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You are seeing a 12 year old boy with pain in his lower back and right buttock for 2 weeks. He is an active soccer player. On exam, he has tenderness over his right sacroiliac joint.
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November 7, 2023 at 11:19 am
D) Etiologies include sports overuse injuries, ankylosing spondylitis, psoriatic arthritis, and pyogenic arthritis
Sacroiliitis is inflammation of the sacroiliac joint. Causes include those listed in answer D, plus pregnancy, hyperparathyroidism, Behcet disease, et. al. When sports-related, it is most associated with repetitive or asymmetric loading (kicking, swinging, throwing, single leg stance). High risk sports include: basketball, weightlifting, gymnastics, golf, cross-country skiing, and rowing. The mechanism of injury described in answer A is associated with pelvic avulsion fractures. FABER test – reproduced pain with Flexing, Abducting, and Externally Rotating the hip, is often positive, while straight-leg-raise is negative. Pain is maximal over the lower back and ipsilateral buttock, and tenderness occurs at the SI joint. Sacroiliitis is more common in teens and young adults than in young children.