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Differential Diagnosis

  • Vertebral compression fracture
  • Pubic rami fracture
  • Fused sacroiliac joints
  • Tailbone (coccyx) fracture
Fused sacroiliac joints

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

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