Disclosures: Byron Schneider, MD: Nothing to disclose

Case Description: The patient was referred for evaluation of “worst case of sciatica I have seen” by her OBGYN, with a request for epidural steroid injection. Her PMH included chronic left foot pain following trauma. She reported lancinating pain down the right leg into the foot with dysesthesia. Physical exam demonstrated positive seated slump test on the right. MRI was ordered but was normal. Treatment consisted of physical therapy and opioid medication, with minimal relief. She returned to spine clinic 6 weeks post-partum. She continued to report severe pain in right gluteal pain with dysesthesia into the right anterior thigh and intermittently into the shin. Physical exam included positive FABERs on the right, positive right thigh thrust, and positive sacral distraction test. Given normal MRI, post-partum posterior pelvic pain involving the sacroiliac joint complex was suspected. She underwent fluoroscopic guided right sacroiliac joint intra-articular injection with anesthetic and steroid.

Setting: Tertiary Medical Center Spine Clinic

Patient: 36-year-old female, 7 months pregnant.

Assessment/Results: Immediately post injection, she reported 100% pain relief, consistent with diagnosis of sacroiliac joint pain. Unfortunately, she did not have long lasting relief. The injection was repeated with the same response. She subsequently underwent dual controlled right L5 dorsal ramus and S1-3 lateral branch block and then radiofrequency neurotomy, with partial relief of her pain including the dysesthesia in the right leg.

Discussion: In pregnant and post-partum women, posterior pelvic pain is a common cause of low back pain, due to ligamentous laxity. Reported incidence is 33%. This case is unique as it mimicked a disk herniation with pain referred into the foot and presence of dysesthesias.

Conclusion: An understanding of the pathophysiology of pregnancy and pain referral patterns possible with SIJ pain resulted in accurate diagnosis and treatment.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/sacroiliac-joint-complex-pain-mimicking-as-acute-disc-herniation-an-uncommon-presentation-of-common-pathology-during-pregnancy-a-case-report/