Pain Management Physician

Pain that is localized to the low back, hips and buttocks is commonly caused by sacroiliac (SI) joint pain.   SI joint pain commonly radiates to the outside of the thigh, but rarely past the knee.  Stress applied to the joint on physician exam can suggest this as the source of pain, but is very non-specific.  A targeted injection with local anesthetic under fluoroscopic (X-Ray) guidance is really the only way to diagnose SI joint pain.  If the pain is relieved completely after injection, a definitive diagnosis can be made.  The addition of a concentrated low dose of steroid to this injection can provide long-term pain relief.  Other treatment of SI joint Arthropathy involves NSAIDs (Non-Steroidal Anti-inflammatory Drugs), local anesthetic patches (5% Lidocaine, but is off-label), and most importantly physical therapy.  Physical therapy involves gait training (how you walk) and muscle strengthening.  The results of Aquatherapy have been promising.  Radiofrequency treatment of the nerves that supply the SI Joint has also shown some promise as a long-term tratment.

Rare causes of SI joint pain include trauma, infection and tumor involvement.

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Facet arthropathy can affect the cervical, thoracic, and/or lumbar spine.  These small joints, also known as z-joints or zygapophysial joints, can be affected acutely or damaged from chronic wear and tear.  In the low back, these joints can be loaded or stressed by extension and lateral rotation (bending back at the waist and to one side).  If your usual pain is reproduced when making this motion without any leg pain, this is likely pain from your facet joints.  Pain can sometimes radiate to the buttocks and/or thigh, but rarely below the knee. 

In the neck, facet pain is reproduced when laterally flexing the neck (trying to touch your ear to your shoulder), as well as extending the neck (looking upwards).

Each individual joint has two nerves that supply it called medial branches.  These nerves are important in the treatment of facet-mediated pain.  This treatment involves medial branch nerve blocks and radiofrequency nerve ablation.

X-rays and MRIs can sometimes be helpful in diagnosing facet pain, but physical exam and diagnostic medial branch nerve blocks are most accurate.

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