SI trauma--question about diagnostic testing

[rubytuesday55]

My SI was traumatized when as a pedestrian I was struck by a moving car at a fairly high rate of speed in my SI in 2004. I had a sacral torsion and hairline fx of the pelvis on that side, along with full body whiplash and huge hematoma in that region and on the upper thoracic spine. I also had seen a gynecologist (within months of the accident) who referred me to a urogynecologist 4 years after the accident, and each told me there was damage to the ligaments in the pelvis.  I underwent several bouts of physical therapy over the years, whereby my pelvis must be realigned manually. In addition I receive some sort of steroid/antiinflammatory agent in the SI joint by my orthopede. The pain never goes completly away and I suffer from it 24 hours/day but cannot take NSAIDS (due to allergies/asthma) and do not like the drowsiness/detachment sensation with other medication trials used. I have never had an MRI of the SI to this day and my orthopede does not think it would be valuable. Having osteopenia, osteoarthritis, and fibromyalgia (in addition to the SI trauma), rather than pursue another painful course of therapy, I would think it might be useful for me to know if the pain is stemming from physical anatomical problems or something such as pain perception from the fibro--or even if there is something that might benefit from a surgical correction of some sort. Would there be any value to checking an MRI after such trauma? Thank you for your response.

[Tuckamore]

You are in a difficult situation and my heart goes out to you. Most Physicians and many Ortho's dismiss SIJ as a causation for severe pain. However the more educated ones, some even specialize, do recognize the debilitating pain that SIJD can bring.

I understand the "small town" comradery that often exists among the medical community. It's a crying shame when it effects patient care. It was a new to the area physician that made my DX. She went out on a limb and stuck to her opinion that I had SIJD. She is a DO and made the initial DX with a clinical examination. It also "showed" on a x-ray but it just revealed an abnormality of the SIJ. Later she referred me to a large city anesthesiologist for the diagnostic injection which as you know is the recognized diagnostic procedure.

I am unclear as to exactly what can be revealed with a fluoroscopy. All I know is that immediately following the procedure the anesthesiologist came to my recover area and told my husband, "Your wife has a really bad SIJ." My husband knows the physician personally and it was his understanding the physician "saw" a bad SIJ during the fluoroscopy procedure.  

As I said I have been told the SIJ does not show up well on an MRI but as you know, other structures do. One has never been utilized to view or DX my SIJ though I have had several for supporting structures and additional diagnostic reasons.  

I encourage you to seek an outside opinion, no matter what the cost. Normally SIJs don't heal on their own. It has been my experience that they continue to worsen, especially when not treated promptly and correctly.

I wish you the very best.  Be assertive. It's a tough road.

Take Care,
~Tuck

[rubytuesday55]

With my sacroiliac inflammation, the small of my back on the side I was hit is always very, very tender, throbs, and sometimes has the sensation of somebody jabbing me there with an ice pick. The buttock on the same side is equally very tender (like a very bad bruise) and the muscles, very tight--to the point that they pull on my pelvis, taking it out of alignment. When things get really bad, the back pain radiates to my groin and into the front of my thigh--almost to my knee. Any bending, squatting, stretching seem to make the inflammation worse, I cannot tolerate sitting upright (especially in hard chairs and church pews) for any length of time and lying on my back is painful to me, too. I cannot stand very long without the strain causing more pain in the area. The ortho tells me the SI is part of the hip but since I feel the pain in the small of my back (around where the kidney would be), I relate it more to the back than the hip. I have weakness in that hip, though, and have fallen with the leg just giving out on me without warning. My physical therapists have repeatedly done maneuvers to try to 'release' the muscles in the buttocks but have never been 100% successful since the onset. I do know the pain worsens when I need the pelvis realigned, but the time and expense of repeated visits with no long term or lasting results is so discouraging. I hope that I may have answered some of your questions. Everybody is different, so what I experience may not be identical to what everybody else feels. There are so many individual variances that factor into peoples perceptions and responses. Good luck with your condition.
Ruby

[rubytuesday55]

Thank you, Tuck. I have read similar literature that suggests even injecions are just measures designed for temporary relief (if any). I have read similar literature about surgical intervention. The courses of repeated physical therapy become very expensive with co-pays and deductibles on the rise. And they are very painful. I cannot take pain medication beforehand and trust myself to drive. Of course, then with the fibro, therapy seems to make the inflammation worse. I had seen a rheume who specializes in fibro and he indicated that I walk a fine line between activity that would not increase inflammation. I do my exercises (not aggressive, but 35 min./day) religiously for the fibro and arthritis and to try to gently stretch the SI but other than that, I am done. I pace my activities and pay the price for several days following just basic housework. My ortho has been doing the SI injections in his office. He said since I am so small (about 100 lbs), he can easily get into my joint. With the minimal response with this last one, he did set me up with an interventional radiologist who will be injecting the SI (I am assuming under fluroscopy?). Am I to understand that he will be able to see if there is something structurally deviant when he views the site performing the test? Do you know, do they send a report to the referring doctor? It would be nice to finally at least perhaps get an answer, and even more, some longer term relief. I am very nervous about getting the procedure since my husband had this done about a year ago and he lost consciousness during his procedure (blood pressure bottomed out that the doctor speculated was 'vasovagal' response). I have weakness in the SI joint and I fear the pressure that I may feel may give me the sense that I will lose control of bodily function. Also I am on medication because  run low blood pressure and with that happening to my husband, I hope I don't pass out on them. I do know they insert an IV so that the blood pressure can be brought up quickly with trendelenburg and IV fluids, so I know I will be alright but the loss of control is frightening. After 6 years of living with this pain, every minute of every day, I suppose that for now, the injections seem to be 'the treatment of choice'. We live i a rural area where specialists and options are rather limited--because of the economy, many health professionals have abandon our community and our hospital sold out to some company to salvage it.

[rubytuesday55]

Thank you for your response. I asked my ortho 2 years after the accident about checking an MRI (2006) but he said there would be no value. Anticipating the same response (here in 2010), I tried going through the 'back door' by asking my PCP about ordering one since the SI injections didn't work the last 2-3 times. She defers all/any ortho issue to my orthopede (who is retiring in a year or two). I did ask my ortho again and he declined, but did schedule me for an interventional radiologic injection of the SI. I have read that MRIs may not be the technology of choice for the SI, but none of my health care professionals seem to suggest anything other than therapy (which I've done time and time again and SI injections, and realigning the pelvis.

[rubytuesday55]

Thank you for your respnse. I had initial x-rays immediately upon the injury but I had a very extensive and pronounced hematoma that I am sure would have obscured the details. I asked my ortho for an MRI 2 years later, in 2006 and he saw no benefit of ordering. I asked my PCP if she woul order one for me a couple of weeks ago, but she defers all such matters to my ortho. My ortho still declines my request to check an MRI or CT scan. He injects the SI periodically but since the last 2-3 were of little effect, he has scheduled me to have an interventional radiologist inject the SI joint. I have bone densities every 2 years and the osteopenia worsens minimally with the Actonel, calcium and vitamin D. I have tried Cymbalta and Lyrica, but these seem to make me excessively drowsy through the day, despite adjusting dosages and schedules. Neither really took the pain away. I refuse to succumb to narcotics, so I forge through the pain at least enough to do my daily exercise for the fibro and arthritis. I have to pace my activities and settle with whatever I can accomplish as a success, but then I am toast. It's quite discouraging. In our rural area, there are only 2 (tight knit) orthos, so if mine wouldn't get the MRI, I would anticipate the other ortho being loyal to my ortho and likewise decline my request. Riding far away to the biggr groups of specialists isn't really an option for me since riding in a vehicle is so painful for me and I would anticipate repeated trips for follow-ups.

[littleone536]

I had suffered from a very bad fall at work and I was only seeing a chiropractor and went to thearpy.(per my works instructions)
Last week I had an MRI because the pain is the same and is not going away.
My doctor thinks I may have a rupture disc
But I have also been told I have signs of damage to my SI. but this was from my chiropractor.
What are the symptoms?. I dont even know what a SI joint is.
The side of my left butt hurts all the time and it travels down it. Some times when the chiropractor pushed down on my left buttucks then I would get releif.

[optimus22mac]

A few years ago, I fell down stairs and crushed my tailbone...and the MRI showed that...and a few years later, I had surgery to remove the damaged part of my coccyx.  Post surgery, my pain was still excruciating--even a year after, so another MRI was ordered which showed the permanent damage to my SIJ.  When I asked another doctor why the surgeon did not see the SIJ before my surgery, I was told that it is difficult to see on MRI sometimes, and easier on an X-ray.  I'm just telling you because YES, an MRI eventually showed my damage, but it is generally hard to determine from an MRI (according to one of my doctors)...so I do think you could try to get an MRI, but if it shows nothing, be ready for that possibility...though your injuries are different and may show up more easily.

It is a very painful condition to live with...both of my SIJ are "jarred" out of place and inflamed, and it is very very painful every day of my life, so I am very sympathetic to your situation:(  I would definitely ask for an MRI...so you can understand more about your condition.  Is it your surgeon who doesn't think it would be worth it? Would your PCP order one for you?

My case is also similar to yours for another reason....I am waiting for a surgery w/ my GYN...or with a Urogynecologist...during my surgery to remove my coccyx, all of my pelvic organs prolapsed---uterus, bladder, rectum, intestine... So I am waiting to be cleared for that surgery to put everything back where it belongs....

Keep us posted, and I am here if you ever want to message me:)
My name is Alison btw:)

[mema444]

Many things could have changed since 2004 and yes a MRI could help emensly or CT scan  there could be changes that have happened to that area hurt in 2004  the fibro and other problems complicate what is going on because some of the symptoms could be from them  A MRI could be benefical to you to help you know what is going on   and relieve your worries hopefully   good luck to you

[mkh9]

Hi,
I am sorry you are going through all this. It sounds very painful. The PT thought I had pelvic misalignment two and SI joint involvement but I don't think I do. Both PT's injured me doing manual manipulation of the SI joint and the pelvis. I was in so much pain I did succumb to pain meds for the first time in my life. Anyway, on the one had you will probably not see the SI joint in or out but you probably would see the pelvis if it was out on the MRI. You may also find other things and a torn ligament usually shows up too. I really think you need to get one.  I don't agree with the doctor that doesn't see utility in it. Though, sometimes when you see things on an MRI it may have been there all the time and not causing the problem. In your case I believe you should get it to see what is going on after that big accident. Ligaments take about 4-6 months to heal.  But try (unlike what I did) to start walking if you are not and doing daily activities. I am very stiff and weak from inactivity due to pain and very sorry I didn't do something about it sooner. Get the MRI first then go from there. Did they at least get Xrays?
Have you had a bone density test lately to check on your osteopenia etc?  Have you tried Cymbalta for the Fibro? It is now approved for low back pain too and of course depression. I do worry about the side effects of all these druugs and withdrawal. but sometimes it is needed.
take care,
mkh9