The Relationship between Hip, Sacroiliac and Low Back Pain – Preventing Unnecessary SI Fusions

Hip pain, sacroiliac (SI) joint and low back pain can be intrinsically related.  Previously, I had blogged about distinguishing hip pain from true sacroiliac pain. In light of an increasing number of people going under the knife to fuse their SI joints with the sacroiliac implant iFuse® (an estimated 5,000 people in the United States in 2013), I want to revisit the topic. I want to try to answer the question when SI fusions are warranted and what patients should know.

Iliopsoas Impingement as a Unique Cause of Hip Labral Tears

We know that bony lesions of the femoral head-neck junction (CAM impingement) and of the hip socket (pincer impingement) can cause labral tears. We also know that impingement of the iliopsoas tendon on the acetabular labrum is fairly common in patients with hip impingement (femoroacetabular impingement, FAI). Therefore a partial release, or tenotomy, of the psoas tendon is often performed during hip arthroscopy. Some physicians now say that, in some cases, psoas impingement in itself – without bony impingement – may be the cause of tears of the labrum.