BACKGROUND: Chronic orchialgia poses a diagnostic challenge as it is largely a diagnosis of exclusion. Rarely, it is linked to spinal etiologies. To date, there has only been one case report attributing orchialgia to sacroiliac joint (SIJ) dysfunction.

CASE REPORT: This case report presents a 46-year-old man with chronic left orchialgia of 20 years that is improved with SIJ injection. Subsequent L5 dorsal ramus and S1-S3 lateral branch injections and radiofrequency ablation of these branches resolved the patient’s symptoms, suggesting that SIJ dysfunction is the origin for his pain.

CONCLUSIONS: This case highlights SIJ dysfunction as an underrecognized cause of chronic orchialgia and emphasizes the importance of considering this etiology on workup and management.

KEYWORDS: Orchialgia, sacroiliac joint dysfunction, sacroiliac joint injection, sacroiliitis, testicular pain