By Chris Faubel, M.D.
ICD-9 code
- 846.0 “Sprains and strains of sacroiliac region, lumbosacral (joint)(ligament), or
- 846.1 “Sprains and strains of sacroiliac region, sacroiliac (ligament)
Cause
- Soft tissue injury to the iliac insertion of the ligament.
- Can be from direct trauma, a fall in which the ligament is pulled at that iliac crest insertion site, or a lifting injury
Location of the ligament
- Located typically 1-inch cephalad and 1-inch lateral from the ipsilateral posterior superior iliac spine (PSIS)
Presentation
- Usually chronic or recurring, unilateral low back pain with a tender point at the posterior iliac crest
- The patient points to the most painful spot, which is lateral to the more midline facets.
- Worse with prolonged sitting or standing
Physical Exam
- Said to be frequently painful with the FABERs/Patrick test, though I have not seen this.
- Tender point(s) along the posterior iliac crest — must cause concordant low back pain when pressed, otherwise it is just soft tissue pain from overzealous pressure by the examiner.
- NOT painful with facet loading (as facetogenic pain would be)
Treatment
- Acute cases may resolve with relative rest, ice, and analgesics.
- Friction massage along the ligament may also be tried (see video link here)
- Chronic cases frequently need injections of local anesthetic (and sometimes steroid) along that posterior iliac crest. (INJECTION TECHNIQUE HERE)
Best done under fluoroscopic-guidance so the crest can be visualized and you can ensure an even distribution of injection sites.
