What Is Sacroiliitis –Buttock Pain?
Sacroiliitis is an underestimated cause of low back and buttock pain. The sacroiliac joint is often presented as low back or buttock pain. The sacroiliac joint is a true joint in the lower portion and a fused joint in the upper region. The joint is made more mobile in certain conditions such as pregnancy on the pelvic floor to accommodate the birthing process. The diagnosis is made by a thorough history and physical examination combined with appropriate imaging studies to rule out other conditions as well as appropriate bloodwork when appropriate.
Differential diagnoses of sacroiliitis include piriformis syndrome, facet arthritis, and causes of sciatica Including lumbar degeneration and herniated discs. Treatment options begin with conservative therapy, physical therapy, anti-inflammatory medication, yoga, chiropractic manipulation, and finally selective injections into the joint. The joint hypermobility can be treated by procedures that fused the sacroiliac joint. Surgical options are rare and are reserved for malignancies or fractures.
Piriformis Syndrome
The piriformis is a muscle loaded in the buttock region of the lower extremity. Along with five other muscles, it forms the lateral rotator group.
This essentially means that the muscle helps to turn the upper thigh outwards.
The piriformis sits in a very strategic area cutting across above the largest nerve in the body, the sciatic nerve.
Irritation of the piriformis can manifest either as localized pain in the buttock area that’s worsened with walking and sitting and turning the thigh inwards or it can manifest as a shooting pain going down the leg. The second symptom classically happens because the piriformis when inflamed can also cause inflammation of the underlying sciatic nerve.
After the diagnosis is made, the treatment options can include physical therapy anti-inflammatory medications either by mouth or topically applied, ice and/or heat therapy, therapeutic ultrasound and stretching, and even yoga.
When these conservative therapies are ineffective, the next option is to try and inject the muscle and reduce some of the spasms and inflammation.
The procedure is often done either under ultrasound guidance or fluoroscopic x-ray guidance. The latter method relies on a fluoroscope and injected x-ray ink also called contrast to identify the picture of the piriformis muscle appearing as striations.
Ultrasound guidance is another unique localizing technique and has some advantages, and there is no radiation.
Regardless of the technique once the muscle is identified a small amount of steroid mixed with a combination of local anesthetics is injected into the muscle and often provides immediate relief.
Recovery is rapid although on occasion patients may feel numbness down the leg, which can happen in some of the local anesthetics spills onto the underlying sciatic nerve.
Postinjection ice is often the next day followed by gentle stretching and resumption of physical therapy.
