Sacroiliac joint

Last revised by Joshua Yap on 16 Jul 2022

The sacroiliac joint (SIJ) is a synovial joint between ilium and the sacrum. It has little movement and its main function is to transfer weight between the axial and lower appendicular skeletons. The sacroiliac joint is a symmetrical joint (i.e. is paired) with an oblique coronal orientation and is located at the S1-3 level 1-3.

The sacroiliac joint is formed by the irregularly-shaped (jagged) articular surfaces of the sacrum and the ilium, which provide some strength to the joint 1,2. The upper one-third is a syndesmosis. The lower two-thirds are lined by articular cartilage, although only the lower third is lined by synovium, while the middle third resembles a symphysis. The iliac auricular surfaces are lined by fibrocartilage, while the sacral auricular surfaces are covered with hyaline cartilage.

Movement and stability are also conferred by a few muscles 3:

Being a synovial joint it is surrounded by a capsule. Stability is conferred by the irregular articular surfaces but is actually mainly through extracapsular ligaments 1,2. Ligaments and joints complete the greater and lesser sciatic foramina. 

  • interosseous sacroiliac ligament: from iliac tuberosity to the sacral tuberosity; located posteriorly; thick and strong; fills the space behind the joint
  • anterior sacroiliac ligament
  • posterior sacroiliac ligament: located superficial to the interosseous sacroiliac ligament
  • iliolumbar ligament
    • shaped like a V lying sideways, the apex of the V is attached to the transverse process of the L5 vertebra
    • the upper band passes to join the iliac crest and the lower band passes to join the front of the anterior sacroiliac ligament
  • sacrospinous ligament
  • sacrotuberous ligament

Primarily anteriorly:

The posterior rami of the spinal nerves and vessels pass between the interosseous and dorsal ligaments. 

Movement at the sacroiliac joint is minimal and is limited to gliding and rotation. Most movement is experienced during pregnancy due to the laxity of ligaments and the joint typically fuses after the age of 50 years 1,2

  • via iliac and lumbar nodes

Via branches from the lumbar and sacral plexuses 3:

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Cases and figures

  • Figure 1: pelvic ligaments (Gray's illustrations)
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  • Case 1: normal plain X-ray appearance
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  • Case 2: normal CT appearance
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  • Case 3: normal MR appearance in adults
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  • Case 4: accessory sacroiliac joints
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  • Case 5: sacroiliac joint injection (CT guided)
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  • Case 6: normal MR appearance in pediatrics
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