacroiliac joint pain is:

  • 60% at PSIS
  • 40% hip/flank3

Next page: Lumbar Exam

Learn more:
Sacroiliac Joint Anatomy
Sacroiliac Joint Treatment Options
Watch: Low Back Pain's Missing Piece


  1. Fortin JD, Falco FJE. The Fortin Finger Test: an indicator of sacroiliac pain. Am J of Orthopedics 1997; 24(7):477-480.

  2. Fortin JD et al. Sacroilliac joint pain, referral maps upon applying a new injection technique. Spine 1994;Jul1;(19)13:1483-9.

  3. Fortin JD et al. Sacroilliac joint: Pain referral maps upon applying a new injection/arthrography technique. Spine 1994;Jul1;(19)13:1475-82.









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