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Long Island Sacroiliac Joint
Injury Lawyer

SI joint injuries from car accidents are routinely misdiagnosed as lumbar disc disease. Proving these injuries requires fluoroscopic diagnostic injections, STIR-sequence MRI, and a treating physician who understands the \u00a75102(d) threshold. We know exactly how to build that record. No fee unless we win.

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Sacroiliac joint injuries from car accidents — SI joint sprains, ligament tears, and SI joint dysfunction — must satisfy New York Insurance Law §5102(d)’s serious injury threshold to support a pain and suffering claim. These injuries are frequently misdiagnosed as lumbar radiculopathy. The gold standard for objective diagnostic confirmation is a fluoroscopic-guided SI joint injection: greater than 75% pain relief confirms the SI joint as the pain generator. STIR-sequence MRI identifies ligamentous edema and bony injury; EMG rules out competing radiculopathy. Treatment escalates from physical therapy and corticosteroid injections through prolotherapy, PRP, radiofrequency ablation, and ultimately SI joint fusion surgery (iFuse titanium implants or SImmetry system) for refractory cases. See our main Long Island car accident lawyer page for full PI overview.

Last updated: April 2026 · Every case is unique — these ranges reflect general New York outcomes and are not guarantees.

SI Joint Injury Cases We Handle

What Type of Sacroiliac Joint Injury Do You Have?

SI Joint Sprain / Ligament Tear

SI Joint Dysfunction (Sacroiliac Instability)

Iliosacral / Sacroiliac Ligament Complex Injury

Posterior SI Joint Capsule Disruption

SI Joint Fusion (iFuse / SImmetry) Cases

Permanent Consequential Limitation (§5102(d))

Results That Matter

SI Joint Case Results

$925K

SI Joint Fusion Surgery (iFuse) + Permanent Disability

Rear-end collision on the LIE caused sacroiliac joint ligament complex disruption confirmed by fluoroscopic-guided diagnostic SI joint injection (greater than 75% pain relief) and STIR-sequence MRI showing bone edema at the right iliac surface; plaintiff underwent bilateral SI joint fusion with iFuse titanium implants after failed conservative care; treating orthopedist documented permanent consequential limitation of use of the sacroiliac joint under §5102(d); plaintiff, a 47-year-old delivery driver, unable to return to occupation

$685K

SI Joint Dysfunction + Radiofrequency Ablation

T-bone collision at a Nassau County intersection caused left SI joint sprain with positive FABER, Gaenslen’s, and thigh thrust provocative tests; fluoroscopic diagnostic injection confirmed SI joint pain source; lateral branch blocks followed by radiofrequency ablation achieved 70% sustained relief; treating pain management physician documented significant limitation satisfying §5102(d); EMG ruled out L5 radiculopathy as alternative diagnosis

$485K

Sacroiliac Ligament Tear + PRP and Prolotherapy

Side-impact collision caused right iliosacral ligament complex injury; MRI STIR sequence showed ligament edema at the posterior SI joint; plaintiff treated with prolotherapy followed by platelet-rich plasma (PRP) injections; physiatrist documented permanent restriction in prolonged sitting and stair use; positive Patrick’s test and asymmetric pelvic mobility on successive examinations satisfied the significant limitation threshold under §5102(d)

$295K

Bilateral SI Joint Sprain + Corticosteroid Injection Series

Rollover accident caused bilateral sacroiliac joint sprain; CT scan showed no fracture but sacral sulcus tenderness and positive FADIR bilaterally; fluoroscopic-guided bilateral SI joint corticosteroid injections provided partial relief; treating orthopedist documented 35% loss of pelvic range of motion satisfying §5102(d) significant limitation; plaintiff, a 39-year-old nurse, required permanent work modification limiting patient transfers

$185K

SI Joint Sprain + 90/180-Day Category

Rear-end collision caused sacroiliac joint sprain with positive Gaenslen’s and sacral thrust tests; treating physiatrist documented inability to perform substantially all usual and customary daily activities for 110 days within the first 180 days post-accident; employer absence records and treating physician restrictions corroborated the 90/180-day category; physical therapy and SI joint injection over 5 months

$110K

Unilateral SI Joint Sprain + Conservative Treatment

Rear-end collision caused right-sided sacroiliac joint sprain; physiatrist documented positive FABER and Patrick’s test on successive examinations and measured 20% restriction in hip external rotation satisfying §5102(d); gap-in-treatment defense defeated by treating physician testimony explaining treatment interruption due to no-fault IME cutoff; physical therapy course of 4 months

Past results do not guarantee a similar outcome. Each case is unique.

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Why Tenenbaum Law for SI Joint Cases

Proving SI Joint Injuries Under New York’s Serious Injury Threshold

Sacroiliac joint cases are among the most technically demanding personal injury claims on Long Island. The injury is frequently invisible on standard lumbar spine MRI, the diagnosis requires a pain management physician with interventional SI joint expertise, and the defense will inevitably argue that the plaintiff’s symptoms are explained by pre-existing lumbar disc disease rather than a traumatic SI joint injury. Jason Tenenbaum has spent 24 years litigating exactly these cases — working with treating physiatrists and pain management physicians to build the fluoroscopic injection record, the STIR-sequence MRI evidence, and the provocative test documentation that satisfies New York’s §5102(d) threshold.

§5102(d) Threshold — Permanent Consequential Limitation of the SI Joint

The sacroiliac joint is a body member within the meaning of §5102(d). Permanent consequential limitation of use of the SI joint — documented by treating orthopedist or pain management physician with goniometric hip and pelvic ROM measurements on successive examinations — satisfies the threshold. Significant limitation of pelvic function also qualifies.

Fluoroscopic Injection Confirmation — the Objective Gold Standard

Greater than 75% pain relief on diagnostic fluoroscopic SI joint injection is the objective confirmation courts require. This finding, documented in the treating physician’s procedural note, distinguishes SI joint dysfunction from lumbar disc pathology and satisfies the Toure objective evidence standard.

SI Joint Fusion Surgery Cases — iFuse and SImmetry

When SI joint dysfunction is refractory to conservative and interventional treatment, fusion surgery with iFuse titanium implants or the SImmetry system is the definitive treatment. SI joint fusion cases represent the highest-value SI joint claims and require experienced legal representation that understands the surgical indications and the post-surgical prognosis.

SI Joint Injury: Accident Mechanisms

The sacroiliac joint is uniquely vulnerable to injury in motor vehicle accidents because of the shear and torsional forces transmitted through the pelvis at impact. Three accident mechanisms are particularly associated with traumatic SI joint injury:

Rear-end collision: The most common mechanism. The posterior shear force transmitted through the pelvis when the vehicle is struck from behind creates a posteriorly directed translational force on the sacrum relative to the iliac bones, stressing the posterior SI joint ligament complex and the iliosacral ligament.
Side impact (T-bone): Lateral force applied to the pelvis through the car door and seat creates asymmetric loading of the SI joints, with compressive force on the impacted side and tensile distraction on the contralateral side. This can cause unilateral SI joint capsule disruption and posterior ligament injury.
Rollover accident: Multi-directional forces during a rollover load the SI joint in multiple planes sequentially, creating the potential for posterior capsule disruption, ligament complex tearing, and, in severe cases, partial sacral avulsion injury visible on STIR MRI.

SI Joint vs. Disc Herniation — Critical Distinction

SI joint pain is typically below L5, unilateral, localized to the posterior pelvis and buttock (Fortin point), and aggravated by prolonged sitting, standing, and stair climbing. It does NOT produce dermatomal leg pain below the knee, does NOT cause reflex changes or motor weakness, and is NOT accompanied by positive EMG findings.

Lumbar disc herniation with radiculopathy produces dermatomal leg pain extending below the knee, positive straight leg raise, reflex asymmetry, and positive EMG. EMG to rule out radiculopathy is an essential step in SI joint case documentation — a negative EMG in the context of positive SI joint provocative tests and a positive diagnostic injection strengthens the SI joint injury claim.

SI Joint Injuries Under New York Insurance Law §5102(d)

New York Insurance Law §5102(d) requires that a plaintiff in a car accident case establish a "serious injury" to recover non-economic damages for pain and suffering. For sacroiliac joint injuries, the applicable threshold categories are permanent consequential limitation of use of a body organ or member (the SI joint is a body member), significant limitation of use of a body function or system (pelvic stabilization and ambulatory function), and the 90/180-day category for cases where the SI joint injury caused the plaintiff to be unable to perform substantially all usual and customary daily activities for not less than 90 days within the first 180 days post-accident.

The Court of Appeals established in Toure v. Avis Rent A Car System, 98 N.Y.2d 345 (2002) that objective medical evidence is required to satisfy the threshold — subjective complaints of pain are not sufficient. For SI joint cases, the objective evidence record must include: (1) positive provocative test findings documented at successive clinical examinations (FABER, FADIR, Gaenslen’s, thigh thrust, Patrick’s test); (2) fluoroscopic-guided diagnostic SI joint injection result, with the specific percentage of pain relief documented in the procedural note; (3) STIR-sequence MRI findings of ligamentous edema, bone marrow edema, or posterior capsular injury at the SI joint; (4) CT scan if bony erosion or sacral fracture is suspected; (5) EMG/NCV to rule out L5 or S1 radiculopathy; and (6) the treating orthopedist or pain management physician’s opinion of permanence and causation.

The pre-existing degeneration defense — arguing that SI joint findings represent degenerative sacroiliac arthropathy rather than traumatic injury — is addressed by the treating physician’s documentation of the plaintiff’s pre-accident asymptomatic status and the temporal relationship between the accident mechanism and symptom onset. STIR-sequence MRI is particularly important in this context because acute bone marrow edema and ligamentous signal change are time-sensitive findings that reflect recent injury rather than chronic degeneration.

Damages in SI Joint Car Accident Cases

Economic damages in SI joint injury cases include: past and future medical expenses for interventional pain management (fluoroscopic injections, lateral branch blocks, radiofrequency ablation, prolotherapy, PRP injections); SI joint fusion surgery costs (iFuse or SImmetry system, surgical facility, anesthesia, post-surgical physical therapy rehabilitation); physical therapy and chiropractic care; lost wages during the treatment and recovery period; and future lost earning capacity if the permanent SI joint injury prevents the plaintiff from returning to their prior occupation or requires permanent work modification. Non-economic damages for pain and suffering — the subjective experience of chronic unilateral pelvic pain, restriction of daily activities, and permanent limitation in ambulation, sitting, and physical activity — are recoverable once the §5102(d) threshold is satisfied and are the primary driver of settlement value in significant SI joint injury cases. See our Long Island car accident lawyer page for a complete overview of the personal injury claims process on Long Island.

Related practice areas: Car Accident Lawyer • Disc Herniation Lawyer • Spinal Cord Injury Lawyer • Soft Tissue Injury Lawyer • Hip Injury Lawyer • Personal Injury

Sacroiliac Joint Case Questions

Answers You Need Right Now

How do doctors diagnose a sacroiliac joint injury after a car accident?

Diagnosing a sacroiliac (SI) joint injury after a car accident requires a combination of provocative clinical testing and interventional diagnostic procedures. On physical examination, the treating orthopedist or pain management physician will perform a battery of provocative tests specifically designed to stress the SI joint: the FABER test (Flexion-ABduction-External Rotation, also called Patrick’s test) assesses hip and SI joint range of motion; the FADIR test (Flexion-ADduction-Internal Rotation) helps rule out hip pathology; Gaenslen’s test applies torsional stress to the SI joint with the patient supine and one leg hanging off the table; the thigh thrust test applies a posteriorly directed force through the femur; and the sacral thrust test loads the sacrum directly. A positive result on three or more of these provocative tests has strong diagnostic specificity for SI joint pain. Imaging is used to support the diagnosis and rule out competing pathology. CT scan identifies bony changes, fractures, and erosive arthropathy at the SI joint. MRI with STIR (Short Tau Inversion Recovery) sequence is the most sensitive modality for detecting bone marrow edema, ligamentous injury, and inflammatory changes at the SI joint surfaces — these findings on STIR-sequence MRI can confirm acute ligamentous disruption from a traumatic mechanism. EMG/NCV studies are essential to rule out L5 or S1 radiculopathy as the source of pain, which is a common alternative diagnosis. The gold standard for diagnostic confirmation is a fluoroscopic-guided SI joint injection using local anesthetic: if the patient experiences greater than 75% reduction in their typical pain within the first two hours after injection, the SI joint is confirmed as the pain generator. This diagnostic injection finding is critical in personal injury litigation because it provides objective, reproducible evidence that the SI joint — not the lumbar spine or hip — is the source of the claimant’s symptoms.

How is SI joint pain different from a herniated disc or lumbar radiculopathy?

Sacroiliac joint pain and lumbar disc herniation with radiculopathy are frequently confused because they can produce similar patterns of low back, buttock, and leg pain. Understanding the distinction is critical in personal injury litigation because the diagnosis determines the treatment course, the objective evidence available, and ultimately the value of the case. SI joint pain is typically unilateral — one-sided — and is localized to the posterior pelvis and buttock, usually at or below the level of the posterior superior iliac spine (PSIS). The Fortin finger test, in which the patient points to the area of maximum pain with one finger, typically identifies a spot within 1 cm inferior and medial to the PSIS in SI joint cases. SI joint pain is characteristically aggravated by prolonged sitting (particularly on a hard surface), prolonged standing, transitioning from sitting to standing, and stair climbing — all activities that load the SI joint asymmetrically. Lumbar disc herniation with radiculopathy, in contrast, typically produces dermatomal leg pain extending below the knee into the foot, consistent with the nerve root distribution of L4, L5, or S1. Radiculopathy is characterized by positive straight leg raise (SLR) test, dermatomal sensory deficits, reflex asymmetry (diminished ankle jerk for S1, knee jerk for L4), and objective EMG findings of acute denervation potentials at the affected root level. SI joint pain typically does NOT cause neurological deficits, does not extend below the knee, and is NOT accompanied by positive EMG findings. The critical distinction in litigation is that SI joint dysfunction cases require the fluoroscopic diagnostic injection for objective confirmation — negative EMG, negative or non-specific MRI at L4-L5 and L5-S1 disc levels, and the absence of classic radicular signs are actually consistent with SI joint injury. This is why SI joint cases are commonly misdiagnosed as lumbar radiculopathy in the early treatment phase, and why working with a pain management physician experienced in interventional SI joint diagnosis is essential to building a viable personal injury claim.

What treatments are available for a sacroiliac joint injury from a car accident?

Treatment for a traumatic sacroiliac joint injury progresses through a defined protocol, from conservative measures to interventional pain management and, in refractory cases, surgical fusion. The treating physician’s documentation of each treatment stage and the clinical response at each step is the foundation of the personal injury claim. Conservative treatment begins with physical therapy focused on SI joint stabilization: core strengthening, gluteal strengthening, and pelvic stabilization exercises; SI joint manipulation and mobilization; sacroiliac belt bracing for acute instability; and activity modification. Physical therapy typically continues for 6 to 12 weeks before the treating physician reassesses and considers interventional options. Fluoroscopic-guided SI joint corticosteroid injections are the first-line interventional treatment: the treating pain management physician uses fluoroscopy to confirm needle placement within the SI joint space before injecting a combination of local anesthetic and corticosteroid. If the diagnostic injection confirms greater than 75% pain relief, the corticosteroid injection is both therapeutic and diagnostic confirmation of the SI joint as the pain source. Prolotherapy involves the injection of a proliferant solution (typically dextrose-based) into the posterior SI joint ligament complex to stimulate fibroblastic repair of disrupted ligamentous tissue — particularly relevant for cases involving iliosacral ligament complex injury. Platelet-rich plasma (PRP) injections use the patient’s own concentrated growth factors to stimulate healing of the posterior SI joint capsule and ligamentous complex; PRP is emerging as an evidence-based option for ligamentous SI joint injury. Radiofrequency ablation (RFA) of the lateral branches of the L4-S3 dorsal rami denervates the SI joint and can provide sustained pain relief of 9 to 24 months; RFA is documented in the plaintiff’s medical records as an objective interventional procedure that supports the severity and permanence of the SI joint injury. SI joint fusion surgery is the definitive surgical option for refractory cases: the iFuse system (SI-BONE, Inc.) uses triangular titanium implants placed across the SI joint under fluoroscopic guidance; the SImmetry system uses cylindrical threaded titanium implants. Surgical fusion is a major surgical intervention that significantly increases the value of a personal injury claim.

What is the serious injury threshold for an SI joint injury under New York Insurance Law §5102(d)?

New York Insurance Law §5102(d) establishes the serious injury threshold that a plaintiff must satisfy to recover non-economic damages — pain and suffering — in a car accident case. For sacroiliac joint injuries, the relevant threshold categories are: (a) permanent consequential limitation of use of a body organ or member — the sacroiliac joint is a "body member" within the meaning of §5102(d) and permanent consequential limitation of use of the SI joint satisfies this category; (b) significant limitation of use of a body function or system — significant restriction of pelvic range of motion, restriction of ambulatory function, and documented limitation of daily activities satisfies this category; and (c) the 90/180-day category, which requires that the plaintiff was unable to perform substantially all usual and customary daily activities for not less than 90 days during the 180 days immediately following the accident. Documenting SI joint injury for the serious injury threshold requires treating orthopedist or pain management physician records that: (1) document positive provocative tests at each examination (FABER, FADIR, Gaenslen’s, thigh thrust); (2) document the results of the fluoroscopic diagnostic SI joint injection with the percentage of pain relief; (3) document quantified restrictions in hip abduction, external rotation, and pelvic mobility using goniometry; (4) include a treating physician opinion that the SI joint injury is permanent and is causally related to the accident; and (5) include MRI or CT imaging confirming ligamentous or bony injury. EMG documentation ruling out lumbar radiculopathy is important to prevent the defense from arguing that the plaintiff’s symptoms are explained by a lumbar disc herniation rather than the SI joint. The distinction between SI joint dysfunction from a traumatic mechanism and pre-existing degenerative sacroiliac arthropathy is addressed by the treating physician: documenting that the plaintiff was asymptomatic before the accident, with no prior treatment for low back or pelvic pain, establishes that the SI joint findings are accident-related rather than pre-existing.

How much is a sacroiliac joint injury car accident case worth on Long Island?

The value of a sacroiliac joint injury case on Long Island depends primarily on the severity of the injury, the treatment required, the degree of permanent limitation documented by the treating physician, and the strength of the objective medical evidence. Cases requiring only physical therapy and a limited series of SI joint corticosteroid injections, with documented significant limitation under §5102(d), typically settle in the range of $75,000 to $200,000 in Nassau and Suffolk County, depending on liability, prior medical history, and the treating physician’s documentation of permanence. Cases requiring radiofrequency ablation — with documented denervation of the lateral branches and sustained pain relief — carry higher values reflecting the severity and the interventional nature of the treatment, typically in the range of $200,000 to $500,000. Cases progressing to SI joint fusion surgery (iFuse or SImmetry systems) represent the most significant SI joint injury cases: the surgery is a major orthopedic procedure with a defined recovery period, physical therapy rehabilitation, and a permanent documented change to the SI joint anatomy. SI joint fusion cases on Long Island have settled and resulted in verdicts in the $500,000 to over $1,000,000 range, depending on the plaintiff’s age, occupation, permanence of limitation, and bilateral versus unilateral involvement. The critical value drivers in SI joint cases are: (1) objective confirmation via fluoroscopic diagnostic SI joint injection (greater than 75% pain relief); (2) STIR-sequence MRI findings of ligamentous or bony SI joint injury; (3) treating orthopedist or pain management physician opinion of permanent consequential limitation; (4) the specific interventional treatments performed and their documentation in the medical record; and (5) the plaintiff’s age, occupation, and the degree to which the SI joint injury affects their work capacity and daily function. SI joint cases are frequently worth more than comparable lumbar soft tissue cases because the diagnostic workup is more extensive, the interventional treatment is more expensive, and the surgical option — when indicated — is a clearly documented, major surgical procedure.

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SI joint injury lawyers serving Long Island & NYC

Sacroiliac joint car accident cases are litigated in Nassau and Suffolk County courts, with treating pain management physicians and orthopedists across Long Island. This page is the primary guide for SI joint injury car accident claims across Nassau, Suffolk, and the five boroughs.

Jason Tenenbaum, Personal Injury Attorney serving Long Island, Nassau County and Suffolk County

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Jason Tenenbaum, Esq.

Jason Tenenbaum is a personal injury attorney serving Long Island, Nassau & Suffolk Counties, and New York City. Admitted to practice in NY, NJ, FL, TX, GA, MI, and Federal courts, Jason is one of the few attorneys who writes his own appeals and tries his own cases. Since 2002, he has authored over 2,353 articles on no-fault insurance law, personal injury, and employment law — a resource other attorneys rely on to stay current on New York appellate decisions.

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Syracuse University College of Law

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SI Joint Sprains. Ligament Tears. Fusion Surgery. Permanent Disability.

Your Sacroiliac Joint Injury Case Deserves Expert Legal Representation.

SI joint injuries are routinely misdiagnosed and minimized by insurance companies. We know how to build the fluoroscopic injection record, the STIR-sequence MRI evidence, and the treating physician documentation that wins these cases. Call us today — no fee unless we win.

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Long Island Sacroiliac Joint Injury Lawyer