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. 2013 Jul;22(7):1657-64.
doi: 10.1007/s00586-013-2660-5. Epub 2013 Mar 2.

Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis

L H Visser  1 , P G N Nijssen, C C Tijssen, J J van Middendorp, J Schieving
Affiliations

Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis

L H Visser et al. Eur Spine J. 2013 Jul.

Abstract

Purpose: To compare the clinical features of patients with sacroiliac joint (SIJ)-related sciatica-like symptoms to those with sciatica from nerve root compression and to investigate the necessity to perform radiological imaging in patients with sciatica-like symptoms derived from the SIJ.

Methods: Patients with pain radiating below the buttocks with a duration of 4 weeks to 1 year were included. After physical and radiological examinations, a diagnosis of SI joint-related pain, pain due to disk herniation, or a combination of these two causes was made.

Results: Patients with SIJ-related leg pain (n = 77/186) were significantly more often female, had shorter statue, a shorter duration of symptoms, and had more often pain radiating to the groin and a history of a fall on the buttocks. Muscle weakness, corkscrew phenomenon, finger-floor distance ≥25 cm, lumbar scoliosis, positive Bragard or Kemp sign, and positive leg raising test were more often present when radiologic nerve root compression was present. Although these investigations may help, MRI of the spine is necessary to discriminate between the groups.

Conclusions: Sciatica-like symptoms derived from the SIJ can clinically mimic a radiculopathy. We suggest to perform a thorough physical examination of the spine, SI joints, and hips with additional radiological tests to exclude other causes.

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Figures

Fig. 1
Fig. 1
Flow chart of the patient entry, drop-outs, grouping, the initial clinical diagnoses, and for the initial SIJ-related pain group the definite diagnoses after additional laboratory and radiological examinations
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