Dear editor
We read with great interest the article entitled “Accuracy of the Diagnostic Tests of Sacroiliac Joint Dysfunction” by Parisa Nejati et al published in the Journal of Chiropractic Medicine in September 2020.1 The authors examined the reliability and validity of motion palpation and pain provocation maneuvers versus sacroiliac joint block. The presented data are thorough and the statistical analysis is appealing. In their inclusion criteria, the authors considered patients with suspected sacroiliac pathology as those who have at least two positive results on pain provocation tests. This, in our point of view, narrows the diagnostic yield while excluding some patients who would potentially benefit from sacroiliac joint block.
According to the International Association for the Study of Pain criteria, sacroiliac block is considered a mandatory criterion for sacroiliac joint dysfunction.2 Differential diagnoses of sacroiliac joint dysfunction are ankylosing spondylitis, lumbar radicular pain, lumbar facetogenic pain, piriformis syndrome, myofascial pain, and hip pain that is only reduced by blocking the sacroiliac joint when this joint is involved. Therefore, any individual with suspected sacroiliac pathology should initially receive a diagnostic injection into the sacroiliac joint, because the pathology may be inside or outside the joint.3 Intra-articular injection of 1.5-2 mL local anesthetic into sacroiliac joint has therapeutic and diagnostic aspects. It has been widely cited in the literature that intra-articular injection of local anesthetic is the definitive test for sacroiliac joint pain.3 Consequently, sacroiliac joint block with a low dose of local anesthetic provides good evidence for diagnosing joint pain in different studies.4
The true anteroposterior C-ARM view can be used to guide the needle to penetrate the intra-articular space and confirm it by injecting contrast material, then perform the intra-articular injection of local anaesthetic.5 In brief, we would like to highlight the fact that a sacroiliac block could be an initial conclusive pathway both diagnostically and therapeutically to pursue for patients with relevant signs and symptoms rather than advanced high-cost imaging studies and various clinical tests and provocation maneuvers that still lack sufficient sensitivity and specificity.
References
- 1.Nejati P, Sartaj E, Imani F, et al. Accuracy of the diagnostic tests of sacroiliac joint dysfunction. J Chiropr Med. 2020;19(1):27–38. doi: 10.1016/j.jcm.2019.12.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Van Zundert J, Patijn J, Hartrick C, et al. John Wiley & Sons; Chichester, UK: 2011. Evidence-Based Interventional Pain Medicine: According to Clinical Diagnoses. [DOI] [PubMed] [Google Scholar]
- 3.Ballantyne JC, Fishman SM, Rathmell JP. Lippincott Williams & Wilkins; Philadelphia, PA: 2018. Bonica's Management of Pain. [Google Scholar]
- 4.Manchikanti L, Kaye AD, Falco FJ, et al. Springer; Cham, Switzerland: 2018. Essentials of Interventional Techniques in Managing Chronic Pain. [Google Scholar]
- 5.Taheri A, Lajevardi M, Abad M, et al. Sacroiliac joint intraarticular injection in true anteroposterior view: description of a new C-Arm guided method. Pain Physician. 2018;21(1) 66-61. [PubMed] [Google Scholar]