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Differential Diagnosis
- Vertebral compression fracture
- Pubic rami fracture
- Fused sacroiliac joints
- Tailbone (coccyx) fracture
![Fused sacroiliac joints](https://www.jucm.com/wp-content/uploads/2024/04/04.2024-JUCM-Image-X-ray-2-730x.webp)
Diagnosis
The correct diagnosis is fused sacroiliac joints. On the image above, there is no joint space present in either the left or right sacroiliac joints. This is a chronic condition that results from prolonged inflammation of the sacroiliac joints (sacroiliitis). Common causes for bilateral symmetric sacroiliac joint fusion include: ankylosing spondylitis, inflammatory bowel disease (eg, Crohn’s disease, ulcerative colitis), osteitis condensans ilii, osteoarthritis, Reiter’s symdrome/reactive disease, and rheumatoid arthritis (adult).
What to Look For
- Morning stiffness and pain with symptoms improved during exercise but not rest
- Pain and tenderness overlying the sacroiliac joint regions of the lower back
- Limited range of motion of the lower back
Pearls for Urgent Care Management
- Treatment with nonsteroidal anti-inflammatory medications is first line
- Referral to a rheumatologist for further evaluation of the underlying cause is warranted
Read More
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- Back Pain, An Urgent Care Visit—And A Devastating Outcome
- 47-Year-Old With Left Hip Pain
- A 55-Year-Old Female With Hip Pain
- A 40-Year-Old With Back Pain After A Fall
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38-Year-Old With Pelvic Pain After a Fall
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