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The Sacroiliac Joint Can Be A Pain In The Gut - Page #1
 

Author: Mary Swinton, DO
Co Author #1: Bridget Caulkins, MD
Co Author #2: Carlton Covey, MD
Senior Editor: Christian Fulmer, DO, FAMSSM
Editor: Michael Peyton, MD

Patient Presentation:
The patient was a 24-year-old male who presented for evaluation of right-sided low back pain localized near the sacroiliac (SI) joint. His past medical history was significant for a Grade 4B femoral neck stress fracture (compression side) in 2021 and a Grade 4B iliac stress fracture in March 2024.

History:
The patient was a long-distance runner who had participated in a 5-mile training race approximately 2 weeks prior to presentation, which coincided with the onset of symptoms. Following the race, the pain became severe and disrupted his sleep at night. Prior to this event, he had been pain-free and had been running approximately 25 miles per week. The pain improved after he stopped running 1 week prior to presentation but remained noticeable as a dull ache during prolonged walking. He denied any additional medical history and was not taking any medications.

Physical Exam:
Vital signs were not assessed. Subjectively, the patient appeared afebrile and well appearing with a body mass index (BMI) of 22 kg/m².

Physical examination demonstrated a slight antalgic gait but was otherwise unremarkable on inspection. He had point tenderness over the right SI joint. There was no tenderness over the gluteus medius insertion or deep gluteal region. Hip range of motion was symmetric bilaterally and pain free. The SI joint compression test was negative.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

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