Patent Publication Number: US-2022211274-A1

Title: Posterior-inferior sacroiliac joint fusion procedure employing an implant having a pair of fixation members connected by a bridge

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation application of U.S. application Ser. No. 16/282,114, filed Feb. 21, 2019, which application is a continuation-in-part application of U.S. patent application Ser. No. 15/789,602, filed Oct. 20, 2017, now U.S. Pat. No. 10,492,688, which application is a continuation application of U.S. patent application Ser. No. 14/723,384 filed May 27, 2015, now U.S. Pat. No. 9,801,546, which application claims the benefit of U.S. Provisional Application 62/003,053, which was filed May 27, 2014, entitled “SYSTEMS FOR AND METHODS OF TREATING A MUSCULOSKELETAL JOINT.” application Ser. No. 16/282,114 also claims the benefit of U.S. Provisional Application No. 62/633,205, filed Feb. 21, 2018. The contents of all the above-mentioned patent applications are hereby incorporated by reference in their entireties. 
    
    
     TECHNICAL FIELD 
     Aspects of the present disclosure relate to medical apparatus and methods. More specifically, the present disclosure relates to devices and methods for diagnosing and treating a sacroiliac joint. 
     BACKGROUND 
     The sacroiliac joint is the joint between the sacrum and the ilium of the pelvis, which are joined by ligaments. In humans, the sacrum supports the spine and is supported in turn by an ilium on each side. The sacroiliac joint is a synovial joint with articular cartilage and irregular elevations and depressions that produce interlocking of the two bones. 
     Pain associated with the sacroiliac joint can be caused by traumatic fracture dislocation of the pelvis, degenerative arthritis, sacroiliitis an inflammation or degenerative condition of the sacroiliac joint, osteitis condensans ilii, or other degenerative conditions of the sacroiliac joint. Currently, sacroiliac joint fusion is most commonly advocated as a surgical treatment for these conditions. Fusion of the sacroiliac joint can be accomplished by several different methods encompassing an anterior approach, a posterior approach, and a lateral approach with or without percutaneous screw or other type implant fixation. 
     A general overview of anatomy, function, pathology and certain treatment options are shown and discussed in “Surgery for the Painful, Dysfunctional Sacroiliac Joint”, copyrighted 2015 and edited by Drs. Bruce Dall, Sonia Eden, Michael Rahl and with chapters authored by Drs. E. J. Donner, Arnold Graham Smith, Michael Moore and David Polly. This book is hereby incorporated by reference in its entirety. 
     Improvements to sacroiliac joint fusion involve systems and methods for non-transverse delivery of an implant into the sacroiliac joint are described in U.S. patent application Ser. No. 12/998,712, filed May 23, 2011 entitled SACROILIAC JOINT FIXATION FUSION SYSTEM; Ser. No. 13/236,411, filed Sep. 19, 2011 entitled SYSTEMS FOR AND METHODS OF FUSING A SACROILIAC JOINT; and Ser. No. 13/475,695, filed May 18, 2012, entitled SYSTEMS FOR AND METHODS OF FUSING A SACROILIAC JOINT; and Ser. No. 13/945,053, filed Jul. 18, 2013, entitled SYSTEMS FOR AND METHODS OF FUSING A SACROILIAC JOINT; and Ser. No. 13/946,790, filed Jul. 19, 2013, entitled SYSTEMS FOR AND METHODS OF FUSING A SACROILIAC JOINT; and Ser. No. 14/216,975, filed Mar. 17, 2014, entitled SYSTEMS AND METHODS FOR FUSING A SACROILIAC JOINT AND ANCHORING AN ORTHOPEDIC APPLIANCE; and Ser. No. 14/447,612, filed Jul. 31, 2014, entitled SYSTEMS FOR AND METHODS OF FUSING A SACROILIAC JOINT; and Ser. No. 16/133,605, filed Sep. 17, 2018, entitled “SYSTEMS FOR AND METHODS OF PREPARING AND FUSING A SACROILIAC JOINT”. All of application Ser. Nos. 12/998,712, 13/236,411, 13/475,695, 13/945,053, 13/946,790, 14/216,975, and 14/447,612 are herein incorporated by reference in their entirety. 
     To determine whether a sacroiliac joint is a source of pain, an injection of analgesics into a sacroiliac joint can be performed by a physician and a patient&#39;s subjective measurement of pain can be recorded before, during and for some time after the intervention. The injection may reduce or substantially eliminate pain temporarily. If the injection substantially reduces the pain then the physician could conclude that the sacroiliac joint is indeed a source of the patient&#39;s pain. 
     Other conventional methods for determining sacroiliac joint pain include physical manipulation of body parts within close proximity to the joint which can be meant to stress the sacroiliac joint and thereby provoke pain in hopes of eliciting a reproduction of the patient&#39;s accustomed pain. The sacroiliac pain provocation tests can include distraction, right or left sided thigh thrusts, right or left sided Gaenslen&#39;s test, compression, and sacral thrust. 
     The pain referral pattern associated with sacroiliac joint pain can be confused with other etiologies of the pain due to overlapping pain referral patterns. For example, lumbar spinal disc herniations, lumbosacral facet pathologies, femoral acetabular impingement and other musculoskeletal or medical conditions may cause confusingly similar pain referral patterns. 
     A significant problem with certain conventional methods, which include the injection of material within the joint, for determining sacroiliac pain may be that the physician has introduced an amount of analgesic or other combined substances into the joint which exceeds the capacity of the joint and the solution could then go beyond the joint and or affect other parts of the body. Similarly, without regard to the amount of solution injected, the solution can leave the joint and affect other structures. For example, if the analgesic solution affects the sciatic nerve, the lumbosacral trunk, the L4 nerve root, the sacral plexus, or the S1, S2 or S3 nerves, all of which are in close proximity to the sacroiliac joint, and, for example, if the patient&#39;s pain is due to some condition of one of these nerves which has a similar pain referral pattern as sacroiliac joint pain, the sensitivity and specificity of the diagnostic procedure can be grossly misleading. 
     Another substantial problem with conventional methods which include manipulation of body parts near the joint can be that the structures targeted by the provocative tests are not the only structures affected. One or more different innervated structures in close proximity to the sacroiliac joint could also be stressed by these tests and refer pain or other symptoms into the lower back, pelvis or lower extremities thereby complicating the diagnosis. 
     As seen in  FIGS. 1A-1B , external pelvic fixators  5  are conventionally used to stabilize and rest a traumatized sacroiliac joint  3  until healed or asymptomatic (e.g., 6-12 weeks). External pelvic fixators  5  are conventionally recommended to diagnose and determine whether sacroiliac joint fusion would be a treatment option if the patient received pain relief from temporary stabilization of the sacroiliac joint  3 . 
     However, the external pelvic fixators  5  require multiple pins  2  placed in, e.g., the ilium  1  bilaterally (i.e., in both ilia) which is associated with significant risk and morbidity including but not limited to pain, infection and the inconvenience to the patient and medical person due to a bulky external frame around the pelvis. Another problem with conventional procedures can be that there may be no or an insufficient reduction in the movements of a sacroiliac joint  3 . For example, an insufficient reduction in the movements of a sacroiliac joint  3  may be due to the extended distance from the fixation point provided by the external fixator relative to the sacroiliac joint  3  being evaluated. The complication rate for definitive and temporary conventional pelvic external fixation has been reported to be rather significant. 
     Referring to  FIG. 1C , other conventional techniques for fixation of the joint  3  may include placement of rods or screws  4  across a sacroiliac joint  3  within the ilium  1  and sacrum  0  defining the sacroiliac joint  3 . Yet further conventional techniques and implants may distract the joint and may thereby alter the tension of the surrounding ligamentous structure. Problems associated with these and other conventional techniques used primarily for sacroiliac joint fusion may include the difficulty of removal of the implants, namely, because the implants and the associated conventional methods of use are generally intended for insertion only. That is, the implants, rods, and screws described with reference to the conventional art are not configured for temporary use or for diagnostic purposes. Explanation of the implants, rods, or screws are generally not intended and is generally only utilized when complications arise. For example, the rods shown in  FIG. 1C  may disrupt the interosseous ligament which the sacroiliac joint  3  depends on, in part, for stability in a healthy patient. As another example, other conventional implants and method may significantly disrupt the inner and outer table of the ilium, the cortical surface of the sacrum and may remove a significant volume of the bone of the sacrum and ilium. 
     Accordingly, there is a need in the art for systems and methods of diagnosing and treating a sacroiliac joint that minimally and temporarily disrupts the patient&#39;s anatomical structure and tissues. It is with these thoughts in mind, among others, that the present disclosure involving systems and methods of diagnosing and treating a sacroiliac joint were developed. 
     SUMMARY 
     Aspects of the present disclosure may involve a method of diagnosing and treating a sacroiliac joint of a patient, the method may include delivering a first member into the ilium via a first posterior approach, delivering a second member into the sacrum via a second posterior approach, coupling the first and second members to a pliers, and manipulating the first member relative to the second member via the pliers to determine an ailment of the sacroiliac joint. 
     In certain instances, the pliers are a dual-axis pliers may include first and second handles, first and second head portions, and a pair of joints adjustably coupling the first and second handles and the first and second head portions, the pair of joints facilitating rotation of the first and second head portions about first and second axes, the first and second axes are generally perpendicular to each other. 
     In certain instances, the pliers may include first and second handles, first and second head portions, and a first joint adjustably coupling the first and second handles and the first and second head portions, the pliers are expanding pliers such that movement of the first and second handles closer together via rotation about a first axis of the first joint causes the first and second head portions to move apart from each other. 
     In certain instances, the pliers further may include a second joint adjustably coupling the first and second handles and the first and second head portions, the second joint facilitates rotation of the first and second head portions about a second axis of the second joint, the second axis being generally perpendicular to the first axis. 
     In certain instances, the pliers further may include at least one stud member configured to be engaged and disengaged with the first joint, engagement of the stud member with the first joint limits rotation of the pliers to the first axis of the first joint, and disengagement of the stud member with the first joint permits rotation of the pliers to the first axis of the first joint and the second axis of the second joint. 
     Aspects of the present disclosure may involve a method of diagnosing and treating a sacroiliac joint of a patient, the method may include delivering a first member into the ilium via a first posterior approach, delivering a second member into the sacrum via a second posterior approach, coupling the first and second members to a first and second guide blocks, respectively, of a clevis guide, and manipulating the first member relative to the second member via the clevis guide to determine an ailment of the sacroiliac joint. 
     In certain instances, the clevis guide may include a pair of prongs adjustably coupled to the first and second guide blocks. 
     In certain instances, the first guide block may include rotationally coupled to the pair of prongs, and the second guide block may include rotationally and slidingly coupled to the pair of prongs so as to permit parallel alignment of the first and second guide blocks. 
     In certain instances, manipulation of the first member relative to the second member via the clevis guide may include relative longitudinal displacement of the first and second members. 
     In certain instances, the first guide block may include a first through-hole and a first screw-lock to secure the first member in a first position within the first through-hole, the second guide block may include a second through-hole and a second screw-lock to secure the second member in a second position within the second through-hole. 
     Aspects of the present disclosure may involve a method of diagnosing and treating a sacroiliac joint of a patient, the method may include delivering a first member into the sacrum via a first posterior approach, sliding a first dilator over the first member, sliding a sleeve of a first guide of a parallel pin guide over the first dilator, positioning a second guide of the parallel pin guide so as to target the ilium, inserting a second dilator into the second guide, and delivering a second member into the ilium via guidance by the second dilator. 
     In certain instances, the first and second members are guide wires, and the method further may include delivering first and second bone pins, respectively into the locations of the first and second members. 
     In certain instances, further may include manipulating the first and second bone pins relative to each other in order to determine a condition of the sacroiliac joint. 
     In certain instances, further may include using at least one of a pliers and a clevis guide to manipulate the first and second bone pins relative to each other in order to determine a condition of the sacroiliac joint. 
     In certain instances, further may include inserting a pair of radiographic contrasting members into radiographic guide holes of the parallel pin guide, and aligning the radiographic contrasting members with the sacroiliac joint. 
     In certain instances, aligning the radiographic contrasting members with the sacroiliac joint may include done under radiographic imaging. 
     In certain instances, aligning the radiographic contrasting members with the sacroiliac joint causes the second guide of the parallel pin guide to target the ilium. 
     While multiple embodiments are disclosed, still other embodiments of the present disclosure will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative embodiments of the disclosure. As will be realized, the various embodiments of the present disclosure are capable of modifications in various aspects, all without departing from the spirit and scope of the present disclosure. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1A  is a superior view of a pelvic region and a conventional method and device for temporarily stabilizing the sacroiliac joint. 
         FIG. 1B  is an anterior view of the pelvic region and the conventional method and device for temporarily stabilizing the sacroiliac joint of  FIG. 1A . 
         FIG. 1C  is an anterior view of the pelvic region and a conventional method and device for permanently stabilizing the sacroiliac joint. 
         FIG. 2A  is an isometric view of an example system for fusing a sacroiliac joint. 
         FIG. 2B  is the same view as  FIG. 2A , except the delivery tool and implant assembly are decoupled from each other. 
         FIG. 2C  is the same view as  FIG. 2A , except the system is exploded to better illustrate its components. 
         FIG. 3  is a posterior-inferior view of a sacroiliac joint with a patient body shown in broken line. 
         FIG. 4  is a close-up view of the implant and anchor element in the sacroiliac joint. 
         FIG. 5A  is a right lateral view of a hip region of a patient lying in a prone position, wherein the soft tissue surrounding the skeletal structure of the patient is shown in dashed lines. 
         FIG. 5B  is an enlarged view of the hip region of  FIG. 5A . 
         FIG. 5C  is generally the same view as  FIG. 5B , except that the ilium is removed to show the sacroiliac joint space boundary defined along the sacrum and an implant positioned for implantation within the joint space. 
         FIG. 5D  is a lateral side view of the pelvic region of a patient with a nearest ilium removed to clearly show the regions of the sacroiliac joint. 
         FIG. 5E  is a lateral posterior view of the hip region of the patient showing the regions of the sacroiliac joint. 
         FIG. 5F  is a posterior view of the hip region of the patient showing the regions of the sacroiliac joint. 
         FIGS. 6A-6D  are each a step in the methodology and illustrated as the same transverse cross section taken along a plane extending generally medial-lateral and generally anterior posterior. 
         FIG. 7A  is an isometric view of a diagnostic pin. 
         FIG. 7B  is a bottom view of the diagnostic pin of  FIG. 7A . 
         FIG. 7C  is a top view of the diagnostic pin of  FIG. 7A . 
         FIG. 7D  is a side view of the diagnostic pin of  FIG. 7A . 
         FIG. 7E  is an isometric view of a diagnostic pin guidance tool. 
         FIG. 8A  is an isometric view of a diagnostic pin with a blunt distal end. 
         FIG. 8B  is an isometric view of a diagnostic pin with a blunt distal surface and a tapered tip extending distally of the blunt distal surface. 
         FIG. 9  is an isometric view of a diagnostic pin having a distal end with a pair of openings, the diagnostic pin coupled with an anchor guide. 
         FIG. 10A  is a posterior view of a hip region of a patient showing a diagnostic pin positioned in the sacrum and another diagnostic pin positioned in the ilium. 
         FIG. 10B  is a lateral side view of the hip region of the patient with a nearest ilium removed and a diagnostic pin positioned in the sacroiliac joint region. 
         FIG. 10C  is a posterior cross-sectional view of the sacroiliac joint with one pin positioned in the sacrum and one pin positioned in the ilium. 
         FIGS. 10D-10E  are transverse cross-sectional views of the sacrum and ilium showing various pin placements in the sacrum. 
         FIG. 10F  is a posterior view of the hip region of the patient showing pins in a right ilium and a left ilium. 
         FIG. 10G  is a posterior view of the hip region of the patient showing pins positioned in a right ilium and a left ilium for distracting the joint. 
         FIG. 10H  is a posterior view of the hip region of the patient showing pins positioned in a right ilium and a left ilium for compressing the joint. 
         FIG. 10I  is a posterior view of the lumbar spine showing pins to either stabilize or selectively allow motion between segments of the spine. 
         FIG. 11  is a lateral side view of the hip region of the patient in a neutral position with one pin in the sacrum and one pin in the ilium. 
         FIG. 12A  is a lateral side view of the hip region of the patient showing anterior-posterior movement of the ilium via the pins positioned in the sacrum and ilium. 
         FIG. 12B  is a lateral side view of the hip region of the patient showing cranial-caudal movement of the ilium via the pins positioned in the sacrum and ilium. 
         FIGS. 12C-12D  are lateral side views of the hip region of the patient showing rotational movement of the ilium via the pins positioned in the sacrum and ilium. 
         FIG. 13A  is a lateral side view of the hip region of the patient showing possible pin placements in the ilium and sacrum. 
         FIG. 13B  is a lateral side view of the hip region of the patient showing releasable distal portions of the pins being coupled with a coupling member. 
         FIG. 14  is a front isometric view of a diagnostic system including a mechanical coupling assembly coupled between a pair of diagnostic pins in accordance with embodiments of the present disclosure. 
         FIG. 15  is a back isometric view of the diagnostic system of  FIG. 14 . 
         FIG. 16A-16C  are back views of the diagnostic system of  FIG. 15 . 
         FIG. 17  is a top view of the diagnostic system of  FIG. 14 . 
         FIG. 18  is an enlarged view of the mechanical coupling assembly of  FIG. 14 . 
         FIG. 19  is an isometric view of the first coupling member of the diagnostic system of  FIG. 14 . 
         FIG. 20A  is one isometric view from the side of the second coupling member  5008  of the diagnostic system of  FIG. 14 . 
         FIG. 20B  is one isometric view from the bottom of the coupling member of the diagnostic system of  FIG. 14 . 
         FIG. 20C  is one isometric view from the top of the coupling member of the diagnostic system of  FIG. 14 . 
         FIG. 21  is an isometric view of the fastener of the diagnostic system of  FIG. 14 . 
         FIG. 22  is an isometric view of the washer of the diagnostic system of  FIG. 14 . 
         FIG. 23  is an isometric view of the side screw of the diagnostic system of  FIG. 14 . 
         FIG. 24A  is an isometric view from the back of the third coupling member  5010  of the diagnostic system of  FIG. 14 . 
         FIG. 24B  is an isometric view from the front of the third coupling member  5010  of the diagnostic system of  FIG. 14 . 
         FIG. 25A  is an isometric view from the bottom of the connector at the end of the extension bar connected to the handle of the diagnostic system of  FIG. 14 . 
         FIG. 25B  is an isometric view from the top of the connector at the end of the extension bar connected to the handle of the diagnostic system of  FIG. 14 . 
         FIG. 26  is an isometric view of a diagnostic system including a pivot type mechanical coupling assembly for causing translational movements of the pins in accordance with embodiments of the present disclosure. 
         FIG. 27  is an isometric view of the diagnostic system of  FIG. 26  in a position that one of the diagnostic pin moving upward in accordance with embodiments of the present disclosure. 
         FIG. 28  is an isometric view of the diagnostic system of  FIG. 26  in a position that one of the diagnostic pin moving downward in accordance with embodiments of the present disclosure. 
         FIG. 29  is an isometric view of a diagnostic system including a pivot type mechanical coupling assembly for causing rotational movements of the pins in accordance with embodiments of the present disclosure. 
         FIG. 30A  is an isometric view of the diagnostic system that rotates one diagnostic pin clockwise with respect to another diagnostic pin. 
         FIG. 30B  is an isometric view of the diagnostic system that rotates one diagnostic pin counterclockwise with respect to another diagnostic pin. 
         FIG. 30C  is a front view of a diagnostic system that allows selective sliding of one pin relative to another pin. 
         FIG. 31  is an isometric view from a bottom of a surgical system for delivering an implant in accordance with embodiments of the present disclosure. 
         FIG. 32  is an isometric view from a top of the surgical system for delivering an implant of  FIG. 31 . 
         FIG. 33  is an isometric view of the surgical system of  FIG. 31  with the implant inserted partially. 
         FIG. 34  is a sectional view of the surgical system of  FIG. 33  with the implant inserted partially. 
         FIG. 35  is an enlarged sectional view illustrating that the implant is inserted in the extra-articular region. 
         FIG. 36  is an enlarged sectional view illustrating that a cross type implant is inserted in the extra-articular region. 
         FIG. 37  is an enlarged sectional view illustrating that the fork-like shaped implant is inserted in the intra-articular region. 
         FIG. 38  is a sectional view of  FIG. 37  as shown by arrows A-A. 
         FIG. 39A  is an enlarged sectional view illustrating that one pin is inserted in ilium near extra-articular region and one pin is inserted into the sacrum near the intra-articular region with coupling between the pins. 
         FIG. 39B  is an enlarged sectional view illustrating that one pin is inserted in ilium near extra-articular region and one pin is inserted into the sacrum near the extra-articular region with coupling between the pins. 
         FIG. 39C  is an enlarged sectional view illustrating that one pin is inserted in ilium near intra-articular region and one pin is inserted into the sacrum near the intra-articular region with coupling between the pins. 
         FIG. 40  is a simplified diagram illustrating an adjustable coupling member for the pins. 
         FIG. 41  is an enlarged sectional view illustrating that a temporary implant including coupled pins is inserted in the intra-articular region. 
         FIG. 42  illustrates a radiographic contrast tool that injects radiographic contrast under fluoroscopic guidance into the joint. 
         FIG. 43A  is an isometric view from a distal end of an implant in accordance with a first embodiment of the present disclosure. 
         FIG. 43B  is another isometric view from a proximal end of the implant of  FIG. 43A . 
         FIG. 44A  is an isometric view from a distal end of an implant in accordance with a second embodiment of the present disclosure. 
         FIG. 44B  is another isometric view from a proximal end of the implant of  FIG. 44A . 
         FIG. 45A  is an isometric view from a distal end of an implant in accordance with a third embodiment of the present disclosure. 
         FIG. 45B  is another isometric view from a proximal end of the implant of  FIG. 45A . 
         FIG. 46A  is an isometric view from a distal end of an implant in accordance with a fourth embodiment of the present disclosure. 
         FIG. 46B  is another isometric view from a proximal end of the implant of  FIG. 46A . 
         FIG. 47A  is an isometric view from a distal end of an implant in accordance with a fifth embodiment of the present disclosure. 
         FIG. 47B  is another isometric view from a proximal end of the implant of  FIG. 47A . 
         FIG. 48A  is an isometric view from a distal end of an implant in accordance with a sixth embodiment of the present disclosure. 
         FIG. 48B  is another isometric view from a proximal end of the implant of  FIG. 48A . 
         FIG. 48C  is a side view of a curved implant in accordance with a seventh embodiment of the present disclosure. 
         FIG. 48D  is an isometric view from a proximal end of the implant of  FIG. 48C . 
         FIG. 49A  is a lateral side view of the hip region of the patient with a nearest ilium removed and an implant positioned in the extra-articular region of the sacroiliac joint. 
         FIG. 49B  is a lateral side view of the hip region of the patient showing an implant coupled with a delivery tool positioned for delivery into the sacroiliac joint. 
         FIG. 49C  is the same view as  FIG. 48B , except the implant has been delivered into the extra-articular region of the sacroiliac joint. 
         FIG. 50  is a lateral side view of the hip region of the patient showing positioning of the implant within the extra-articular region of the sacroiliac joint. 
         FIG. 51  is a posterior view of the hip region of the patient showing the implant within the extra-articular region of the sacroiliac joint. 
         FIG. 52A  is an isometric front view of a parallel pin guide supporting a pair of dilators. 
         FIG. 52B  is a front view of the parallel pin guide supporting the pair of dilators. 
         FIG. 52C  is a cross-sectional view of the parallel pin guide supporting the pair of dilators. 
         FIG. 52D  is a top view of the parallel pin guide supporting the pair of dilators. 
         FIG. 52E  is a bottom view of the parallel pin guide supporting the pair of dilators. 
         FIG. 52F  is an isometric front view of the parallel pin guide separated from the pair of dilators. 
         FIG. 52G  is a side view of the parallel pin guide supporting the pair of dilators. 
         FIG. 52H  is a cross-sectional view of the parallel pin guide supporting the pair of dilators. 
         FIG. 53A  is an isometric front view of a dual-axis pliers. 
         FIG. 53B  is an isometric rear view of the dual-axis pliers. 
         FIG. 53C  is an isometric exploded view of the dual-axis pliers from a first side. 
         FIG. 53D  is an isometric exploded view of the dual-axis pliers from a second side. 
         FIG. 53E  is an isometric front view of the dual-axis pliers supporting a pair of bone pins in a first parallel orientation. 
         FIG. 53F  is an isometric front view of the dual-axis pliers supporting a pair of bone pins in a second parallel orientation where the bone pins are spaced apart a farther distance than in the first parallel orientation. 
         FIG. 53G  is an isometric front view of the dual-axis pliers supporting a pair of bone pins in a third orientation where the pair of bone pins are angled relative to each other but within parallel planes. 
         FIG. 54A  is an isometric front view of a clevis guide supporting a pair of bone pins in a first parallel orientation. 
         FIG. 54B  is an isometric front view of the clevis guide supporting the pair of bone pins in a second parallel orientation where the bone pins are moved longitudinally relative to each other relative to their positions in the first parallel orientation. 
         FIG. 54C  is an isometric exploded view of the clevis guide. 
         FIG. 55A  is an inferior view of a sacrum and an ilium with a guide wire delivered into the sacrum. 
         FIG. 55B  is an inferior view of the sacrum and the ilium with a first dilator positioned over the guide wire. 
         FIG. 55C  is an inferior view of the sacrum and the ilium with the parallel pin guide positioned over the first dilator. 
         FIG. 55D  is an inferior view of the sacrum and the ilium with a pair of radiographic contrasting cylinders positioned through the radiographic guides of the parallel pin guide. 
         FIG. 55E  is a posterior view of the sacrum and the ilium showing the pair of radiographic contrasting cylinders parallel with each other and generally parallel with a joint line of the sacroiliac joint. 
         FIG. 55F  is an inferior view of the sacrum and the ilium with a second dilator positioned up against the ilium and through a guide hole of the parallel pin guide. 
         FIG. 55G  is an inferior view of the sacrum and the ilium with a second guide wire positioned through the second dilator and into the ilium. 
         FIG. 55H  is an inferior view of the sacrum and the ilium with the dual-axis pliers secured to a pair of pins (positioned in the sacrum and ilium where the guide wires were previously). 
         FIG. 55I  is an inferior view of the sacrum and the ilium with the clevis guide secured to the pair of pins (positioned in the sacrum and ilium where the guide wires were previously). 
     
    
    
     DETAILED DESCRIPTION 
     Implementations of the present disclosure involve a system for diagnosing and treating a sacroiliac joint disorder or ailment. In particular, the system may include a diagnostic tool for manipulating a pair of rods temporarily implanted or engaged with the hip region of the patient. A first rod may engage with or be delivered into the sacrum and a second rod may be delivered parallel to the first rod and may engage with or be delivered into the ilium. The rods may span an intra-articular region or extra-articular region of the sacroiliac joint. The diagnostic tool may be used to grasp and manipulate the rods such that the sacrum and ilium are manipulated relative to each other. Through manipulation of the diagnostic tool, the ilium may be, for example, translated proximally, distally, cranial, or caudal relative to the sacrum. Additionally, the ilium may be, for example, rotated in various planes relative to the sacrum via the diagnostic tool. Alternatively and in certain embodiments, the rods may be manipulated by hand without the aid of the diagnostic tool. The manipulation of the sacrum and ilium via the rods may be beneficial for a medical professional to diagnose a sacroiliac joint disorder because, for example, the rods may isolate the forces exerted to specific areas of the hip region (e.g., sacrum, ilium or lumbosacral spine). In certain instances, the diagnosis may indicate that stabilization of the joint is necessary. 
     The joint may be stabilized in a number of ways. For example, the rods may be replaced by anchor or shorter rods and the rods may be coupled together, beneath the patient&#39;s skin. If a suitable amount of pain is reduced by this procedure, this may indicate that permanent fixation of the joint should alleviate or substantially reduce the pain. 
     As another example of joint fixation and while the rods are in place in the sacrum and ilium, the rods may act as an alignment system for the subsequent delivery of a temporary implant. More particularly, a sleeve may be fitted over the rods and an insert may be fitted within the sleeve to guide a particular implant for delivery into the sacroiliac joint. The implant may be delivered via a posterior approach into the sacroiliac joint and the implant may be delivered such that a portion of the implant bridges the joint and affixes into a portion of each of the sacrum and the ilium. In certain implementations, the implant may include an open distal end such that a majority of the body of the implant occupies the sacrum and the ilium with the open portion of the implant occupying the sacroiliac joint space so as to minimally disrupt the cartilage in the joint space. 
     The temporary implant may remain in the patient for a period of time to determine if a subsequent, permanent implant is needed. For example, if the temporary implant successfully treats the disorder, the implant may be removed in favor of implanting a permanent implant such as those described in U.S. patent application Ser. Nos. 14/447,612; 13/475,695; 13/236,411; 12/998,712; and Ser. No. 16/133,605, all of which are incorporated by reference in their entireties into the present application. Accordingly, if a subsequent implant is to be delivered into the joint space, the joint may be prepared according to the systems, tools, and methods described in U.S. patent application Ser. Nos. 14/514,221, and 16/133,605 which is hereby incorporated by reference into the present application in its entirety. Or, the implant may remain implanted and a subsequent implant may or may not be delivered into the sacroiliac joint. 
     In particular instances, a portion or entirety of a sacroiliac joint may be treated, stabilized, or replaced by an implant, system and/or method as described in U.S. patent application Ser. No. 14/127,119, filed Dec. 17, 2013, entitled “Sacroiliac Joint Implant System” and incorporated herein by reference in its entirety. 
     In certain instances, when a patient may have pain in the region near the sacroiliac joint, a fluid injection method may be used to inject pain medicine in the sacroiliac joint. When using the fluid injection method, it may be difficult to accurately determine if the pain arises from the sacroiliac joint or other regions, because the fluid may leak to other nearby regions. The pain medicine may leak in to other nearby regions and relieve the pain in those regions such that even if the pain is reduced, it is difficult to determine if the pain truly comes from the sacroiliac joint. 
     Current diagnostic procedures may not be accurate enough to determine whether the root cause of the pain comes from the sacroiliac joint. As a result, a surgeon may place an implant in the sacroiliac joint, which may not be necessary or helpful for relieving the patient&#39;s pain, or possibly subjecting the patient to unnecessary potential complications. 
     The present diagnostic system provides a diagnostic system that can generate localized forces to cause movement of the sacroiliac joint. The diagnostic system may assist to accurately determine the need of an implant in the sacroiliac joint (or other treatment), either by stabilizing the joint to reduce the pain in a patient or by reproducing the pain in the patient via the localized forces to mobilize the joint or cause movement of the joint. This diagnostic system and method may provide accurate diagnostics on whether an implant is needed, thus, reducing the possibility of an unnecessary implant being implanted into the sacroiliac joint. 
     The present disclosure provides a diagnostic system that can be used to mobilize the sacroiliac joint of a patient in order to reproduce or stimulate pain in the patient. The patient may provide feedback on whether the pain is similar to his or her familiar pain pattern. If the pain in the patient can be reproduced by manipulating the movement of the sacroiliac joint, this suggests that fusion, fixation, stabilization, or other treatment of the joint (e.g., with an implant) may be helpful to reduce the pain. Various methods and means may be used to mobilize the sacroiliac joint. For example, the diagnostic system may include pins, rods, or bars that may be inserted or engaged with the sacrum or ilium at different locations to cause particular movements of the sacroiliac joint. The pins or bars may have a distal end portion that can engage a larger region of the ilium or sacrum to cause the movement. For example, the distal end portion may extend from the pin in a radial direction such that the distal end portion may have a larger surface area. The distal end portion may be a 2D or 3D plate. The diagnostic system may also include screws that are inserted in the ilium or sacrum. One shaft may be used to couple to one screw while another shaft may be coupled to another screw. The shafts may be used to cause movements or stabilization of the joint. The distal portion may be a hook. The distal portion may be configured to reversibly expand (i.e., similar to a molly bolt or toggle bolt). 
     The present disclosure also provides a diagnostic system that can help determine if stabilizing the sacroiliac joint of a patient helps with reducing pain or other symptoms in the patient. The diagnostic system may include diagnostic pins coupled together that may be temporarily placed in the patient to stabilize the joint and to determine if the patient may have reduced pain. The pins may remain in the patient for a given period of time to determine if stabilization of the joint via the pins is effective at reducing pain. Instructions may be given to the patient to perform, e.g.: single leg stands, squats, sitting, rolling on side, movement of leg in various directions, an activity which causes accustomed symptoms. The patient may do certain work out routines on a running machine or cycling machine to provide feedback on whether the pain is reduced. The patient may also be instructed to live a regular daily life to provide feedback on whether the pain is reduced. The diagnostic system may also include delivering tools for implanting into the joint. 
     I. System for Fusion of the Sacroiliac Joint 
     To begin a detailed discussion of a system  10  for delivering an implant  12  into the sacroiliac joint, reference is made to  FIGS. 2A-2C .  FIG. 2A  is an isometric view of the system  10 .  FIG. 2B  is the same view as  FIG. 2A , except an implant assembly  14  of the system  10  is separated from a delivery tool  16  of the system  10 .  FIG. 2C  is the same view as  FIG. 2A , except the system  10  is shown exploded to better illustrate the components of the system  10 . 
     As can be understood from  FIGS. 2A and 2B , the system  10  includes a delivery tool  16  and an implant assembly  14  for implanting at the sacroiliac joint via the delivery tool  16 , the implant assembly  14  being for fusing the sacroiliac joint. As indicated in  FIG. 2C , the implant assembly  14  includes an implant  12  and an anchor element  18  (e.g., a bone screw or other elongated body). As discussed below in greater detail, during the implantation of the implant assembly  14  at the sacroiliac joint, the implant  12  and anchor element  18  are supported by a distal end  20  of the delivery tool  16 , as illustrated in  FIG. 2A . The delivery tool  16  is used to deliver the implant  12  into the sacroiliac joint space. The delivery tool  16  is then used to cause the anchor element  18  to extend through the ilium, sacrum and implant  12  generally transverse to the sacroiliac joint and implant  12 . The delivery tool  16  is then decoupled from the implanted implant assembly  14 , as can be understood from  FIG. 2B . As illustrated in  FIGS. 2A-2C , the delivery tool  16  further includes a proximal end  22  opposite the distal end  20 , an arm assembly  24 , a handle  26 , an implant retainer  28 , a sleeve  30  and a trocar or guidewire  32 . While in the embodiment of  FIGS. 2A-2C , the delivery tool  16  is fixed and non-adjustable and configured to deliver the anchoring element  18  in a single orientation relative to the implant  12 , the delivery tool  16  may be adjustable and configured to deliver the anchoring elements  18  within a range of orientations relative to the implant  12  that will orient the anchoring element  18  either within a bore of the implant  12 , or adjacent implant  12  as described in U.S. patent application Ser. No. 14/447,612, filed Jul. 31, 2014, entitled SYSTEMS FOR AND METHODS OF FUSING A SACROILIAC JOINT, which is hereby incorporated by reference in its entirety. 
     In particular embodiments, first and second articular faces of the implant  12  may be selected to match the contour of the joint space of the sacroiliac joint within which the implant  12  is to be inserted. For example, the sacral, medial or first articular faces of the implant may be configured to be generally convex to match the contour of a sacral auricular boney surface or to match the contour of an extra-articular region of a sacrum (e.g., a sacral fossa). In one aspect and referring to portions of the anatomy shown  FIG. 5C , the sacral, medial or first articular face of the implant  12  may be generally a surface negative of the articular surfaces  1016  of the extra-articular region  3007  and/or articular region  1044  of the sacrum  1004 . As another example, the lateral, iliac or second articular face of the implant  12  may be configured to be generally concave to match the contour of an iliac auricular boney surface or to match the contour of an extra-articular region of an ilium (e.g., an iliac tuberosity). In one aspect, the lateral, iliac or second articular face of the implant  12  may be generally a surface negative of the articular surfaces  1016  of the extra-articular region  3007  and/or articular region  1044  of the ilium  1005 . 
     A system as described in  FIGS. 2A-2C  may be used in a surgical procedure via a posterior approach, as seen in  FIGS. 3-4 . As can be understood from  FIG. 3 , which is a posterior-inferior view of a sacroiliac joint  36  with a patient  40  shown in broken line, the delivery tool  16  is positioned to deliver the implant  12  into a caudal region  34  of the sacroiliac joint  36  and the anchoring element  18  through the ilium  5  and into the bore  38  of the implant  12 . Referring to  FIG. 4 , the implant  12  and anchoring element  18  have been inserted into the caudal region  34  of the sacroiliac joint  36  and the delivery tool  16  has been removed. 
     With further reference to the boney anatomy shown in  FIG. 5C , a system as described herein may be used in a surgical procedure via an anterior approach (e.g., such that the surgical pathway includes traversing an anterior boundary segment  3004  and/or traversing an anterior-inferior corner  3010 ) and may further include positioning an implant into a sacroiliac joint such that: 1) the implant longitudinal axis a) is generally parallel to a sacroiliac joint inferior boundary segment  3002 , or b) points towards a posterior superior iliac spine, or c) point towards a posterior inferior iliac spine, or d) points toward a sacroiliac extra-articular region; or, 2) the distal end of the implant generally lies within a) a caudal region of the sacroiliac joint articular region, or b) an extra-articular portion of the sacroiliac joint, or c) a cranial portion or cephalad region of the sacroiliac joint articular region. 
     Additionally, a system as described herein may be used in a surgical procedure via an approach which includes a surgical pathway which transverses a sacroiliac joint inferior boundary segment  3002 , e.g., as described in U.S. patent application Ser. No. 13/945,053, filed Jul. 18, 2013, entitled SYSTEMS AND METHODS OF FUSING A SACROILIAC JOINT, which is hereby incorporated by reference in its entirety. A surgical procedure via this pathway may further include positioning an implant into a sacroiliac joint such that: 1) the implant longitudinal axis a) is transverse to a sacroiliac joint inferior boundary segment  3002 , or b) points towards a posterior superior iliac spine, or c) point towards a posterior inferior iliac spine, or d) points toward a sacroiliac extra-articular region, or e) points towards a sacroiliac joint anterior boundary segment  3004 , or f) points towards either superior boundary segment corner  3014  or  3012  or somewhere in-between; or, 2) the distal end of the implant generally lies within a) a caudal region of the sacroiliac joint articular region, orb) an extra-articular portion of the sacroiliac joint, or c) a cranial portion or cephalad region of the sacroiliac joint articular region. 
     Furthermore, in certain embodiments, an implant  12  may be inserted along a generally arcuate path. Accordingly, a surgical preparation technique and tools may be utilized while operating in an arcuate path. The implant arcuate path may follow and generally match the surgical preparation arcuate path and the path arc may include a radius of between approximately 3 cm to 6 cm. The portion of the path having an arcuate path including a radius of between approximately 3 cm to 6 cm may reside substantially in the plane of the sacroiliac joint or in a plane in close proximity and generally parallel thereto. Furthermore, the arcuate path may generally or substantially reside in sacroiliac joint articular region  1044 . Additionally, an implant may be selected for use during the procedure which substantially matches the radius or curvature of the arcuate or curved insertion path or surgical preparation path. 
     In certain embodiments, after drilling or otherwise producing an opening through an ilium (or sacrum) leading toward or into a sacroiliac joint, a sleeve may guide (alone or along with another cannulated tool, e.g., a needle) a bone paste, bone marrow aspirate, stem cells, allograft or any biocompatible material or substance into the sacroiliac joint space via a path with a trajectory which may be generally transverse to the plane of the sacroiliac joint. The sleeve may be caused to form a seal with a bone defining the sacroiliac joint, e.g. the ilium. The seal may be created by impacting a proximal end of sleeve which may, for example, cause the sleeve to slightly penetrate the cortex of the outer table of the ilium. Alternatively, a cannulated tool such as a large gauge needle or tube may either be interference fit within a hole in the ilium or the needle or tube may have a threaded distal end which may be threaded into the bore formed in the ilium. A plunger or bone tamp may be forced through a sleeve to advance the bone paste or other material into the sacroiliac joint space, adjacent/around the implant and/or into the bone graft window of the implant. 
     Subsequently, an anchor such as a bone screw may be advanced via the sleeve into engagement with an opening formed in the ilium and driven across the sacroiliac joint and further into the sacrum. Alternatively, a bone plug may be positioned into the opening formed in the ilium in order to occlude the passageway between the outer cortex of the ilium and the implanted bone paste or other material positioned generally in the plane of the joint. 
     II. Methods of Preparing the Sacroiliac Joint for Fusion 
     The following discussion will focus on various methods of diagnosing and treating a sacroiliac joint ailment utilizing the tools and devices discussed previously. 
     A. Preoperative Planning for a Diagnostic and/or Surgical Procedure 
     Prior to any joint treatment, preparation or fusion, a surgeon or other medical person may diagnose a particular ailment of the sacroiliac joint and select a suitable procedure to treat the sacroiliac joint, e.g., fusion, fixation, stabilization, replacement, resurfacing, restructuring, repairing, or altering of boney ligamentous or capsular tissue. The procedure may include fusing the joint with or without delivering an implant in the joint space. A diagnostic and/or treatment procedure may be planned and/or conducted (and, e.g., the surgeon may select an implant configuration for delivery into the sacroiliac joint region of the patient) based on preoperative or intraoperative data. The data may be the result of post-processing of raw or other imaging data (e.g. CT or MRI DICOM files). The post-processing may include the use of a software program (e.g., 3DSLICER available from http://www.slicer.org) that may be used for medical image processing and 3D visualization of image data. Other data may include the patient&#39;s weight, activity level, spinal alignment, posture and general health. 
     The preoperative or intraoperative data may assist in the planning and selecting of desirable implant and final anchor positioning, trajectories (e.g., starting and stopping points on patient&#39;s soft tissue and near or within bone tissue), anchor, number, configurations and dimensions (e.g., length, cannulation, apertures, cross sectional geometry, surface treatments, diameter, head size, washer, thread pitch), implant types, number, configurations and dimensions, and joint preparation tool types, dimensions, and configurations. A particularly system for preparing and fusing the sacroiliac joint may be selected, for example, for a hypermobile joint, which may include an implant or fusion system that is resistant to the expected forces (magnitude and vector) present at that particular patient&#39;s sacroiliac joint. The determination of fixation sufficiency may be calculated based on the patient&#39;s data and also on the performance results of various bench and/or finite element analysis (“FEA”) tested implant assembly (or individual components) configurations. For example, a calculated anchor and/or implant trajectory may be considered and determined from certain patient imaging and post-processing data with an overlayed implant assembly. Further, the implant assembly footprint within the joint plane may be selected as a lower percent of total joint surface area to permit sufficient boney fusion across the joint while maintaining a sufficient implant sacral and iliac face surface area to prevent implant subsidence. 
     Specific measurements and characteristics of the patient&#39;s anatomy may influence the selection of a particular joint fusion system. For example, the patient&#39;s bone density may be measured at numerous locations in proximity to and surrounding the elements of the implant assembly. Lower bone density (e.g., osteopenia, osteoporosis) corresponding to a T-score lower than −1, sacroiliac joint instability, or hypermobility may require the use of an implant assembly with a greater amount of keel (or a particular keel configuration) (i.e., the material cross section as defined by thickness of the keel and its length along implant longitudinal axis and also keels extending a greater distance into both bones defining the sacroiliac joint) and anchor extending across the sacroiliac joint and into the ilium and sacrum. Additionally, the relative angles between the implant longitudinal axis and anchor or anchors, and also the relative angles between multiple anchors (e.g., parallel, divergent, convergent) may be preselected based on the patient&#39;s anatomy. 
     A comparison of the preoperative or intraoperative data (e.g., sacroiliac joint surface area, joint mobility, loading, bone density, desirable anatomic pathways) and the selected implant assembly and joint preparation tools may be conducted to ensure or validate compatibility before the manufacture ships the implant system and/or before the surgeon employs the system in a surgical procedure. After implant assembly and preparation tools validation, the selected assemblies may be shipped to the surgeon and the surgeon may proceed with the surgical fusion procedure utilizing the selected assemblies. 
     Similarly, various aspects of the diagnostic tools (discussed herein) may be selected based on the same or similar data and/or studies. Additionally, placement of the various components of the diagnostic systems in to the sacroiliac joint region and/or the amount of displacement of one bone relative to another may be chosen or guided by one or more of the following: the anchor trajectory and placement may be guided and confirmed with imaging studies before the end of the surgical procedure or afterwards. For example, a surgeon may use fluoroscopy (and/or arteriography) to obtain an anteroposterior view, lateral view, an inlet view, an outlet-oblique view, Judet views of the pelvis, an internal (obturator) oblique view, a Ferguson view, an external (iliac) oblique view or other relevant views and further use radiographic boney landmarks such as the superimposed greater sciatic notches, superimposed iliac cortical densities or alar slope, sacral promontory, first sacral endplate, sacral foramina, arcuate sacral lines, iliopectineal line, ilioishial line, acetabular teardrop lines bony corridors of S1 or S2, superimposed acetabula, ventral and dorsal surfaces of the sacrum, etc.; or using an angiogram to identify vascular structures such as the superior gluteal artery, internal iliac artery and vein, iliolumbar vein, etc. 
     B. Fusion of the Sacroiliac Joint Via Implant Delivery 
     The following is an overview of the anatomy and methods of fusing the joint. To begin, reference is made to  FIGS. 5A-5B , which depict various bone landmarks adjacent, and defining, the sacroiliac joint  1000  of a patient  1001 . 
     Reference is first made to  FIG. 5A , which is a right lateral view of a hip region  1002  of a patient  1001  lying prone, wherein the soft tissue  1003  surrounding the skeletal structure  1006  of the patient  1001  is shown in dashed lines. Delivery of an implant into the sacroiliac joint  1000  and, thus, preparing of the joint  1000  for delivery of the implant may be conducted via a posterior approach to the hip region  1002 .  FIG. 5B , which is an enlarged view of the hip region  1002  of  FIG. 5A , depicts a lateral view of the patient&#39;s hip region  1002  and reveals certain features of the ilium  1005 , including the anterior superior iliac spine  2000 , the iliac crest  2002 , the posterior superior iliac spine  2004 , the posterior inferior iliac spine  2006 , the greater sciatic notch  2008  extending from the posterior inferior iliac spine  2006  to the ischial spine  2010 , and the tubercle of the iliac crest  2012 . 
     The sacroiliac joint articular region or intra-articular region  1044  is shown in dashed lines. The articular region  1044  is a portion of the sacroiliac joint  1000  formed between articular surfaces of the ilium  1005  and sacrum  1004 . The articular region  1044  is typically covered in a thin plate of cartilage and is surrounded by a fibrous capsule containing synovial fluid. 
     Boundaries of the sacroiliac joint articular region  1044  are as follows. A posterior inferior access region  2016  of the sacroiliac joint articular region  1044  has a superior end  2018  on the sacroiliac joint line  2019  that is between approximately 0 mm and approximately 40 mm inferior the posterior inferior overhang  2020  of the posterior superior iliac spine  2004 . The posterior inferior access region  2016  of the sacroiliac joint articular region  1044  has an inferior end  2022  on the sacroiliac joint line that is at approximately the intersection of the posterior inferior iliac spine  2006  with the lateral anterior curved boundary  2024  of the sacrum  1004 . In other words, the posterior inferior access region  2016  of the sacroiliac joint articular region  1044  has an inferior end  2022  on the sacroiliac joint line that is at approximately the superior beginning of the greater sciatic notch  2008 . 
     Still referring to  FIG. 5B , the sacroiliac joint articular region  1044  roughly defines an L-shape or boot-shape that includes a caudal region  1086  and a cranial region  1087 . Access into the caudal region  1086  of the sacroiliac joint may be accomplished via the posterior inferior access region  2016  that extends between corners defined by the superior end  2018  and the inferior end  2022 . Access into the cranial region  1087  may be accomplished by continual, anterior travel in the caudal region  1086  until the articular region  1044  turns superiorly into the cranial region  1087 . 
     To begin a discussion of implant delivery into the sacroiliac joint articular region  1044 , reference is made to  FIG. 5C , which is a close-up lateral side view of the hip region  1002  of a patient  1001  with a nearest ilium  1005  removed in order to show the sacroiliac joint boundary  3000  defined along the sacrum  1004  and outlining the sacroiliac joint articular region  1044 , and an implant  25  positioned for implantation within the sacroiliac joint articular region  1044 . 
     As seen in  FIG. 5C , boundaries along the sacroiliac joint articular region  1044  include an inferior boundary segment  3002 , an anterior boundary segment  3004 , a superior boundary segment  3006 , and a posterior boundary segment  3008 . The inferior boundary segment  3002  is immediately adjacent, and extends along, the sciatic notch  2024 . 
     The inferior boundary segment  3002  and anterior boundary segment  3004  intersect to form an anterior-inferior corner  3010 . The anterior boundary segment  3004  and superior boundary segment  3006  intersect to form an anterior-superior corner  3012 . The superior boundary segment  3006  and posterior boundary segment  3008  intersect to form a superior-posterior corner  3014 . The posterior boundary segment  3008  and posterior inferior access region  2016  intersect to form a superior-posterior corner  3016  of the posterior inferior access region  2016 . The inferior boundary segment  3002  and posterior inferior access region  2016  intersect to form an inferior-posterior corner  3018  of the posterior inferior access region  2016 . 
     The inferior boundary segment  3002  extends between corners  3010  and  3018 . The anterior boundary segment  3004  extends between corners  3010  and  3012 . The superior boundary segment  3006  extends between corners  3012  and  3014  and provides an access into the cranial portion  1087  of the sacroiliac joint. The posterior boundary segment  3008  extends between corners  3014  and  3016 . The posterior inferior access region  2016  extends between corners  3016  and  3018  and provides an access into the caudal region  1086  of the sacroiliac joint. 
     The posterior boundary segment  3008  separates the articular region  1044  and the extra-articular region  3007 , which includes the sacral fossa on the sacrum  1004  and the corresponding iliac tuberosity on the ilium  1005  and defined by the extra-articular region boundary  3009 . 
     In one aspect and as seen in  FIG. 5C , the implant  25  may be delivered via an implant arm  111  of a delivery tool into the caudal region  1086  of the sacroiliac joint articular region  1044 . As shown via the implant  25  and implant arm  111  shown in solid lines, in one embodiment, the implant  25  enters the posterior inferior access region  2016 , and is further advanced into the caudal region  1086  of the sacroiliac joint articular region  1044 , in an orientation such that the implant arm  111  and wide planar members  51  are in the joint plane and the longitudinally extending edge  3050  of the wide planar member  51  next to the inferior boundary segment  3002  is generally parallel to, and immediately adjacent to, the inferior boundary segment  3002 . Thus, the distal end  43  of the implant is heading generally perpendicular to, and towards, the anterior boundary segment  3004 . 
     As shown in  FIG. 5C  via the implant  25  and implant arm  111  shown in dashed lines, in one embodiment, the implant  25  enters the posterior inferior access region  2016 , and is further advanced into the caudal region  1086  of the sacroiliac joint articular region  1044 , in an orientation such that the implant arm  111  and wide planar members  51  are in the joint plane and the longitudinally extending edge  3050  of the wide planar member  51  next to the inferior boundary segment  3002  is somewhere between being generally parallel to the inferior boundary segment  3002  (as illustrated by the solid-lined implant  25  in  FIG. 5C ) or forming an angle AJ with the inferior boundary segment  3002  of up to approximately 50 degrees. Thus, the distal end  43  of the implant shown in dashed lines can be said to head anywhere from generally perpendicular to, and towards, the anterior boundary segment  3004  to heading generally towards the superior-anterior corner  3012 , or points in between. 
     In one embodiment, the implant  25  may be first directed into the joint space as illustrated by the solid-lined implant  25  in  FIG. 5C  after which the implant  25  is rotated within the joint space to be positioned somewhere between, and including, angled position depicted by the dashed-lined implant  25 . In other embodiments, the implant  25  may be first directed into the joint space as illustrated by the dashed-lined implant  25  in  FIG. 5C  after which the implant  25  is rotated within the joint space to be positioned somewhere between, and including, the parallel position depicted by the solid-lined implant  25 . Thus, an implant  25  may be delivered non-transversely (i.e., within the joint and not across the joint) into the caudal region  1086 , the cranial portion  1087 , or partially within each of the caudal and cranial regions  1086 ,  1087  of the sacroiliac joint articular region  1044 . Further details of the implant delivery can be found in related applications, mentioned previously, such as U.S. patent application Ser. No. 12/998,712, which is incorporated by reference herein in its entirety. 
     Reference is now made to  FIG. 5D , which depicts a close-up lateral view of the hip region  1002  of  FIG. 5C , except the implant is not shown. In particular,  FIG. 5D  shows additional anatomical features of the extra-articular region  3007  of the joint. As seen in the figure, the extra-articular region boundary  3009  has a caudal boundary segment  3093 , an anterior boundary segment  3094 , and a posterior boundary segment  3097 . The caudal boundary segment  3093  and the anterior boundary segment  3094  separate the intra-articular region  1044  and the extra-articular region  3007 . The posterior boundary segment  3097  is immediately adjacent and extends along the sacroiliac joint line  2019 . The caudal and anterior boundary segments  3093 ,  3094  intersect to form an anterior-inferior corner  3095 . The caudal boundary segment  3093  intersects with the posterior boundary segment  3097  to form a posterior-inferior corner  3091 . The anterior boundary segment  3094  of the extra-articular boundary  3009  intersects with the posterior boundary segment  3097  for form a posterior-anterior corner  3096 . 
     The sacroiliac extra-articular region  3007  has an extra-articular recess access region  6000 , which spans the posterior boundary segment  3097  and has an inferior end  3092  (i.e., generally coincident with posterior inferior corner  3091 ) and a superior end  3098  located near the posterior anterior corner  3096  along the sacroiliac joint line  2019 . 
     The extra-articular access region  6000  has an extra-articular posterior-inferior access region  6001  that has an inferior end  3092  along the sacroiliac joint line  2019 . The inferior end  3092  is generally coincident with the posterior inferior corner  3091 . The inferior end  3092  is immediately adjacent both the superior-posterior corner  3016  and the superior end  2018  of the posterior inferior access region  2016 . 
     Reference is now made to  FIGS. 5E-5F , which depict, respectively, a lateral-posterior view and a posterior view of the hip region  1002  of the patient  1001 . These figures include many of the anatomical features referred to in  FIGS. 5B-5C  and the some of the additional anatomical features described in  FIG. 5D . For example, the articular region  1044  and extra-articular region  3007  are shown in dashed line with many of their respective boundaries identified in each figure.  FIG. 5E  depicts the posterior inferior access region  3090  of the sacroiliac joint extra-articular region  3007  and inferior end  3092  of the extra-articular posterior inferior access on the sacroiliac joint line  2019 . The posterior inferior access region  2016  of the intra-articular region  1044  has the superior end  2018  on the sacroiliac joint line  2019  that is immediately adjacent the inferior end  3092  of the caudal boundary segment  3093  of the extra-articular region  3007 . 
     C. Preparing the Sacroiliac Joint for Fusion 
     Now that an overview of the relevant anatomical landmarks and an example fusion procedure has been described, the discussion may now focus on preparing the sacroiliac joint for a fusion procedure. In doing so, reference will be made to  FIGS. 6A-6D , among additional figures, which are steps in the methodology and illustrated in the same transverse cross section taken in along a plane extending medial-lateral and anterior posterior. In this cross section, articular surfaces  1016  are covered by a thick layer of articular cartilage with a joint space existing between them, the  FIGS. 6A-6D  are simplified for illustrative purposes and do not show these features to scale. 
     Now referring primarily to  FIG. 6A , an embodiment of the method can include the step of placing a patient under sedation prone on a translucent operating table (or other suitable surface). The sacroiliac joint  1000  can be locally anesthetized to allow for injecting a radiographic contrast  1046  (as a non-limiting example, Isoview 300 radiographic contrast) under fluoroscopic guidance into the inferior aspect of the sacroiliac joint  1000  to outline the articular surfaces  1016  of the sacroiliac joint  1000 ) defined between the sacrum  1004  and ilium  1005 , the sacroiliac joint  1000  having an interarticular region  1044 . Injection of the radiographic contrast  1046  within the sacroiliac joint  1000  can be accomplished utilizing a tubular member  1047  (e.g., a syringe needle) having first tubular member end  1048  which can be advanced between the articulating surfaces  1016  of the sacroiliac joint  1000  and having a second tubular member end  1049  which removably couples to a hub  1050 . The hub  1050  can be configured to removably couple to a syringe barrel  1051  or other device to contain and deliver an amount of radiographic contrast  1046 . In the example of a syringe barrel  1051 , the syringe barrel  1051  can have an internal volume capable of receiving an amount of the radiographic contrast  1046  sufficient for outlining the articular surfaces  1016  of the sacroiliac joint  1000 , for example, under lateral fluoroscopy. A plunger  1052  can be slidingly received within the barrel  1051  to deliver the radiographic contrast  1046  through the tubular member  1047  into the sacroiliac joint  1000 . The tubular member  1047  can have a gauge in the range of about 16 gauge and about 20 gauge and can further be incrementally marked on the external surface to allow determination of the depth at which the first needle end  1048  has advanced within the sacroiliac joint  1000 . As the first needle end  1048  advances into the sacroiliac joint  1000  the radiographic dye  1046  can be delivered from within the syringe barrel  1051  into the sacroiliac joint  1000  to allow visualization of the sacroiliac joint  1000  and location of the tubular needle  1047  within the sacroiliac joint  1000 . 
     Now referring primarily to  FIG. 6B , once the first tubular member end  1048  has been sufficiently advanced into the sacroiliac joint  1000  and the articular surfaces  1016  of the sacroiliac joint  1000  have been sufficiently visualized, the hub  1050  can be removed from the tubular member  1047  leaving the tubular member  1047  fixed within the sacroiliac joint  1000  as an initial guide for tools subsequently used to locate or place the sacroiliac joint implant non-transversely between the articulating surfaces  1016  of the sacroiliac joint  1000  (e.g., locate the implant non-transversely to the joint plane  1030  generally defined by the articulating surfaces  1016  of the interarticular region  1044  of the sacroiliac joint  1000 ) or in removal of a portion of the sacroiliac joint  1000  within the region defined by the articular surfaces  1016  to generate an implant receiving space  1029 . Alternately, one or more guide pins  1013  can be inserted along substantially the same path of the tubular member  1047  for fixed engagement within the sacroiliac joint  1000  and used in subsequent steps as a guide(s). 
     Now referring primarily to  FIG. 6C , a small incision  1053  can be made in the skin at the posterior superior, or as to certain embodiments inferior, aspect of the sacroiliac joint  1000 , extending proximal and distal to the tubular member  1047  along the line of the sacroiliac joint  1000  to provide a passage to access the interarticular space between the articulating surfaces  1016  (see  FIG. 6B ) of the sacroiliac joint  1000 . More specifically, the small incision  1053  can be made along the joint line of the sacroiliac joint  1000  in the tissue covering the posterior inferior access region  2016  of the sacroiliac joint articular region  1044 . A cannulated probe  1054  can be slidingly engaged with the tubular member  1047  (or guide pin  1013 ) extending outwardly from the sacroiliac joint  1000  (while the sacroiliac joint may be shown in the figures as being substantially linear for illustrative purposes, it is to be understood that the normal irregular features of the sacroiliac joint have not been removed). The cannulated probe  1054  can have a probe body  1054  of generally cylindrical shape terminating in a spatulate tip  1055  at the end advanced into the sacroiliac joint  1000 . A removable cannulated probe handle  1056  couples to the opposed end of the probe body  1054 . The spatulate tip  1055  can be guided along the tubular needle  1047  or guide wire  1013  into the posterior portion of the sacroiliac joint  1000  and advanced to the anterior portion of the sacroiliac joint  1000  under lateral fluoroscopic visualization. The cannulated probe handle  1056  can then be removed providing the generally cylindrical probe body  1054  extending outwardly from the sacroiliac joint  1000  through the incision  1053  made in the skin. 
     Alternatively, the probe  1054  can be used to guide, advance or place a needle, guide wire or other instrument up to, near, or into the joint. 
     Additionally, in particular embodiments, probe handle  1056  or the opposed end of the probe body  1054 , or both, can be configured to have an interference fit or a luer lock hub to communicate with a syringe barrel  1051  in order to advance contrast, in situ curable biocompatible materials, stem cells, or etc. through the cannulated probe  1054  or cannulated probe handle  1056 . 
     Now referring primarily to  FIG. 6D , a passage from the incision  1053  (see  FIG. 6C ) to the sacroiliac joint  1000  can be generated by inserting a cannula  1057  into the incision. A soft tissue dilator  1058  having a blunt end  1059  can be advanced over the probe body  1054 , or a plurality of soft tissue dilators of increasing size, until the blunt end  1059  of the soft tissue dilator  1058  and the corresponding cannula end contact the posterior aspect of the sacroiliac joint  1000 . More specifically, in one embodiment, the ends of the dilator  1058  and cannula  1057  contact the joint line  2019  of the sacroiliac joint  1000  at the posterior inferior access region  2016  of the sacroiliac joint articular region  1044 . The soft tissue dilator  1058  can be removed from within the cannula  1057 . The external surface of the cannula  1057  can be sufficiently engaged with the surrounding tissue to avoid having the tissue locate within the hollow inside of the cannula  1057 . A non-limiting embodiment of the cannula  1057  provides a tubular body having substantially parallel opposed side walls which terminate in a radius at both ends (lozenge shape) into which a plurality of different jigs can be inserted. Alternatively, as a non-limiting example, according to particular embodiments, cannula  1057  and corresponding dilators  1058  and alignment jigs  1060  can be configured to have tubular bodies with an elliptical or circular cross section. 
     In some embodiments, the cannula  1057  may be additionally configured to have within or near its walls a light source such as, for example, a fiberoptic or a LED light source to assist in visualization of the working area. Also, in some embodiments, irrigation and suction tubing may communicate with the inside passage of cannula  1057 . 
     At this stage, additional tools and methods may be employed to provide access to the sacroiliac joint  1000  as described in U.S. patent application Ser. No. 13/475,695 filed May 18, 2012 entitled “SYSTEMS FOR AND METHODS OF FUSING A SACROILIAC JOINT”, Ser. No. 14/514,221 filed Oct. 15, 2015 entitled “SYSTEMS FOR AND METHODS OF PREPARING A SACROILIAC JOINT FOR FUSION,” and Ser. No. 16/133,605, filed Sep. 17, 2018, entitled “SYSTEMS FOR AND METHODS OF PREPARING AND FUSING A SACROILIAC JOINT”, all of which are hereby incorporated by reference in their entireties. For example, drill jigs may be further advanced over the probe body  1054  to align a drill or other joint preparation tool. Accordingly, the discussion will now focus on employing the tools and devices described in previous sections of this application. 
     In certain embodiments of the method, an amount of articular cartilage or other tissues from between the articular surfaces of the sacroiliac joint  1000  can be removed sufficient to allow embodiments of the sacroiliac joint implant to be implanted in replacement of the removed articular cartilage or tissue. Because the method removes the degenerative articular cartilage or tissue between the articular surfaces of the sacroiliac joint  1000 , the articular surfaces of the sacroiliac joint  1000  can remain intact or substantially intact allowing the sacroiliac joint implant to be non-transversely located between the articular surfaces of the sacroiliac joint  1000 . 
     Understandably, other instruments can be utilized separately or in combination during the course of any of the steps of the methodology, e.g., for the removal of articular cartilage or tissue between articular surfaces, such as any of the tools previously described or any of: endoscopy tools, box chisels, side cutting router bits, burs, flexible burs and bits, hole saws, key hole saw, medical bone chainsaw osteotome, curettes, lasers (e.g., C02, Neodymium/Y AG (yttrium-aluminum-garnet), argon, and ruby), electrosurgical equipment employing electromagnetic energy (the cutting electrode can be a fine micro-needle, a lancet, a knife, a wire or band loop, a snare, an energized scalpel, or the like) where the energy transmitted can be either monopolar or bipolar and operate with high frequency currents, for example, in the range of about 300 kHz and about 1000 kHz whether as pure sinusoidal current waveform where the “crest factor” can be constant at about 1.4 for every sinus waveform, and a voltage peak of approximately 300 V to enable a “pure” cutting effect with the smallest possible coagulation effect or as amplitude modulated current waveforms where the crest factor varies between 1.5 and 8, with decreasing crest factors providing less of a coagulation effect. Electrosurgical waveforms may be set to promote two types of tissue effects, namely coagulation (temperature rises within cells, which then dehydrate and shrink) or cut (heating of cellular water occurs so rapidly that cells burst). The proportion of cells coagulated to those cut can be varied, resulting in a “blended” or “mixed” effect. Additionally, a fully rectified current, or a partially rectified current, or a fulguration current where a greater amount or lateral heat is produced can be employed to find the articular surfaces of the joint and aid in advancing a probe or guide wire into a position in between the articulating surfaces. These currents can effectively degrade the cartilage and allow advance into the joint without grossly penetrating much beyond the cartilage. 
     III. Tools, Systems, and Methods for Diagnosing and Treating the Sacroiliac Joint 
     The following discussion will focus on various tools, systems, and methods of diagnosing and treating a sacroiliac joint ailment or disorder. The tools, systems, and methods may be useful in determining if fusion of the sacroiliac joint may be beneficial to a patient by, for example, alleviating pain. The tools and systems may be used to isolate the bones in the pelvic region such that manipulation of the bones (e.g., sacrum, ilium) can more easily, accurately, and efficiently diagnose the sacroiliac joint as a source of pain and discomfort. Upon diagnosing the sacroiliac joint as a source of pain and fusion as a possible solution, the joint may be temporarily or permanently fixated. The following discussion will focus on the tools, systems and methods of diagnosing and treating a sacroiliac joint disorder or ailment. 
     A. Diagnostic Pins, Rods, or Bars 
       FIGS. 7A-7F  illustrate diagnostic pins, rods, or bars  50  for use in diagnosing an ailment of a sacroiliac joint of a patient. The diagnostic pins  50  may be manipulated to cause movement of the sacrum and/or ilium, which may reproduce the pain in the patient or alleviate the pain in the patient (e.g., may realign the sacroiliac joint). In either scenario and depending on the particular manipulation, reproducing or alleviating the pain may suggest a need for fusing the joint via, for example, an implant. If the movement induced in the joint does not reproduce the pain in the patient, the diagnostics may suggest that the pain may come from areas other than the sacroiliac joint, such that fusion of the sacroiliac joint may not help to reduce the patient&#39;s pain. For these reasons, among others, the diagnostic method described herein may eliminate unnecessary implantation and trauma to the sacroiliac joint. 
     The diagnostic pins  50  may be caused to rotate or translate, which may cause movement of the sacrum and ilium about the joint. For example, one pin  50  may be placed in the sacrum while the other pin  50  may be placed in the ilium. The movement of the sacrum and ilium may vary depending upon the locations of the diagnostic pins or bars  50  and direction of the force. If the pin  50  is positioned on (or in) the caudal region of the sacrum and pushed anteriorly, the cephalad portion sacrum may rotate toward the posterior direction. If the pin is placed near the first sacral body (i.e., a cephalad portion of the sacrum) and a force is directed anteriorly, the cephalad portion of the sacrum may rotate toward the posterior direction. One pin may be placed in the ilium near the intra-articular region or extra-articular region of the joint. 
     Referring to  FIGS. 7A-7D , which are respective isometric, front, back, and side views of the pin  50 , the pin  50  may include an elongated body  52  extending between a distal end  54  and a proximal end  56 . In some embodiments, the distal end  54  may be tapered and include threads  60  that terminate at a point  58  such that the pin  50  may be rotationally driven into the bone. In certain embodiments, the threads  60  may be self-tapping threads. The distal end  54  may have a smaller cross-section than the proximal end  56 . It will be appreciated by those skilled in the art that the cross-section of pins or bars  50  may be generally circular, oval, square, rectangular or triangular in shape. 
     As seen in the figures, the elongated body  52  includes longitudinally extending and radially projecting ridges  62  that extend from the proximal end  56  to the threads  60  near the distal end  54  of the pins  50 . The ridges  60  provide grip for the pins  50  when grasped by a medical professional or a mechanical device. Alternatively, the pins may be configured with a high-friction surface. 
     As one non-limiting example, the elongate body  52  may have a diameter of in the range of about 3 millimeters (“mm”) to about 8 mm (e.g., 6 mm) and a length disposed between the proximal and distal ends  56 ,  54  in the range of about 2 centimeters (“cm”) and about 20 cm. Pin length measurements may be marked along the length of the pin  50 . 
     The pin  50  proximal end  56  may have a tool interface configured to permit, e.g., a handle or other tool to couple to the elongate body  52 . 
     As to particular embodiments of the pin  50 , the elongate body  52  can further include a cannulation which communicates between the distal end  54  and the proximal end  56 . The cannulation allows for placement within the cannulation a guide pin (or other guide member) about which embodiments of the pins  50  can be guided for insertion and placement in the bones of the sacrum  1004  or ilium  1005 , or allow injection of analgesics. 
     Reference is made to  FIG. 7E , which is an isometric view of a pin guidance tool  520  for guiding the placement of the pins  50  within the sacrum and ilium, respectively. The tool  520  includes a guidance head  522  with three cylindrical openings  524  on a left side  526  of the head  522  and three cylindrical openings  524  on a right side  528  of the head  522 . The tool  520  further includes a handle  530  coupled and extending from the guidance head  522 . The tool  520  is configured to guide one or more pins  50  within the openings  524  into the sacrum or ilium. When used to guide multiple pins  50 , the pins will be delivered parallel to each other and with a predetermined amount of space or distance between the placements. For example, a first pin may be guided along trajectory TR 1  into the sacrum and a second pin may be guided along another trajectory TR 2  into the ilium. The doctor or medical professional can be assured that the pins are parallel to each other and spaced apart a certain, known, distance. While this example and the figure shows the trajectories TR 1 , TR 2  utilizing the most inner openings  524 , the tool  520  may be used with other combinations of openings  524  without limitation. 
     Referring to  FIG. 8A , which is an isometric view of another embodiment of the pin  50 , the pin  50  may include a similar proximal end  56  and elongated body  52  with ridges  62  that was previously described in reference to  FIGS. 7A-7D . The pin  50  of  FIG. 8A  may, however, include a blunt distal end  64  instead of a threaded  60  distal end  54  that terminates at a point  58 . The blunt distal end  64  may include, for example, a planar distal surface  66  that may conform to the surface features of the bone or may simply be configured to not penetrate or minimally penetrate into the boney surfaces of the sacrum or ilium upon contact. The planar distal surface  66  may include surface features such as ridges or points that are configured to grip the bone surfaces upon contact. For example, as seen in  FIG. 8B , the planar distal surface  66  may include a threaded distal end  54  that extends through the planar distal surface  66  and distally terminates at a point  58 . Other variations to the pin  50  are contemplated herein and may include any type and kind of blunt distal end that is not designed to extend into the patient&#39;s bone upon application of a force. Alternatively, the distal end  64  may include surface contours that match the bones of the ilium and sacrum so as to provide a mating surface with which to apply force against. 
     With the blunt distal end  64 , the medical professional may position the pin  50  in various orientations and on various boney landmarks to manipulate the sacrum and ilium without boring multiple holes into the patient&#39;s bone. Thus, the medical professional can attempt multiple different kinds and styles of manipulation prior to or instead of boring holes into the patient&#39;s bone. 
     Another embodiment of the pin  50  is shown in  FIG. 9 . As seen in the figure, the pin  50  includes a planar, plate member  64  at the distal end  54  with a pair of openings  66  extending transversely or across the plate member  64 . The pin  50  may be used in conjunction with an anchor guide  68  that may guide anchors  70 , such as bone screws, into the openings  66  of the plate member  64  when a sleeve  72  of the anchor guide  68  extends over the elongated body  52  of the pin  50 . The anchor guide  68  may further include an extension member  74  extending from the sleeve  72  to a pair of guides  76  that are configured to align a trajectory TJ of the anchors  70  across the plate member  64  and into the openings  66  when the sleeve  72  is positioned on the elongated body  52 . A shaft of a delivery tool (not shown) may be guided by the guides  76  to deliver the anchors  70  into the openings  66 . 
     The pin  50  and anchor guide  68  shown in  FIG. 9  may be delivered into a patient&#39;s pelvic region and positioned such that the plate member  64  lies generally parallel with a posterior lateral surface of the ilium, for example. The openings  66  of the plate member  64  may be oriented on the ilium such that a trajectory of the anchors  70  is across either the intra-articular region or the extra-articular region of the sacroiliac joint and into the sacrum. Once positioned adjacent the ilium, the anchors  70  may be delivered via the anchor guide  68  into the openings  66  and into the ilium. At this point, the pin  50  may be manually manipulated by a medical professional with his or her hands or with the aid of a diagnostic tool that grasps the pin  50 . The pin  50  may, for example, facilitate nutation and counternutation of the ilium and sacrum, flexing and compression of the joint, or other manipulations of the bones and joint. 
     Upon determining that the joint requires fusion, the anchors  70  may be threadably released from the ilium and the pin  50  may be removed from the patient&#39;s pelvic region. If fusion by the anchors  70  is suitable for the particular patient and the ailment, the anchors  70  may be re-inserted into the ilium and further advanced across the sacroiliac joint and into the sacrum. 
     The plate member  64  may include a releasable feature (not shown) that releases the anchors  70  from being positioned within the openings  66  such that the anchors  70  do not need to be threadably released from the ilium prior to re-inserting them back into the ilium and, then, across the joint and into the sacrum. The releasable feature may be that the plate member  64  includes two longitudinally extending members that come together at the openings  66  in a scissor-like fashion. In a deployed state, the plate member  64  may close such that the member  64  appears as shown in  FIG. 9 . In a non-deployed state, the plate member  64  may open in the scissor-like fashion such that two longitudinally extending members separate and, thus, the pin  50  and the plate member  64  may be retracted from the anchors  70  without removing the anchors  70  from the bone. 
     While the pin  50  in  FIG. 9  is shown as having a plate member  64  at a distal end  54  of the pin  50 , the pin  50  may be differently configured. For example, the pin  50  may be as described with reference to  FIGS. 7A-7D  and further include one or more openings  66  extending through a distal end  54  of the pin  50 . That is, the openings  66  would extend through a cylindrical portion of the pin  50 , either through the tapered threaded portion or the elongated body portion having the ridges  62 . 
     Alternatively, the plate may be releasably coupled to the pin  50  and left in place after the diagnostic procedure. 
     The pins  50  may be used individually, in pairs, or in other combinations. The following discussion will focus on the placement of the previously described pins  50  in the sacrum and ilium. Then, there will be a discussion of manipulating the pins to diagnose an ailment of the joint. 
     B. Positioning and Delivery of the Pins in the Sacrum and Ilium 
     Reference is now made to  FIGS. 10A-10E , which show multiple views of positioning and delivery the pins into the sacrum and ilium. 
     In certain instances, such as when the pins  50  may be used to guide a temporary implant into the extra-articular region  3007 , it may be beneficial to deliver the pins  50  into the sacrum and ilium in regions of the respective bone that are medial or lateral (i.e., immediately adjacent) of the extra-articular region  3007  of the sacroiliac joint. That is, the pins may be delivered into the sacrum and ilium superior of the intra-articular region  1044 . In other instances and possibly depending on the configuration of the temporary implant, it may be beneficial to deliver the pins  50  into the sacrum and ilium in regions of the bone that are immediately adjacent the intra-articular region  1044 . The ilium is generally harder in the region of the intra-articular region, so there may be advantages in certain instances to delivering the pins  50  in this region. 
     To begin, reference is made to  FIG. 10A , which is a posterior view of the hip region  1002  of the patient  1001  with a pin  50  in each of the sacrum  1004  and the ilium  1005 . As seen in the figure, the pin  50  may be posteriorly delivered into a patient  1001  with a generally anterior trajectory. In doing so, the pin  50  may extend through the soft tissue  1003  of the patient  1001  and extend into the hip region  1002  via tissue penetration in a superior region of the patient&#39;s buttock. The pin  50  in the ilium may be oriented immediately lateral of the posterior inferior access region of the extra-articular region  3007  of the joint  1000 . The pin  50  in the sacrum may be oriented inferior and lateral of the superior articular facet and lateral of the median sacral crest. 
     Turning to  FIG. 10B , which is a lateral side view of the hip region  1002  with a nearest ilium removed from view to more clearly see the intra-articular region  1044  and the extra-articular region  3077 , the pin  50  may be delivered into the sacrum  1004  or ilium  1005  immediately adjacent the posterior inferior access region  3090  of the extra-articular region of the joint  1000 . As seen in the figure, the pin may include a trajectory TJ 1  within a range of degrees AJ while still penetrating the bone immediately adjacent the posterior inferior access region  3090 . In certain embodiments, the range of degrees AJ may be 20 degrees, 30 degrees, 50 degrees, or 60 degrees, among others. 
     As seen in  FIG. 10C , which is a cross-sectional view, generally in a coronal plane, of the extra-articular region  3007  and the intra-articular region  1044  of the sacroiliac joint, one pin  50  is positioned in the ilium  1005  immediately adjacent the extra-articular region  3007  and one pin  50  is positioned in the sacrum  1004  immediately adjacent the intra-articular region  1044 . The pin  50  in the sacrum  1004  may also be positioned superiorly such that it would be parallel with the pin  50  in the ilium  1005  and a line connecting the pins would be generally perpendicular to a plane of the sacroiliac joint  1000 . Additionally, the pin  50  in the ilium  1005  may also be positioned inferiorly such that it would be parallel with the pin  50  in the sacrum  1004  and a line connecting the pins would be generally perpendicular to a plane of the sacroiliac joint  1000 . 
     Reference is now made to  FIG. 10D , which is a transverse cross-section of the sacrum  1004  and ilium  1005  viewed superiorly showing a pin  50  positioned in the sacrum  1004 . As seen in the figure, the longitudinal axis LCA 2  of the elongate body  52  of the pin  50  may be generally parallel to the joint line  1030  of the sacroiliac joint  1000 . In this embodiment, the longitudinal axis LCA 2  may be offset from the joint line  1030  by a distance at a proximal portion of the joint DP-SIJ. In certain embodiments, the distance DP-SIJ may be about 0.5 centimeter (“cm”), 1 cm, 1.5 cm, 2 cm, 3 cm, 4 cm, 5 cm, or 6 cm, among others. And the distance DP-SIJ may be within a range of about 0.5 cm to about 6 cm. In this embodiment, the longitudinal axis LCA 2  may be offset from the joint line  1030  by a distance at a distal portion of the joint DD-SIJ. In certain embodiments, the distance DD-SIJ may be about 0.5 centimeter (“cm”), 1 cm, 1.5 cm, 2 cm, 3 cm, 4 cm, 5 cm, or 6 cm, among others. And the distance DD-SIJ may be within a range of about 0.5 cm to about 6 cm. 
     Alternatively and as seen in the dashed line pin  50 , the longitudinal axis LCA 2  of the elongate body  52  of the pin  50  may be generally offset to the joint line  1030  of the sacroiliac joint  1000  by a certain degree OA. The certain degree may be between about 5 degrees and about 50 degrees, in certain embodiments. In other embodiments the certain degree may be about 5 degrees, 10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees, 40 degrees, 45 degrees, or 50 degrees, among others and may include being directed medially (as shown in the figures) or laterally (while not crossing the sacroiliac joint). 
     As another alternative of an angled placement of the pin  50  relative to the joint line  1030 , as seen in  FIG. 10E , which is the same view of the sacrum  1004  and ilium  1005  as in  FIG. 10C , the pin  50  in dashed line may penetrate the sacrum  1004  such that the longitudinal axis LCA 2  of the elongate body  52  extends a greater angle relative to the pin  50  that is positioned parallel to the joint line  1030 . 
     Although not shown in  FIGS. 10D and 10E , the pin  50  in the ilium may be parallel to the joint line, directed laterally or even medially, or generally parallel to an ilium outer cortex. 
     As an example of possible pin placements in the pelvic region, a first pin having a tapered and threaded distal end may be posteriorly delivered into the ilium just lateral of the extra-articular region of the sacroiliac joint (i.e., an upper or superior region defined between the posterior inferior iliac spine  2006  and the posterior superior iliac spine  2004 , as seen in  FIG. 10A ). A second pin having a tapered and threaded distal end may be posteriorly delivered into the sacrum, between the lateral sacral crest ( 1007  in  FIG. 10A ) and the joint line of the joint. 
     As another possible example of pin placements in the pelvic region, a first pin having a tapered and threaded distal end may be posteriorly delivered into the ilium just lateral of the intra-articular region of the sacroiliac joint (i.e., a lower or inferior region defined between the posterior inferior iliac spine  2006  and the posterior superior iliac spine  2004 , as seen in  FIG. 10A ). A second pin having a tapered and threaded distal end may be posteriorly delivered into the sacrum, between the lateral sacral crest ( 1007  in  FIG. 10A ) and the median sacral crest ( 1009  in  FIG. 10A ). 
     As another possible example of pin placements in the pelvic region, a first pin having a tapered and threaded distal end may be posteriorly delivered into the ilium just lateral of the intra-articular region of the sacroiliac joint (i.e., a lower or inferior region defined between the posterior inferior iliac spine  2006  and the posterior superior iliac spine  2004 , as seen in  FIG. 10A ). A second pin having a blunt distal end may be posteriorly positioned against the sacrum, between the lateral sacral crest ( 1007  in  FIG. 10A ) and the posterior sacral foramina ( 1011  in  FIG. 10A ). Or, the second pin may be positioned against the lateral sacral crest. 
     As another possible example of pin placements in the pelvic region, as seen in  FIG. 10F , which is a posterior view of the hip region  1002  of the patient  1001 , a first pin  50  having a tapered and threaded distal end may be posteriorly delivered into a right side ilium  1005 R just lateral of the extra-articular region of the sacroiliac joint (i.e., an upper or superior region defined between the posterior inferior iliac spine  2006  and the posterior superior iliac spine  2004 , as seen in  FIG. 10A ). A second pin  50  having a tapered and threaded distal end may be posteriorly delivered into a left side ilium  1005 L just lateral of the extra-articular region of the sacroiliac joint (i.e., an upper or superior region defined between the posterior inferior iliac spine  2006  and the posterior superior iliac spine  2004 , as seen in  FIG. 10A ). In this example, the two pins  50  are delivered into opposite iliums  1005 R,  1005 L. Thus, the joints may be manipulated without delivering a pin  50  into the sacrum  1004 . Since the sacrum  1004  is a softer bone than the ilium  1005 R,  1005 L, this example of pin  50  placement may be useful in certain patients with an especially soft or brittle sacrum  1004 . 
     Reference is now made to  FIG. 10G , which is a posterior view of a pelvic region of a patient with a distractor  500  positioned between a pair of pins  50  positioned in opposing iliums  1005 L,  1005 R. As seen in the figure, the pins  50  may include anchors  502  extending through a plate member  504  at a distal end of the pins  50 . The pins  50  may be positioned such that the anchors  502  extend through openings in the plate member  504  and extend into an inner cortex of the ilium near the posterior superior iliac spine  2004 . The pins  50  may couple with an extension rod  508  spanning the sacrum  1004  via adjustable couplers  510  that may be variably fixed on the length of the pins  50 . The extension rod  508  may be a cylindrical rod having a spring  512  engaged with a thumb-wheel  506  that may be movably adjusted along the extension n rod  508 . The spring  512  may bias the thumb-wheel  506  to the right. One of the couplers  510  (on right ilium  1005 R) may slidably couple the extension rod  508  and the pin  50  such that as the distractor  500  is positioned between the coupler  510  on the right and the thumb-wheel  506 , outward distraction of the arms of the distractor  500  causes a distance between the thumb-wheel  506  and the coupler  510  on the right to increase so as to also increase a distance between the pins  50  (i.e., and the opposing ilium). 
     As opposed to distracting the joints via pins  50  positioned in the ilium  1005 , the pins  50  may be used to compress the joint. As seen in  FIG. 10H , which is a posterior view of a pelvic region of a patient with a pair of pins  50  positioned in opposing ilium  1005 R,  1005 L, the sacroiliac joint may be compressed with similar tools and methods as described with reference to  FIG. 10G , except the pins  50  may be positioned against the outer cortex of the ilium  1005 R,  1005 L or against both the inner and outer cortex (“sandwich PSIS”). As seen in  FIG. 10H , the pins  50  are similar to those described in reference to  FIG. 10G . That is, the pins  50  include the plate member  504  at a distal end and are secured to the ilium via anchors  502  extending through openings in the plate member  504  and into the bone. As seen in the figure, the anchors  502  extend into the ilium on the outer cortex. A device for compressing the joint is not shown in this figure, but may be similar to that shown in  FIG. 10G , except the tool may be configured to compress the joint, as opposed to distract the joint. 
     While not depicted in the figures, the system and methods described in reference to  FIGS. 10G-10H  can be combined to sandwich the posterior superior iliac spine  2004  and provide for distraction or compression, as desired for the particular diagnosis. 
     Reference is now made to  FIG. 10I , which is a posterior view of the lumbar spine showing pins  50  to either stabilize or selectively allow motion between segments L4, L5 of the spine. As seen in the figure, pins  50  or anchors may be delivered into the spinal segments at, for example, the pedicles  540 , which are medial of the transverse process  544 . Further, an extension member  542  may be coupled with the pins  50  via a coupler (not shown) to link the segments of the spine. In this way, upon manipulation of the patient&#39;s sacrum and ilium, the segments of the spine will be linked to either: stabilize the segments of the spine; or allow relative motion between certain segments of the spine. In stabilizing the spine, the pins  50  and extension members  542  may be rigidly coupled via the couplers such forces transferred via manipulation of the sacroiliac joint are not concentrated on any one spinal segment. Rather, the forces are distributed in order to further isolate the movements of the sacrum and ilium, respectively, for diagnosing purposes. Alternatively, certain segments of the spine may be allowed certain movements relative to each other. 
     As seen with the most inferiorly placed pin  50 , the pin  50  and extension member  542  construct may link with the a pin positioned in the ilium (not shown) for further manipulation of the sacroiliac joint. 
     C. Using the Pins to Mobilize the Sacroiliac Joint for Diagnostic Purposes 
     The sacroiliac joint or, more particularly, the sacrum and the ilium may be difficult to manipulate because of the vast array of ligaments surrounding the sacrum and ilium. Additionally, the joint may be difficult to diagnose as a source of pain since manual manipulating the joint may cause movement and pain or discomfort in other areas of the body. 
     With the diagnostic system described herein, the movements of the ilium and sacrum may be isolated from movement of other parts of the body (e.g., the spinal column) to provide for a more accurate diagnosis of a sacroiliac joint ailment. Additionally, the present disclosure provides a diagnostic system that may be effective in mobilizing the joint to determine if pain can be activated or alleviated, depending on the joint condition. The diagnostic system may include the use of the pins, previously described. The diagnostic system may also include one or more mechanical assemblies that assist in the movements of the pins or bars, including translational movements, rotational movements or combination of translational and rotational movements. The rotation of the diagnostic system may be controlled or limited to within a few degrees. The translational displacement or linear movement of the diagnostic system may be limited to within a few millimeters. 
     In some embodiments, the pins or bars described above may be inserted into the bones to cause the movement of the sacroiliac joint. In some embodiments, the pins may include a blunt distal end that is not inserted into the bones, but, rather, is pushed against the bones to cause the movement. In some embodiments, the screws may be used to cause the movement of the joint. In some embodiments, a combination of pins or screws may be used to cause the movement of the joint. 
     In some embodiments, opposing portions of a right and left ilium may be pushed or pulled against each other such that the joint is under tension or compression or rotation. 
     In some embodiments, the diagnostic system may also be used to cause movement of the sacroiliac joint to return to its natural position to release the pain of the patient. 
     Reference is made to  FIGS. 11-12D , which depict lateral side views of a hip region  1002  of a patient  1001  with a pin  50  positioned lateral of the lateral sacral crest  1007  of the sacrum  1004  and another pin  50  positioned in the ilium  1005  just lateral of and in an upper region of the iliac spine between the posterior superior iliac spine  2004  and the posterior inferior iliac spine  2006 .  FIG. 11  depicts a neutral position of the pins  50 , just after delivery into the sacrum  1004  and ilium  1005  and before any manipulation has taken place. In this particular embodiment, the pins  50  are delivered parallel to each other, although the pin  50  in the sacrum  1004  is positioned slightly inferior to the pin  50  in the ilium. In this neutral position, the pins  50  may be manipulated in a variety of ways to determine if the patient&#39;s pain can be alleviated or reproduced. 
     As an example of how manipulation of the pins may alleviate pain while indicating that fusion of the joint may be helpful in reducing pain, a patient may have a compressed joint that is causing pain during normal activities (e.g., standing, walking). Upon inserting the pins into the patient&#39;s bones, the neutral position may be the compressed state of the joint. Thereby, when the doctor applies a force (e.g., distractive force) to relieve the compressive force on the joint, the pain may be alleviated. In that case, fusing the joint may alleviate the compression on the joint and, thus, alleviate the patient&#39;s pain. 
     As an example of how manipulation of the pins may reproduce a patient&#39;s pain while indicating that fusion of the joint may be helpful in reducing pain long term, the patient may only experience pain the in joint upon certain movements (e.g., flexing at the hips, decubital, prone, and standing positions). Upon inserting the pins into the patient&#39;s bones with the patient lying prone on an examining table, for example, the patient may not experience a significant amount of pain. When the doctor manipulates the joint, however, the doctor may be able to manipulate the joint in such a way that causes the same pain in the patient that is experienced upon doing those certain movements (e.g., flexing at the hips, decubital, prone, and standing positions). Thus, the doctor was able to manipulate the joint in order to reproduce the pain and diagnose that a fusion procedure may be helpful in alleviating the patient&#39;s pain. 
     Turning again to  FIG. 11 , in the neutral state, the joint has not yet been manipulated by the doctor or medical professional. Upon manipulation of the sacrum or ilium, the joint will have a tendency to revert back to or spring back to the neutral state. 
     From the neutral state, the joint may be manipulated in a number of ways to either reproduce the patient&#39;s pain or alleviate the patient&#39;s pain. As seen in  FIG. 12A , which is the same view as  FIG. 11 , except the ilium  1005  is caused to move or translate anteriorly, a force F 1  is applied to the pin  50  in the ilium  1005 . The force F 1  could be applied by the medical professional with his or her hands or with the aid of a diagnostic tool. Alternatively, the force F 1  could be applied via a surgical robot. In order to isolate the force F 1  to the pin  50  in the ilium  1005 , a stabilizing or holding force S 1 , acting counter to the force F 1 , may be exerted on the pin  50  in the sacrum  1004 . The stabilizing force S 1  need not be actively pulled posteriorly, but be held at a constant force so as to isolate the movement of the ilium  1005  with respect to the sacrum  1004  and the rest of the upper body (e.g., spine). In certain instances, translating or moving the ilium anteriorly from the neutral state may reproduce or alleviate a patient&#39;s pain and indicate to the medical professional that fusion of the joint may be helpful in alleviating or lowering the patient&#39;s pain long-term. 
     In certain instances, for example, the ilium  1005  may have been posteriorly jammed or knocked out of a natural alignment. Thus, moving the ilium  1005  anteriorly may reduce the patient&#39;s pain as such movement would restore the natural alignment. 
     The force F 1  may be applied in the opposite, posterior direction, as well and as similarly described with reference to applying the force F 1  in an anterior direction. Applying the force F 1  in a posterior direction by pulling on the pin  50  in the ilium  1005  may be helpful in reducing or reproducing pain in the joint. 
     Turning to  FIG. 12B , which is the same view as  FIG. 11 , except the ilium  1005  is caused to move or translate in a cranial direction, a force F 2  is applied to the pin  50  in the ilium  1005 . The force F 2  could be applied by the medical professional with his or her hands or with the aid of a diagnostic tool. Alternatively, the force F 2  could be applied via a surgical robot. In order to isolate the force F 2  to the pin  50  in the ilium  1005 , a stabilizing or holding force S 2 , acting counter to the force F 2 , may be exerted on the pin  50  in the sacrum  1004 . The stabilizing force S 2  need not be actively pulled in a caudal direction, but be held at a constant force so as to isolate the movement of the ilium  1005  with respect to the sacrum  1004  and the rest of the upper body (e.g., spine). In certain instances, translating or moving the ilium  1005  in a cranial direction from the neutral state may reproduce or alleviate a patient&#39;s pain and indicate to the medical professional that fusion of the joint may be helpful in alleviating or lowering the patient&#39;s pain long-term. 
     In certain instances, for example, the ilium  1005  may have been jammed in a caudal direction so as to be out of a natural alignment. Thus, moving the ilium  1005  in a cranial direction may reduce the patient&#39;s pain as such movement would restore the natural alignment. 
     The force F 2  may be applied in the opposite, caudal direction, as well and as similarly described with reference to applying the force F 2  in the cranial direction. Applying the force F 2  in a caudal direction by pushing on the pin  50  in the ilium  1005  may be helpful in reducing or reproducing pain in the joint. 
     The pins  50  may be moved or translated apart while keeping them parallel by, for example, using a tool that grasps the pins at multiple points along the elongated body  52 . That is, the multiple contact points on each arm of the tool would counteract the bending moment caused by the joint resisting the movement. 
     Referring now to  FIGS. 12C-12D , the ilium  1005  may be pivoted or rotated relative to sacrum  1004  via the pins  50  placed in the ilium  1005  and sacrum  1004 . As seen in  FIG. 12C , which is the same view as  FIG. 11 , except the ilium  1005  is caused to pivot or rotate in a posterior direction (i.e., nutation of sacrum  1004 ), a force F 3  is applied to the pin  50  in the ilium  1005 . The force F 3  could be applied by the medical professional with his or her hands or with the aid of a diagnostic tool. Alternatively, the force F 3  could be applied via a surgical robot. In order to isolate the force F 3  to the pin  50  in the ilium  1005 , a stabilizing or holding force S 3 , acting counter to the force F 3 , may be exerted on the pin  50  in the sacrum  1004 . The stabilizing force S 3  need not be actively pulled or pushed in a cranial direction, but be held at a constant force so as to isolate the movement of the ilium  1005  with respect to the sacrum  1004  and the rest of the upper body (e.g., spine). In certain instances, pivoting or rotating the ilium  1005  in a posterior direction from the neutral state may reproduce or alleviate a patient&#39;s pain and indicate to the medical professional that fusion of the joint may be helpful in alleviating or lowering the patient&#39;s pain long-term. 
     In certain instances, for example, the ilium  1005  may have been jammed or damaged so as to be out of a natural alignment. Pivoting or rotating the ilium  1005  in a posterior direction may reduce the patient&#39;s pain as such movement would restore the natural alignment. 
     The force F 3  may be applied in the opposite, anterior direction (i.e., counternutation of sacrum  1004 ), as seen in  FIG. 12D , as similarly described with reference to applying the force F 3  so as to rotate the joint in a posterior direction. Applying the force F 3  in an anterior direction by pushing on the pin  50  in the ilium  1005  may be helpful in reducing or reproducing pain in the joint. 
     The particular manipulations of the joint via the pins  50  described above in reference to  FIGS. 11-12D  are merely exemplary of pin placements in the sacrum  1004  and ilium  1005  and are merely exemplary of possible manipulations to the joint. Other pin placements and manipulations are possible and contemplated herein. As seen in  FIG. 13A , which is the same view as  FIG. 11 , except multiple possible pin placement locations are depicted, the pins  50  may be placed in a number of locations on the sacrum  1004  and ilium  1005  to manipulate the joint. As seen in the figure and referring first to the ilium  1005 , a pin  50 A may be positioned near the posterior superior iliac spine  2004 , a pin  50 B may be positioned prominently in the wing of the ilium (gluteal surface), or a pin  50 C may be positioned near the posterior inferior iliac spine  2006 , among other possible placements of the pin  50 . 
     Referring to placements of the pin  50  in the sacrum  1004 , a pin  50 D may be positioned near a superior region of the lateral sacral crest  1007  near the sacral tuberosity, a pin  50 E may be positioned near a middle region of the lateral sacral crest  1007 , or a pin  50 F may be positioned near an inferior region of the lateral sacral crest  1007 . It is noted that in regions of the sacrum  1004  with softer and/or thinner bone, it may be advantageous to use a pin  50  with a blunt distal end. 
     It is noted that the manipulations of the joint described in reference to  FIGS. 11-12D  may be accomplished using any of the previously described pins  50  in  FIGS. 7-9 . 
     D. Using the Pins to Stabilize the Sacroiliac Joint 
     Upon diagnosing the sacroiliac joint as a source of pain and determining that fusing the joint may be helpful in alleviating the pain, the doctor has a number of choices for the fusion procedure. A temporary or permanent implant may be implanted into the joint with or without the use of the pins as a guide. Another approach is to use the pins or a portion thereof as a temporary implant to assist in determining if the implant helps release the pain of the patient. 
     In some embodiments, the pins or merely a distal portion of the pins may be mechanically coupled together by a mechanical assembly to help stabilize the joint. The pins may be short enough such that they are less disturbing to the patient&#39;s activities, as the pins are not used for causing movements of the joint. The patient may monitor his or her reaction to pain with the temporary pins or implants. When the patient&#39;s pain is reduced, this may suggest that the joint movement may be a root cause for the pain and stabilization of the joint by using an implant may help to permanently reduce the pain. 
     Reference is made to  FIG. 13B , which is a lateral view of the hip region  1002  of the patient  1001  with a distal portion  78  of the pins  50  coupled together with a coupling member  80 . The proximal portion (not shown) of the pins  50  may be releasable or detachable from the distal portion  78  of the pins  50  such that after manipulation of the joint with both the distal and proximal portions of the pins  50 , the proximal portions may be removed from the pins  50  leaving the distal portion  78  still implanted in the sacrum  1004  and ilium  1005 . The distal portion  78  may release from attachment with the proximal portion via a threaded connection or other mechanisms. The coupling member  80  may couple the distal portions  78  together close to the patient&#39;s bones so that the pins  50  do not extend out of the patient&#39;s skin. 
     Temporarily stabilizing the joint in this way allows for a determination if permanent stabilization is likely to be effective in reducing pain in the long-term. Since this method does not destroy or otherwise alter the capsule or cartilage of the sacroiliac joint, the distal portion  78  of the pins  50  and the coupling member  80  can be utilized and later removed without damage to the joint. 
     E. Diagnostic Tools Utilizing the Pins, Rods, or Bars 
     1. Diagnostic Tools and Systems for Causing and Controlling Translational Movement 
     A diagnostic system may include a first elongated member and a second elongated member extending along a longitudinal axis. The elongate members may be the pins or bars, described previously. Each of the members has a distal end that can be delivered into the sacrum and the ilium via a posterior approach, as described above. The diagnostic system may also include a mechanical coupling assembly coupled between the elongated members. The mechanical coupling assembly may be configured to allow one of the elongated members to translate or rotate relative to the other elongated member, such that forces and directions of the forces applied by the elongated members to the sacrum and the ilium can be manipulated to determine a treatment plan. 
     The diagnostic system isolates manipulations of the sacrum and ilium such that a doctor can more accurately determine if the pain in a patient originates from the sacroiliac joint. If the joint causes the pain in the patient, the treatment plan or method may include inserting an implant into the joint to help temporarily stabilize the joint. The treatment plan or method may also include injecting a bio-based fusion material in the joint to aid in the fusion of the joint. 
       FIG. 14  is a front isometric view of a diagnostic system including a mechanical coupling assembly coupled between a pair of diagnostic pins in accordance with embodiments of the present disclosure. This diagnostic system can cause the diagnostic pins to move linearly within a plane defined by the pins by applying forces to the pins using the handles, as shown in  FIGS. 12A-12B . More particularly, the diagnostic system may be configured to move a pin linearly relative to the other pin, in a longitudinal direction of the pins. And, the diagnostic system may be configured to move a pin laterally away from the other pin while maintaining an orientation (e.g., parallel) with the other pin. The diagnostic system may control the forces of the pins and thus control the movement of the joint. 
     As shown in  FIG. 14 , a diagnostic system  5002  may include a pair of elongated members or pins  50 , which were previously described with reference to  FIGS. 7-9 . Each elongated member  50  may include a distal end  58  that can be inserted into the sacrum  1004  or ilium  1005  near the sacroiliac joint. Each elongated member  50  may also include a proximal end  56  where a mechanical coupling assembly  5004  may be coupled to the elongated member  50 . The elongated member  50  extends between the distal end  58  and the proximal end  56  along a longitudinal axis  5016 . The mechanical coupling assembly  5004  can be used to manipulate the translational movement of the elongated members  50  along the longitudinal axis  5016 . The mechanical coupling assembly  5004  may also be configured to align one elongated member  50  to be generally parallel to another elongated member  50 . 
     As shown in  FIG. 14 , the mechanical coupling assembly  5004  may include a first coupling member  5006  positioned between the two elongated members  50 , a second coupling member  5008  that couples to the respective elongated member  50 , and a third coupling member  5010  that couples between the first coupling member  5006  and the respective second coupling member  5008 . The first coupling member  5006  may include a longitudinal slot  5012  that is elongated along the longitudinal axis  5016 . Each third coupling member  5010  may include an engagement element  5035 , as seen in  FIG. 15 , which is configured to slidably engage with the slot  5012  of the first coupling member  5006 , such that the respective elongated member  50  may move up or down. In the example shown in  FIG. 14 , the elongated member  50  on the right side may move up while the elongated member  50  on the left side may move down. The slot size may affect the translational displacement or movement of the elongated members  50 . 
     The third coupling members  5010  may include transverse slots  5013  that extend along a transverse axis that is perpendicular to the longitudinal axis  5016 , such that the third coupling member  5010  may be coupled to the second coupling members  5008 . The transverse slots  5013  in the third coupling members  5010  enable adjustment of the distance between the two elongated members  50 . The third coupling member  5010  may be fixedly attached to the second coupling member  5008  via a fastener  5020 . A washer  5018  may also be used between the fastener  5020  and the third coupling member  5010  to help tighten against the third coupling member  5010 . The fastener  5020  is attached to the elongated member  50  along a second transverse axis  5022 , which is generally perpendicular to the longitudinal axis  5016  and also generally perpendicular to the transverse axis  5014 . 
     The second coupling member  5008  may be fixedly attached to the elongated member  50  by a side screw  5024 , which may be generally parallel to the transverse slot  5013  of the third coupling member  5010  along the transverse axis  5014 . The second coupling member  5008  may include a hollow portion  5026  that is configured to allow the elongated member  50  to pass through to fixedly attach to the elongated member  50  by the side screw  5024 . The second coupling member  5008  may also include a side extension  5042  that may have a threaded end configured to be fastened to the fastener  5020 . The side extension  5042  may be perpendicular to the side screw  5024  for easily adjusting the third coupling member  5010  or the second coupling member  5008  independently without interference. The second coupling member  5008  may also include an opposite side extension  5042  that may be coupled to an extension bar  5032  extending away from the proximal end  56  of the elongated member  50  along the longitudinal axis  5016 . The extension bar  5032  may connect to a handle  5030  at an opposite end. The handle  5030  may be at an angle from the extension bar  5032  for easy manipulation by hand. The handle  5030  may vary in shape or geometry or size to be comfortable for user to grasp. 
       FIG. 15  is a back isometric view of the diagnostic system of  FIG. 14 . As shown in this view, the engagement element  5035  extends beyond the slot  5012  toward sidewalls  5017  that surrounds the slot  5012 . The engagement element  5035  overlaps with portions of the sidewalls  5017  of the first coupling member  5006 . The engagement element  5035  may have a square shape, a circular shape, an oval shape, or a rectangular shape, among other shapes. This figure also illustrates that the extension bar  5032  has a coupling end portion or connector  5021  that includes a hollow portion  5023  that allows the side extension  5042  to pass through. A fastener  5020  including an inner threaded hole may be fastened to the side extension  5042 . The engagement element  5035  may move within the slot  5012  toward one or two ends walls  5019 . The end walls  5019  are connected between the sidewalls  5017  to surround the slot  5012 . 
       FIGS. 16A-16C  depict side views of the diagnostic system of  FIG. 15  with the second coupling members  5008  on the right and left at different translational positions. As shown in the figures, the second coupling member  5008  on the right side is attached to the elongated member  50  at a lower position than the second coupling member  5008  on the left side. 
       FIG. 17  is a top view of the diagnostic system of  FIG. 14 . As shown, the side screw  5024  is pressed against the elongated member  50  so as to fixedly attach the tool to the elongated member  50 . The second coupling member  5008  may have a hollow portion  5031  that is configured to conform to the elongated member  50  and to allow the side screw  5024  to extend into the hollow portion  5031  to tighten against the elongated member  50 .  FIG. 18  is an enlarged view of the mechanical coupling assembly of  FIG. 14 . The hollow portion may be generally oval shaped as shown, “pear” shaped or other shapes (not shown). 
       FIG. 19  is an isometric view of the first coupling member of the diagnostic system of  FIG. 14 . As shown, the slot  5012  is enclosed by surrounding two opposing side walls  5017  along the longitudinal axis  5016  and two opposing end walls  5019  that connect between the two opposing side walls  5017 . In certain instances, the length of the slot  5012  may be configured to correspond to an amount of possible translational movement of the ilium relative to the sacrum. That is, the length of the slot  5012  may be limited so that a medical professional utilizing the tool will not injure the patient by forcing the ilium to move past a certain point relative to the sacrum. In certain instances, the length of the slot  5012  may be about 0.075 cm, 0.1 cm, 0.2 cm, 0.25 cm, 0.3 cm, 0.4 cm, 0.5 cm, 0.6 cm, 0.7 cm, 0.8 cm, 0.9 cm, or 1 cm. In certain instances, the length of the slot  5012  may be within a range of about 0.075 cm to about 1 cm. 
       FIG. 20A  is an isometric view from the side of the second coupling member  5008  of the diagnostic system of  FIG. 14 .  FIG. 20B  is another isometric view from the bottom of the second coupling member of the diagnostic system of  FIG. 14 .  FIG. 20C  is yet another isometric view from the top of the second coupling member of the diagnostic system in an alternative embodiment. 
     As shown in  FIG. 20A , the second coupling member  5008  may also include a non-threaded spacer  5037  between the main body  5040  and the threaded end  5038 . The non-threaded spacer  5037  may be configured to slide within the transverse slot  5013  of the third coupling member  5010 . In this particular embodiment, the non-threaded spacer  5037  has generally planar opposing surfaces that can slide within the slot of the third coupling member  5010 . The threaded end  5038  may include outer threads configured to be received in a matched fastener  5020 . According to other embodiments e.g., in  FIGS. 26-30B , the non-threaded spacer  5037  may be cylindrical. 
     As shown in  FIG. 20B , the second coupling member  5008  may include an inner threaded hole  5039  configured to receive the side screw  5024 . Although the main body  5040  includes an opening  5041  between two opposing end portions  5043  in this particular embodiment, a different embodiment may not have the opening  5041 . Instead, the opening may be solid side wall that connects the two end portions, as shown in  FIG. 20C . 
       FIG. 21  is an isometric view of the fastener  5020  of the diagnostic system of  FIG. 14 . As shown, the fastener  5020  includes inner threaded hole  5051  that is configured to receive the threaded end  5038  of the side extension  5042  of the second coupling member  5008 . The fastener  5020  may also include a flange end portion  5053  that extends sideway from the main body  5055  of the fastener  5020 . 
       FIG. 22  is an isometric view of the washer of the diagnostic system of  FIG. 14 . As shown in  FIG. 22 , the washer  5018  may include a hollow portion  5057  that is shaped and sized to match to the spacer  5037  of the second coupling member  5008  as shown in  FIG. 20A . The hollow portion  5057  may have cross-section that is a square shape, among others. The washer  5018  may include an outer surface, which may be in a cylindrical shape. 
       FIG. 23  is an isometric view of the side screw  5024  of the diagnostic system of  FIG. 14 . The side screw  5024  includes an end portion  5061  with outer threads and a non-threaded grasping portion  5063  that connects to the threaded end portion. 
       FIG. 24A  is an isometric view from the back of the third coupling member  5010  of the diagnostic system of  FIG. 14 . As shown in  FIGS. 24A-24B , the third coupling member  5010  may include a generally planar main body connected to the engagement element  5035  at a first end. The planar main body includes two opposing side walls  5067  connected to two opposing end walls  5069 . The side walls  5067  and end walls  5069  are sandwiched between two generally planar opposing surfaces  5071 . The second end wall  5069  is at an opposing end to the first end wall  5069  near the engagement element  5035 . The planar main body also includes an elongated slot  5013  enclosed by the sidewalls  5067  and the end walls  5069 . The elongated slot  5013  allows adjustment of the distance between the two elongated members  50 . In certain instances, the length of the slot  5013  may be about 1 cm, 2 cm, 3 cm, 4 cm, 5 cm, 6 cm, 7 cm, 8 cm, 9 cm, 10 cm, 11 cm, 12 cm, 13 cm, 14 cm, or 15 cm. In certain instances, the length of the slot  5013  may be within a range of about 1 cm to about 15 cm. 
     The engagement element  5035  includes an extended portion that extends above one of the planar surfaces  5071  near the first end wall  5069  of the planar main body. The extended portion  5073  can fit within the slot  5012  of the first coupling member  5006 . The engagement element  5035  also includes an end flange portion  5075  extending sideway from the extended portion  5073 , such that the end flange portion can extend on sidewall of the first coupling member  5006  to hold the third coupling member  5010  within the slot  5012  of the first coupling member  5006 . 
       FIG. 25A  is an isometric view from the bottom of the connector  5021  at the end of the extension bar  5032  connected to the handle  5030  of the diagnostic system of  FIG. 14 .  FIG. 25B  is an isometric view from the top of the connector  5021  at the end of the extension bar  5032  connected to the handle  5030  of the diagnostic system of  FIG. 14 . The handle  5030  is coupled to the second coupling member  5008 , and configured to ergonomically force the third coupling member  5010  to slide within the first coupling member  5006  to move one of the first or second members relative to the other of first or second member along the longitudinal axis  5016 . 
     As shown in  FIGS. 25A-25B , the handle  5030  is at one end of the extension bar  5032  and the connector  5021  is at an opposing end of the extension bar  5032 . The connector  5021  is configured to connect to the second coupling member  5008 . Specifically, the connector  5021  includes a first surface  5081  having a square shape opening  5085  and a second surface  5082  with a generally circular opening  5083 . The square shape opening  5085  is configured to fit to the spacer of the second coupling member  5008 . The circular opening  5083  is configured to be large enough to allow the fastener  5020  as shown in  FIG. 21  to fasten against the threaded portion  5038  of the second coupling member  5008  as shown in  FIG. 20A . Again, the shapes of the opening may vary with the extension  5042  of the second coupling member  5008 . 
     The amount of movement of the ilium relative to the sacrum may depend on the particular ailment of the sacroiliac joint. When used to manipulate the sacroiliac joint, as shown in  FIGS. 11-12A , the ilium may have a small, moderate, or large amount of translational movement relative to the sacrum. In some embodiments, the translational movement may be less than 5 mm. In some embodiments, the translational movement may be less than 4 mm. In some embodiments, the translational movement may be less than 3 mm. In some embodiments, the translational movement may be less than 2 mm. In some embodiments, the translational movement may be less than 1 mm. 
     2. Diagnostic Tools and Systems for Causing and Controlling Translational and Rotational Movement 
     An alternative mechanical coupling assembly may be used to cause translational movement and/or rotational movement. The mechanical coupling assembly may include a pivot subassembly, which may be attached to one diagnostic pin and used to cause translational movement or rotational movement of another diagnostic pin. 
       FIG. 26  is an isometric view of a diagnostic system including a pivot type mechanical coupling assembly in accordance with embodiments of the present disclosure. As shown, a mechanical coupling assembly  5090  may include a first coupling component  5008  attached to a first elongated member  50 , such as a pin or bar described with reference to  FIGS. 7A-9 , a handle  5030  coupled to the first coupling component  5008  attached to the first elongated member  50  by using a side screw  5024 , such as shown in  FIG. 23 . The mechanical coupling assembly  5090  may also include a second coupling component  5008  attached to a second elongated member  50  by using the side screw  5024 , such as shown in  FIG. 23 . The first and second coupling components  5008  may be similar to the second coupling member  5008  as shown in  FIGS. 20A-20C . 
     The mechanical coupling assembly  5090  may also include a pivot subassembly  5092 , which may include a handle bar  5094  with a free end  5101  and an opposite end  5103 , and a middle portion  5099  being pivotally attached to the first elongated member  50  and connected to the end  5103  of the handle bar  5094 . The middle portion  5099  is connected to an arm portion  5096 , which may be angled from the handle bar  5094 . The middle portion  5099  is a curved transition portion between the handle bar  5094  and an arm portion  5096 . The arm portion  5096  may extend from the transition portion and may be at an angle from the handle bar  5094 . This angle may vary for different pivot subassemblies. In some embodiments, the angle is less than 90°. In some embodiments, the angle is less than 80°. In some embodiments, the angle is less than 70°. In some embodiments, the angle is less than 60°. In some embodiments, the angle is less than 50°. In some embodiments, the angle is greater than 40°. In some embodiments, the angle is greater than 50°. In some embodiments, the angle is greater than 60°. In some embodiments, the angle is greater than 70°. In some embodiments, the angle is greater than 80°. 
     The arm portion may include an elongated slot  5097 , such that the position of the arm portion  5096  with respect to the second elongated member  50  can be adjusted with respect to the first elongated member  50 . The slot size and configuration may vary to allow translational movement of the second elongated member  50  or diagnostic pin. The arm portion  5096  may be slidably attached to the second elongated member  50  to cause translational movement of the second member. 
       FIG. 27  is an isometric view of the diagnostic system of  FIG. 26  in a position such that one of the diagnostic pins is moving upward. As shown in  FIG. 27 , the handle bar  5094  is rotated clockwise about the pivot joint  5095 , as indicated by the arrow, such that the pin  50  on the left moves upward. The arm portion  5096  may be caused to move relative to the slot  5097  toward a right end of the slot  5097 . The arm portion  5096  may now be slidably attached to the second elongated member  50  near the right end position of the slot  5097 . 
       FIG. 28  is an isometric view of the diagnostic system of  FIG. 26  in a position such that one of the diagnostic pins is caused to move downward. As shown in  FIG. 28 , the handle bar is rotated counterclockwise about the pivot joint  5095 , as indicated by the arrow, such that the second pin  50  moves downward. During this movement, the arm portion  5096  may move within the slot toward a left end of the slot  5097 . The arm portion  5096  may be slidably attached to the second elongated member  50  near the left end of the slot  5097 . 
     In some embodiments, the arm portion  5096  may be fixedly attached to the second member  50  by affixing the arm portion  5096  within the slot  5097 . For example, a fastener may be used affix the arm portion  5096  at a certain position within the slot. In this case, rotation of the handle bar  5094  about the pivot joint  5095  may cause rotational movement of the pins  50  relative to each other.  FIG. 29  is an isometric view of a diagnostic system that is configured to rotate one of the diagnostic pins with respect to another diagnostic pin. As shown in  FIG. 29 , the diagnostic system includes a first coupling component  5008  and a second coupling component  5008  that are respectively coupled to the first and second elongated members  50 , as similarly described above, with respect to  FIG. 28 . The diagnostic system may also include a pivot subassembly  5091  including an arm portion  5096  that is fixedly attached to the second elongated member  50 , for example, by using the fastener  5020  such as shown in  FIG. 21 . 
     The pivot subassembly  5091  may also include a middle portion that is pivotally joined to the first elongated member  50  around a pivot joint  5095  that may be cylindrically shaped. The pivot joint  5095  allows the middle portion  5099  or transition portion  5099  to rotate about such that the arm portion  5096  can cause rotation of the second elongated member  50  when the handle bar  5096  is rotated. 
     The transition portion  5099  may be attached to the end  5103  of the handle bar  5094 . The transition portion  5099  and the arm portion  5096  may be integrated together. Alternatively, the handle bar  5094  may be integrated with the transition portion  5099 , which may be integrated with the arm portion  5096 . The transition portion  5099  may include an opening that is configured to rotatably join to the pivot joint  5095 . The opening may be cylindrically shaped and sized to match to the pivot joint  5095 . 
     Still referring to  FIG. 29 , the arm portion  5096  may be fixedly attached to the second member  50  by a fastener  5020 . The arm portion  5096  may include a slot  5097  for adjusting position of the fastener  5020  within the slot  5097 , which may vary the angle of the rotation of the second elongated member  50 . The other handle  5030  may be used to hold the first elongated member  50  in position such that the first elongated member  50  does not need to rotate or move while only the second elongated member  50  rotates, in this example. 
     In use and in one embodiment, the distal end of the first elongated member  50  may be inserted into the ilium  1005 , while the distal end of the second elongated member  50  may be inserted into the sacrum  1004 . In another embodiment, the first elongated member  50  may be inserted into the sacrum  1004 , while the second elongated member  50  may be inserted into the ilium  1005 . 
       FIG. 30A  is an isometric view of the diagnostic system that rotates one diagnostic pins  50  clockwise with respect to the other diagnostic pin  50 . As shown in  FIG. 30A , the second elongated member  50  is caused to rotate clockwise by rotating the handle bar  5094  clockwise. The position of the fastener  5020  within the slot  5097  remains the same as shown in  FIG. 29 . 
       FIG. 30B  is an isometric view of the diagnostic system that rotates one diagnostic pin  50  counterclockwise with respect to the other diagnostic pin  50 . As shown in  FIG. 30B , the second elongated member  50  is caused to rotate counterclockwise by rotating the handle bar  5094  counterclockwise. The position of the fastener  5020  within the slot  5097  remains the same as shown in  FIG. 29 . 
     In some embodiments, the ilium  1005  or sacrum  1004  may be caused to rotate by using the mechanical coupling including the pivot subassembly shown in  FIGS. 29 and 30A -B. In some embodiments, the rotation may be limited to less than 10°. In some embodiments, the rotation may be less than 5°. In some embodiments, the rotation may be less than 4°. In some embodiments, the rotation may be less than 3°. In some embodiments, the rotation may be less than 2°. In some embodiments, the rotation may be less than 1°. 
     Reference is now made to  FIG. 30C , which is a front view of another diagnostic system  540  for controlled manipulation of pins  50 . As seen in the figure, the system  540  includes a pair of coupling members  542  coupled between the pins  50 . The coupling members  542  are identical. A bottom coupling member  542  is merely flipped relative to the top coupling member  542 . 
     Each coupling member  542  includes a pair of through hole openings  544  that are configured to allow the pins  50  to slide through. One side of each coupling member  542  includes a set screw  546  extending into the opening to selectively affix a position of the pin  50  such that the pin  50  cannot slide within the opening  544 . The opposite side of the coupling member  542  does not include a set screw such that the pin within that side can freely slide. The coupling members  542  include a notch or void  548  for engaging a distractor (not shown), which can drive the coupling members  542  longitudinally away from each other (as seen by the arrows in  FIG. 30C ). 
     In operation, a left side pin  50  can be affixed in a position via the set screw  546  relative to the top coupling member  542  and a right side pin  50  can be affixed in a position via the other set screw  546  relative to the bottom coupling member  542 . A distractor may be positioned within the notch  548  and engaged to drive apart the coupling members  542 . If, for example, the left pin  50  is in the sacrum and the right pin  50  in in the ilium, the distractor would drive the left pin  50  posteriorly and the right pin  50  anteriorly. 
     While reference is made to the previously described tools to manipulate the patient&#39;s bones, a physician may also manipulate the pins with his or her hands without the aid of the tools. Alternatively, a surgical robot may also manipulate the pins. Additionally, features of the various tools described herein may be incorporated into different and other embodiments without limitation. 
     F. Implant Delivery Device Utilizing the Pins, Rods, or Bars as a Guide 
     After diagnosing the patient&#39;s sacroiliac joint as a source of pain and diagnosing fusion of the joint as a possible solution to alleviate the pain, the diagnostic pins, described herein, may be used as a guide for the subsequent delivery of an implant (temporary or permanent) into or near the sacroiliac joint. The implant may be delivered by using a delivery tool that includes a shaft having an end configured to couple to a proximal end of the implant. The implant may also be delivered by using an implant delivery system as described below or as described in related U.S. patent applications incorporated by reference in this application. The implant delivery system may be configured to deliver the implant in a controlled manner (e.g., angle of delivery). The implant delivery system may include a pair of diagnostic pins connected by a guide coupling member, which guides the delivery of the implant. 
     To begin the discussion, reference is made to  FIG. 31 , which is an isometric view from a bottom of an implant delivery system or a surgical system for delivering an implant. As shown in the figure, an implant delivery system  5119  may include a first guide member  50  and a second guide member  50 , as described previously, and a guide coupling member  5120  configured to be slidably positioned between the first and second guide members  50 . The first guide member  50  extends along a first longitudinal axis  5016  and has a distal end  58  configured to be delivered into the sacrum  1004  or ilium  1005  via a posterior approach. The second guide member  50  extends along a second longitudinal axis generally parallel to the first longitudinal axis and has a distal end  58  configured to be delivered into the ilium  1005  or sacrum  1004  via the posterior approach. 
     The guide coupling member  5120  can slide onto the first and second guide members  50  and can receive an implant  25  from the top of the guide coupling member  5120  to deliver the implant  25  into the sacroiliac joint along a predetermined trajectory. The guide coupling member  5120  may have a general planar body with a proximal end  5132 , a distal end  5131 , and an inner opening  5124  configured to allow the implant  25  to be delivered therethrough. The inner opening  5124  may be located in a center of the guide coupling member  5120  and may extend from the proximal end  5132  to the distal end  5131  along the longitudinal axis  5016 . The central opening  5124  may elongate along a transverse axis  5014 , which is generally perpendicular to the first and second guide members  50  to match to the shape of the implant  25 . 
     The guide coupling member  5120  may also include two opposite through-holes  5129  configured to attach to the first and second guide members  50 . The two opposite through-holes  5129  are positioned on opposite ends  5133  of the central opening  5124 . The through-holes  5129  may be sized to provide interference fitting to the first and second guide members  50 . Alternatively, a side screw  5128  may be used to fasten the guide coupling member  5120  to the first or second guide members  50 . 
     The implant delivery system  5119  may also include a guide spacer  5122  positioned between the guide coupling member  5120  and the implant  25  to accommodate various types of implants, which may vary in shape, geometry or dimension. The guide spacer  5122  may have an outer surface  5123  configured to fit inside the central opening  5124  of the guide coupling member  5120  from the proximal end  5132  to the distal end  5131 . The guide spacer  5122  may have an inner opening  5125  configured to fit to a size or shape of the implant  25 , such that the implant  25  can slide through the guide spacer  5122 . 
     The guide spacer  5122  member may also include an end portion  5127  configured to stop by the top surface  5129  near the proximal end  5132  of the guide coupling member  5120 . As shown in  FIG. 31 , the end portion  5127  extends circumferentially to contact the top surface  5129  of the guide coupling member  5120 . The extended end portion  5127  still remains between the first and second guide members  50 . 
     Reference is now made to  FIG. 32 , which is an isometric view from a top of the implant delivery system for delivering an implant of  FIG. 31 . As shown in  FIG. 32 , the implant  25  may include a generally planar body having a proximal end  43 , a distal end  42  opposite the proximal end  43 , and a pair of generally planar surfaces  65  extending between the proximal and distal ends  43 ,  42 . The implant  25  may have a threaded opening  70  near the proximal end  43 . A delivery tool may be coupled to the threaded opening  70  to push the implant  25  through the guide spacer  5122 . 
       FIG. 33  is an isometric view of the implant delivery system of  FIG. 31  with the implant  25  inserted partially. As shown, the implant  25  is pushed into the guide spacer  5122 . The guide coupling member  5120 , which may be distally driven in the patient&#39;s body until the distal end of the guide coupling member  5120  abuts the ilium  1005  and sacrum  1004 , the implant  25  may be delivered into a region of the joint defined between the diagnostic pins  50 , which may be in the intra-articular region or extra-articular region of the joint. That is, if the pins  50  are positioned such that they span the extra-articular region of the sacroiliac joint, the implant  25  will subsequently be delivered into the extra-articular region of the joint. On the other hand, if the pins  50  are positioned such that they span the intra-articular region of the sacroiliac joint, the implant  25  will subsequently be delivered into the intra-articular region of the joint. Accordingly, the physician may choose to position the pins  50  in a certain region of the sacrum  1004  and ilium  1005  during the diagnostic portion of the procedure while contemplating that, if an implant fusion procedure is necessary, the pins may be used to subsequently guide the implant into the joint. 
     As an example, a physician may choose to position a first pin  50  in a patient&#39;s ilium in a superior region of the iliac spine between the posterior superior iliac spine  2004  and the posterior inferior iliac spine  2006  (i.e., lateral of the extra-articular region of the joint). The physician may choose to position a second pin  50  in a patient&#39;s sacrum just medial of the first pin. Thus, after diagnosing the sacroiliac joint as a source of pain and fusion as a procedure for alleviating the pain, the physician may deliver the implant into the extra-articular region of the sacroiliac joint using the pins as a guide. 
     As another example, a physician may choose to position a first pin  50  in a patient&#39;s ilium in an inferior region of the iliac spine between the posterior superior iliac spine  2004  and the posterior inferior iliac spine  2006  (i.e., lateral of the intra-articular region of the joint). The physician may choose to position a second pin  50  in a patient&#39;s sacrum just medial of the first pin. Thus, after diagnosing the sacroiliac joint as a source of pain and fusion as a procedure for alleviating the pain, the physician may deliver the implant into the intra-articular region of the sacroiliac joint using the pins as a guide. 
     Moving on, reference is made to  FIG. 34 , which is a sectional view of the implant delivery system of  FIG. 33  with the implant inserted partially. As shown, the implant  25  slides down from the proximal end toward the distal end. The tolerance between the outer surface of the implant  25  and the inner surface of the guide spacer  5122  may be large enough to allow the implant  25  to slide down without resistance or friction, but small enough such that the implant  25  can be guided down along the longitudinal axis. 
     The guide members  50  may have any shaped cross section, including circular, oval, triangular, rectangular, square, diamond, or the like. As one non-limiting example, the generally cylindrical elongated guide member  50  may have a diameter of in the range of about 3 mm to about 8 mm and a length between the distal end and the proximal end may be in the range of about 2 cm to about 20 cm. 
     G. Implant Delivery Locations 
     During an implantation procedure, the implant or insertion element  25  may be positioned into a pelvic region of a patient through an incision in the patient&#39;s skin. A retractor may be used to open the incision and a trocar or other device may be used to provide a passageway into the surgical site. A medical person may grasp a delivery tool with a mechanically attached insertion element and advance the distal end of the insertion element to a sacroiliac joint region. Alternatively, a surgical robot may conduct the implantation procedure. The distal end of the insertion element may further be advanced into the bones defining a sacroiliac joint. The insertion element may be positioned to substantially or generally avoid the intra-articular portion of the sacroiliac joint. Alternatively, in order to capture the dense bone surrounding the intra-articular portion of the joint, the insertion element may be advanced to be positioned generally or substantially within the intra-articular portion of the sacroiliac joint. 
     A medical personal may apply a force along the longitudinal axis of the insertion element or the delivery tool to advance the insertion element. The force may cause the insertion element to translate or advance into the joint in a generally anterior direction. 
       FIG. 35  is an enlarged sectional view illustrating the implant being inserted in the extra-articular region  3007  of the sacroiliac joint. The sectional view is obtained from  FIG. 50  as shown by arrows in that figure. As shown in  FIG. 35 , the implant  25  is in a generally transverse direction  5140  across the joint line  5144  defining the sacroiliac joint  1000  and the sacrum  1004  and the ilium  1005 . As seen in the figure, the intra-articular region  1044  is shown inferior to the extra-articular region  3007  of the joint. The implant  25  may be positioned substantially perpendicular to the joint line  5144  of the ilium  1005  and sacrum  1004 . The joint line  5144  is along a vertical axis  5142  generally perpendicular to the transverse axis  5140 . The generally planar surface  65  of the implant  25  is generally perpendicular to the joint line  5144  along the vertical axis  5142 , as shown in  FIG. 35 . The joint line  5144  is generally in a plane defined by an ilium plane  5148  and sacrum plane  5146 . The implant  25  may also be positioned to be generally symmetric across the joint line  5144  such that the implant  25  may stabilize the joint evenly from both the ilium  1005  and sacrum  1004 . Specifically, one edge  55  of the implant  25  may extend into the sacrum  1004  and one opposite edge  25  may extend into the ilium  1005 . The distance from the edge  55  to the joint line  5144  may be about the same as the distance from the opposite edge  55 . 
     In alternative embodiments, the implant  25  may be positioned non-symmetrically across the joint line  5144 . For example, the distance of the edge  55  extending into the sacrum  1004  may be smaller or larger than the distance of the opposite edge  55  extending into the ilium  1005 . The distance may vary in order to help temporarily stabilize the joint and to reduce the pain in a patient. In alternative embodiments, the implant  25  may be positioned across the joint line  5144  in a non-perpendicular manner. That is, the implant  25  may be positioned at an angle relative to the joint line  5144  that is less than or more than ninety degrees. 
     In some embodiments, two or more implants  25  may be used. For example, one fork type implant, such as shown in  FIGS. 47A-B , may be used in the intra-articular region  1044 , while another implant, such as shown in  FIGS. 44-46  may be used in the extra-articular region. 
       FIG. 36  is an enlarged sectional view illustrating another type of implant  25  inserted in the extra-articular region  3007 . As shown in the figure, the implant  5500  may include a cross-shape cross-section with a pair of keels  55  extending into the sacrum  1004  and ilium  1005  and a pair of perpendicularly oriented keels  56  extending generally vertically or in-line with the joint line  5144  in a gap between the ilium  1005  and sacrum  1004  in the extra-articular region  3007 . The additional implant  5500  may be similar to implant embodiments described in related U.S. patent applications that are previously identified as being incorporated by reference in this application. 
     Other embodiments of the implant  25  include a fork or U-shaped implant  25 , as seen in  FIGS. 37-38 and 48A-48B .  FIG. 37  is a cross-sectional view of the implant  25  taken along the cross-section line shown in  FIG. 50 , except the implant  25  in  FIGS. 37-38  depict the implant  25  spanning the intra-articular region  1044  instead of the extra-articular region of the sacroiliac joint  1000 . As seen in  FIG. 38 , which is another cross-sectional view of the implant  25  taken along the cross-section line shown in  FIG. 37 , the implant  25  may include a first longitudinally extending member or finger  5520  and a second longitudinally extending member or finger  5520  that are coupled together at a proximal end of the implant  25  by a coupling member  5530 . 
     In use, the first longitudinally extending member  5520  may be positioned in the sacrum  1004 , the second longitudinally extending member  5520  may be positioned in the ilium  1005 , and the coupling member  5530  may span the intra-articular region  1044  of the sacroiliac joint  1000 . In this way, the implant  25  may be used in the intra-articular region  1044 , which includes a harder portion of the ilium  1005  than in the extra-articular region  3007 . Although not shown in  FIGS. 37-38 , the implant  25  may also be positioned such that the coupling member  5530  spans the extra-articular region  3007  of the joint  1000 . 
     When implanted in the joint  1000 , the fingers  5520  may be generally parallel to the joint line  5144 . When implanted in this way, the first and second longitudinally extending members  5520  may be fully positioned within the sacrum  1004  and ilium  1005 , respectively, such that an inner sacrum surface  5534  and an inner ilium surface  5536 , on opposing surfaces of the intra-articular region  1044 , are substantially or completely undisturbed by implantation and positioning of the implant  25 . As seen in  FIG. 38 , the longitudinally extending member  5520  are aligned along a transverse axis  5141 . The transverse axis  5141  and the horizontal axis are in a transverse plane to a human body. Also, when implanted in the region of the intra-articular region  1044 , the coupling member  5530  does not contact the cartilage in the intra-articular region  1044 ; rather, the coupling member  5530  remains positioned outside the joint  1000 . In some embodiments, the coupling portion  5530  may be outside within the patient&#39;s soft tissue, or inside a patient&#39;s body. 
     In some embodiments, a temporary implant may include two implant pins with a mechanical coupling that joins the two implant pins, as previously described with reference to  FIG. 13B . The implant pins  50  may be inserted into the sacrum  1004  and ilium  1005  near intra-articular region  1044  or extra-articular region  3007  to help temporarily stabilize the joint for a patient. The patient may carry the temporary implant for a period of time to evaluate if the temporary implant helps reduce the pain. Then, the temporary implant may be removed. A long term implant may be placed in the joint where the temporary implant locates. 
       FIG. 39A  is an enlarged posterior view of the sacroiliac joint  1000  illustrating that one implant pin is inserted in ilium  1005  near extra-articular region  3007  and one implant pin is inserted into the sacrum  1004  near the intra-articular region  1044 . As shown in  FIG. 39A , one implant pin  50  is inserted into the ilium  1005  near the extra-articular region, while another implant pin  50  is inserted into the sacrum  1004  near the intra-articular region. The pins  50  are respectively coupled together at a proximal end via a mechanical coupling  5160 . 
       FIG. 39B  is an enlarged posterior view of the sacroiliac joint  1000  illustrating that one pin is inserted in ilium  1005  near extra-articular region  3007  and one implant pin  50  is inserted into the sacrum  1004  near the extra-articular region  3007 . As shown in  FIG. 39B , one implant pin  50  is inserted into the ilium  1005  near the extra-articular region  3007 , while another implant pin  50  is inserted into the sacrum  1004  also near the extra-articular region  3007 . The pins  50  are respectively coupled together at a proximal end via a mechanical coupling  5160 . 
       FIG. 39C  is an enlarged posterior view of the sacroiliac joint  1000  illustrating that one pin is inserted in ilium  1005  near intra-articular region  1044  and one implant pin  50  is inserted into the sacrum  1004  near the intra-articular region  1044 . As shown in  FIG. 39C , one implant pin  50  is inserted into the ilium  1005  near the intra-articular region  1044 , while another implant pin  50  is inserted into the sacrum  1004  also near the intra-articular region  1044 . The pins  50  are respectively coupled together at a proximal end via a mechanical coupling  5160 . 
     The implant pins  50  as shown in  FIGS. 39A-C  may be joined by a mechanical coupling  5160  to hold the two implant pins  50  in position, such that the coupling  5160  along with the two implant pins  50  can help stabilize the joint temporarily or permanently depending on the needs of the patient. The mechanical coupling  5160  may be like the guide coupling, as shown in  FIG. 31 , which is positioned between the two implant pins  50  to connect them together. The coupling  5160  can hold the implant pins  50  in their positions such that the joint is effectively stabilized. 
     In some embodiments, the mechanical coupling  5160  may also be configured to adjust the distance between the two implant pins  50 , such that the implant pins  50  may be placed in various locations as shown in  FIGS. 39A-C .  FIG. 40  illustrates a mechanical coupling  5160  that may include a first portion  5162  attached to the first implant pin  50  and a second portion  5164  attached to the second implant pin  50 . The first portion  5162  may include an elongated slot  5166  configured to allow the distance between the two pins  50  to be adjustable, while the second portion  5164  may include a protruded screw  5168  such that the screw  5168  may be fastened within the slot  5166  by a fastener. The mechanical coupling  5160  may be located outside of a patient&#39;s body or inside a patient&#39;s body. The mechanical coupling  5160  may be configured to join the implant pins  50 , fixedly or not fixed depending upon the need according to a medical person. 
       FIG. 41  is an enlarged sectional view illustrating that a temporary implant including coupled implant pins is inserted in the intra-articular region. As shown in  FIG. 41 , a distal end  58  of one implant pin  50  is inserted into the ilium  1005  and a distal end  58  of another implant pin  50  is inserted into the sacrum  1004 . Both implant pins  50  are positioned near the intra-articular region  1044 . One implant pin  50  is inside the sacrum joint surface  5146  and another implant pin  50  is inside the ilium joint surface  5148 . Both proximal ends  56  of the implant pins  50  are outside the joint  1000 , thus, not disturbing the cartilage, capsule, and fluid within the intra-articular region  1044  of the joint  1000 . The implant pins  50  may be coupled together via the mechanical coupling  5160 , which is also positioned outside of the joint  1000 . The implant pins  50  are along a transverse axis  5141  which is generally perpendicular to the vertical axis  5142  as shown in  FIG. 39C , and also perpendicular to the horizontal axis  5140 . The transverse axis  5141  and the horizontal axis are in a transverse plane to a human body. 
     In some embodiments, the implant  25  may be inserted into the sacroiliac joint  1000  without using the guidance tool as shown in the previous figures. 
     H. Imaging and Radiographic Contrasting Agents 
     An imaging system may be used to assist in delivering the implant into the intra-articular region or extra-articular region of the sacroiliac joint. More particularly, the capsule of the intra-articular region of the sacroiliac joint, among other anatomical areas, may be injected with a radiographic contrasting agent such that delivery of the implant, in relation to the anatomical feature injected with the contrasting agent, may be viewed under X-ray or fluoroscopy, among other methods, to ensure proper implant placement. As an example, the intra-articular region of the joint may be injected with the radiographic contrasting agent. Then, the implant may be delivered into the extra-articular region of the joint while the joint is viewed under X-ray or fluoroscopy. In this way, with the intra-articular region of the joint clearly visible with the contrasting agent, the implant may be properly positioned and delivered into the extra-articular region. 
       FIG. 42  illustrates a radiographic contrast tool that injects radiographic contrast under fluoroscopic guidance into the joint. As shown in  FIG. 42 , the sacroiliac joint  1000  can be locally anesthetized to allow for injecting a radiographic contrast  1046  (as a non-limiting example, ISOVIEW 300 radiographic contrast) under fluoroscopic guidance into the inferior aspect of the sacroiliac joint  1000  to outline the articular surfaces  1016  of the sacroiliac joint  1000 ) defined between the sacrum  1004  and ilium  1005 , the sacroiliac joint  1000  having an interarticular region  1044 . Injection of the radiographic contrast  1046  within the sacroiliac joint  1000  can be accomplished utilizing a tubular member  1047  (such as a syringe needle) having first tubular member end  1048  which can be advanced between the articulating surfaces  1016  of the sacroiliac joint  1000  and having a second tubular member end  1049  which removably couples to a hub  1050 . The hub  1050  can be configured to removably couple to a syringe barrel  1051  (or other device to contain and deliver an amount of radiographic contrast  1046 ). In the example of a syringe barrel  1051 , the syringe barrel  1051  can have an internal volume capable of receiving an amount of the radiographic contrast  1046  sufficient for outlining the articular surfaces  1016  of the sacroiliac joint  1000 , for example, under lateral fluoroscopy. 
     A plunger  1052  can be slidingly received within the barrel  1051  to deliver the radiographic contrast  1046  through the tubular member  1047  into the sacroiliac joint  1000 . The tubular member  1047  can have a gauge in the range of about 16 gauge and about 20 gauge and can further be incrementally marked on the external surface to allow determination of the depth at which the first needle end  1048  has advanced within the sacroiliac joint  1000 . As the first needle end  1048  advances into the sacroiliac joint  1000  the radiographic dye  1046  can be delivered from within the syringe barrel  1051  into the sacroiliac joint  1000  to allow visualization of the sacroiliac joint  1000  and location of the tubular needle  1047  within the sacroiliac joint  1000 . 
     By highlighting the intra-articular region  1044  of the sacroiliac joint  1000 , important landmarks for subsequent steps of the for implanting an insertion element via the posterior inferior access region  3090  of the sacroiliac joint extra-articular region  3007  (as described in greater detail below) may be more easily identified, e.g., the posterior inferior corner  3091  of the sacroiliac joint extra-articular region boundary  3009 , the inferior end  3092  of the posterior inferior access region  3090  of the sacroiliac joint extra-articular region  3007 , the inferior boundary segment  3093  of the sacroiliac joint extra-articular region boundary  3009 , the anterior boundary segment  3094  of the sacroiliac joint extra-articular region boundary  3009  or the superior-posterior corner  3016  and superior end  2018  of the posterior inferior access region  2016 . 
     I. Insertion Element or Implant Configurations 
       FIGS. 43A-B - 48 A-B illustrate various embodiments of the insertion element or implant  25 . Each implant or insertion element  25  may have a generally planar body having a proximal end, a distal end opposite to the proximal end. The implants may vary in shape, surface features, for example, main surfaces or side surfaces, which may provide variation in friction or resistance to movements. Also, the implants may vary in edges or surface features to provide better bonding to the bones of the sacrum and ilium. 
     The insertion elements may be formed of biocompatible materials including biocompatible metals, such as stainless steel, titanium, biocompatible ceramics, biocompatible polymers or composite materials. The insertion element may be manufactured by processes including machining, injection molding, among others. 
     To begin, reference is made to  FIGS. 43A and 43B .  FIG. 43A  is an isometric view from a distal end of an implant  25 , in accordance with a first embodiment of the present disclosure.  FIG. 43B  is another isometric view from a proximal end of the implant of  FIG. 43A . As shown in the figures, an insertion element  25  includes a planar member  66 , a distal or leading end  42 , a proximal or trailing end  43 . The planar member  66  has a length between the distal and proximal ends  42 ,  43  along a longitudinal center axis CA. The planar members  66  include a pair of generally opposed main surfaces  65  and side edge surfaces  55 . The insertion element  25  also includes a longitudinally extending body  45 . The planar members  66  that extend the length between the distal end  42  and proximal end  43 . The planar members  66  may radially extend outwardly away from the body  45 . 
     In one embodiment, the radially extending planar members  66  may be grouped into pairs of planar members  66  that are generally coplanar with each other. For example, planar members  66  that are opposite the body  45  from each other, or opposite the longitudinal center axis CA, generally exist in the same plane. More specifically, the planar faces  65  of a first planar member  66  are generally coplanar with the planar faces  65  of a second planar member  66  opposite the body  45  from the first planar member  66 . The longitudinally extending body  45  can extend a greater distance outwardly or transversely from the longitudinal center axis CA than the planar faces  65  of the planar members  66  yet the body  45  does not extend beyond the side edge surfaces  55 . 
     The cylindrical body  45  may include a threaded hole  70  configured to connect to an implant delivery tool. The threaded hole  70  may be large enough such that the outer surface of the body  45  near the threaded hole may radially extend beyond the two generally opposed main surfaces  65 . 
     The distal end  42  may be rounded or tapered. For example, the distal end  42  may have a convex surface that may be less resistant when inserted into the sacroiliac joint. The distal end  42  may also be thinner than the general planar body  66  such that the distal end  42  may be easier to be placed into the sacroiliac joint. 
     The thickness of the planar member  66  may be between approximately 1 mm and approximately 10 mm. In a particular embodiment, the thickness may be approximately 3.5 mm. The length of the planar member may be between approximately 5 mm and approximately 30 mm. In a particular embodiment, the length of the planar member may be approximately 20 mm. The cylindrical body may have a radius between approximately 2 mm and approximately 4 mm. In a particular embodiment, the radius may be approximately 2.75 mm. The width of the planar member  66  may be between 1 cm and 5 cm. 
       FIG. 44A  is an isometric view from a distal end of an implant in accordance with a second embodiment of the present disclosure.  FIG. 44B  is another isometric view from a proximal end of the implant of  FIG. 44A . As shown in  FIGS. 44A-44B , an insertion element  25  may include a generally planar body  66  with an anti-migration surface feature  355  on opposed main surfaces  65  and/or side edge surfaces  55 . The anti-migration surface feature  355  may increase the resistance to the movement of sacroiliac joint. The surface feature  355  may include protruded portions from the planar surfaces  65 . The protruded portions  355  may be spaced from each other. 
     The anti-migration features  355  are generally evenly distributed along the planar surfaces of the planar members in a rows and columns arrangement. The anti-migration features  355  may be in the form of trapezoids, squares, rectangles, etc. The anti-migration features  355  may have a rectangular cross sectional elevation with a thickness FT of between approximately 0.2 mm and approximately 5 mm, with one embodiment having a thickness FT of approximately 1 mm. The anti-migration features may be generally pyramidal. 
       FIG. 45A  is an isometric view from a distal end of an implant  25  in accordance with a third embodiment of the present disclosure.  FIG. 45B  is another isometric view from a proximal end of the implant of  FIG. 45A . As shown in  FIGS. 45A-B , an insertion element  25  may include a generally planar body  66  having opposing planar surfaces  65 . The planar body  66  may include side edges  55  that may have a teeth-type or notch type pattern  360 , that are anti-migration edges. The teeth-type pattern  360  may include a number of protruded portions interleaved with a number of recessed regions. The teeth pattern or notches  360  may increase surface friction or resistance to movement of the sacroiliac joint. The notches  360  may generally be evenly distributed along longitudinally extending free edges or ends of the planar members  66 . The orientation of each notch  365  may be such that the center line NL of the notch  360  forms an angle with the center axis CA of the insertion element  25  that is between approximately 90 degrees and approximately 15 degrees, with one embodiment having an angle NA of approximately 45 degrees. As indicated in  FIG. 45A , each notch  365  may have a length LN between the extreme point on the arcuate end  375  and the outer edge boundary of the notch of between approximately 0.2 mm and approximately 10 mm, with one embodiment having a length LN of approximately 3 mm. Each notch  365  may have a width WN of between approximately 0.5 mm and approximately 20 mm, with one embodiment having a width WN of approximately 2 mm. 
     In some embodiments, the angles may be less than 80°. In some embodiments, the angles may be less than 70°. In some embodiments, the angles may be less than 60°. In some embodiments, the angles may be less than 50°. In some embodiments, the angles may be less than 40°. In some embodiments, the angles may be less than 50°. In some embodiments, the angles may be less than 30°. In some embodiments, the angles may be less than 20°. In some embodiments, the angles may be greater than 15°. The recessed regions may vary in the recessed depth from the outer edge surface. Similar to other insertion elements, this insert element  25  may also include a cylindrical body with a threaded hole at the proximal end. 
       FIG. 46A  is an isometric view from a distal end of an implant in accordance with a fourth embodiment of the present disclosure.  FIG. 46B  is another isometric view from a proximal end of the implant of  FIG. 46A . As shown in  FIGS. 46A-46B , an insert element  25  may include anti-migration features that are in the form of unidirectional serrated triangular shaped teeth or ridges on opposed main surfaces and side surfaces. The ridges  355  may increase the resistance to movement of the implant when positioned in the sacroiliac joint. The triangular ridges  355  are generally evenly distributed along the planar surfaces  65  of the planar members  66  in ridges  355  that run transverse to the length of the insertion element  25 . The anti-migration features  355  are generally similarly distributed along the planar surfaces of the edges of the planar members  66 . 
     Although the anti-migration features  355  are depicted in the form of unidirectional serrated teeth or ridges  355  on each of the textured surfaces of the insertion device, the invention is not so limited and, as to particular embodiments, can be configured to have said features  355  arranged in multiple directions, unidirectional, or a combination of multiple direction on some surfaces of the insertion element and unidirectional on other surfaces of the insertion element. Accordingly, the features  355  can be so arranged on the various surfaces of the insertion element so as to prevent undesired migration in particular directions due to the forces present at the sacroiliac joint. Features  355  may be spike like or pyramidal. 
       FIG. 47A  is an isometric view from a distal end of an implant in accordance with a fifth embodiment of the present disclosure.  FIG. 47B  is another isometric view from a proximal end of the implant of  FIG. 47A . As shown in  FIGS. 46A-46B , an insert element  25  may include anti-migration features that are in the form of unidirectional square shaped teeth or ridges  356  on opposed main surfaces  65  and side surfaces  55 . 
       FIG. 48A  is an isometric view from a distal end of an implant in accordance with a sixth embodiment of the present disclosure.  FIG. 48B  is another isometric view from a proximal end of the implant of  FIG. 48A . As seen in the figures, the insertion element  25  may include a U-shaped or fork-like generally planar member having a pair of longitudinally extending members or fingers that are coupled together by a proximal end member or portion, which may include a cylindrical body with a threaded hole and a planar portion surrounding the cylindrical body. The cylindrical body has a radius larger than the thickness of the planar member. In some embodiments, the side surfaces may include patterns that may increase resistance to movement of the sacroiliac joint. In some embodiments, the main surfaces of the fingers may also include surface features that may that may increase resistance to movement of the sacroiliac joint. 
     Referring still to  FIGS. 48A and 48B , the insertion element  25  includes a distal or leading end  42 , a proximal or trailing end  43 , a length between the distal and proximal ends  42 ,  43 , a longitudinal center axis CA, a longitudinally extending body  45 , and two longitudinally extending members  5520  that extend the length between the distal end  42  and proximal end  43 . The longitudinally extending members  5520  include a pair of generally opposed faces  65  and side edge surfaces  55 . The longitudinally extending members  5520  may radially extend outwardly away from the body  45 . From the longitudinal center axis CA of the insertion element  25 , the longitudinally extending members  5520  project outwardly on opposite sides of the body  45  and extend distally beyond the most distal region of the body  45  forming the fork-like shape of planar finger members  5520 . The longitudinally extending members  5520  define an opening  5521  between the members  5520 . The width of the opening  5521  may correspond with a width of a portion of the sacroiliac joint. For example, a width of the opening  5521  may be slightly wider than a width of a widest portion of the intra-articular region of the joint. In this way, the implant  25  may be implanted in the joint  1000  in the intra-articular region such that the longitudinally extending members  5520  extend into the sacrum and ilium, respectively, while the opening  5521  spans the intra-articular region of the joint and, thus, avoids damaging the capsule, cartilage, and synovial fluid in the joint. 
     The distance D 1  spanned by the longitudinally extending members  5520  is between approximately 5 mm and approximately 25 mm, with one embodiment having a distance D 1  of approximately 14 mm. The distance D 2  of the planar members that project outwardly on opposite sides of the fingers  5520  is between approximately 1 mm and 5 mm, with one embodiment having a distance D 2  of approximately 4.5 mm. The distance D 3  of the cylindrical threaded opening is between approximately 3 mm and 8 mm, with one embodiment having a distance D 3  of 5 mm. Distance D 3  may vary along the length of the implant. The cylindrical threaded opening  70  has a radius R of between approximately 2 mm and approximately 4 mm, with one embodiment having a radius R of approximately 2.75 mm. 
     In one embodiment, the implant  25  has a length L of between approximately 5 mm and approximately 30 mm, with one embodiment having a length L of approximately 20 mm. 
     Reference is now made to  FIGS. 48C-48D , which are, respective, side and isometric views of the implant of  FIG. 48A-48B , except the longitudinally extending members  5520  of the implant  25  in  FIGS. 48C-48D  is curved as it extends from the proximal end  43  to the distal end  42 . The curve of the members  5520  defines a radius R, which may be about 20 mm to about 60 mm. In certain embodiments the radius R may be about 60 mm. In certain embodiments the radius R may be about 55 mm. In certain embodiments the radius R may be about 50 mm. In certain embodiments the radius R may be about 45 mm. In certain embodiments the radius R may be about 40 mm. In certain embodiments the radius R may be about 35 mm. In certain embodiments the radius R may be about 30 mm. In certain embodiments the radius R may be about 25 mm. In certain embodiments the radius R may be about 20 mm. In certain embodiments, an arc of the curved portion of the implant  25  may be about 40, 50, 60, 70, 80, 90, 100, 110, or 120 degrees. In certain embodiments, the implant  25  has a length L that is similar to that of the implant  25  in  FIGS. 48A-48B . The implant  25  may include a ratio of length L to radius of curvature R or a ratio of radius of curvature R to length L as defined by the measurements given herein. 
     The implant  25  of  FIGS. 48C-48D  would look similar to the cross-sectional views shown in  FIGS. 37-38 , except the implant  25  would be curved along a longitudinal extension of the implant  25 . This type of implant  25  may be useful when implanted in the region of the intra-articular region of the sacroiliac joint because the opening  5521  in the implant  25  could span the articular region and follow the contour of intra-articular region as it transitions from the caudal region to the cranial region (i.e., because of the curved nature of the longitudinally extending members  5520 ). 
     This type of implant may be used in the intra-articular region or extra-articular region. The intra-articular region has a higher bone density than the extra-articular region. This may make the intra-articular region a better implant location, for implants that can avoid damaging the intra-articular region, because the implant can anchor into stronger bone. 
     J. Materials, Coatings, and Agents 
     Embodiments of the sacroiliac joint insertion element can further include a coat coupled, generated or integral to all or a part of the external surface of the sacroiliac joint insertion element, elongate bodies, or pins. The coat can be of any composition that can be coupled to the sacroiliac joint insertion element capable of biocompatible osseointegration with the bone of the ilium  1005  and sacrum  1004 , such as pure alumina, titanium-dioxide, hydroxyapatite, calcium triphosphate, or the like. As a non-limiting example, the coat can be applied by plasma spraying with a plasma torch, plasmatron or a plasma gun. Alternately, the coat can be achieved by producing a surface roughness, porosity, or irregularity of the sacroiliac joint insertion element by sand blasting, bead blasting, molding, or the like. The coat can have a thickness in the range of about 40 micrometers and about 100 micrometers. Again, embodiments of the sacroiliac joint insertion element can be configured as a material having interconnecting pores throughout such as TRABECULAR METAL available from Zimmer, P.O. Box 708, 1800 West Center Street, Warsaw, Ind. 46581-0708 or a metallic foam such as a titanium foam available from the National Research Council Canada, 1200 Montreal Road, Bldg. M-58, Ottawa, Ontario, Canada or fully-engineered, porous, titanium structures such as TRABECULITE available from Tecomet, 115 Eames Street, Wilmington, Mass. 01887. 
     One or more biologically active agent(s) can be applied directly to the external surface of the sacroiliac joint insertion element or can be mixed with a biocompatible material or biocompatible biodegradable material or biocompatible osseointegratable material which can be applied to the external surface of the sacroiliac joint insertion element or otherwise made a part of the sacroiliac joint insertion element. As to particular embodiments of the insertion element, the biologically active agent(s) can be mixed with an amount of a biocompatible or biodegradable material or osseointegratable material and located within one or more of the aperture elements. 
     Biocompatible means the ability of any material to perform the intended function of an embodiment of the invention without eliciting any undesirable local or systemic effects on the recipient and can include non-biodegradable materials such as: ceramic; metals or steels such as titanium alloys or rigid polymeric materials or rigid laminate materials or composites which include suitably dimensioned particles of metals or steels dispersed within rigid laminate materials, or suitably sized particles of biocompatible materials suitably bound or formed to provide configurations, polyurethanes, polyisobutylene, ethylene-alpha-olefin copolymers, acrylic polymers and copolymers, vinyl halide polymers and copolymers, polyvinyl esters, polyvinylidene chloride, polyacrylonitrile, polyvinyl ketones, polyvinyl aromatics such as polystyrene, copolymers of vinyl monomers and olefins such as ethylene-methyl methacrylate copolymers, acrylonitrile-styrene copolymers, ABS resins, ethylene-vinyl acetate copolymers, polyamides such as Nylon 66 and polycaprolactone, alkyd resins, polycarbonates, polyoxyethylenes, polyimides, polyesters, epoxy resins, rayon-triacetate, cellophane, polyether ether ketone (PEEK), polyetherketoneketone (PEKK), bone-from-wood available from the Istituto di Scienza e Tecnologia dei Mareriali Ceramici, Faenza, Italy, or the like, or biodegradable materials, as herein described. 
     Biodegradable means the ability of any biocompatible material to breakdown within the physiological environment of the sacroiliac joint by one or more physical, chemical, or cellular processes at a rate consistent with providing treatment of a condition of the sacroiliac joint at a therapeutic level controllable by selection of a polymer or mixture of polymers (also referred to as polymeric materials), including, but not limited to: polylactide polymers (PLA), copolymers of lactic and glycolic acids (PLGA), polylactic acid-polyethylene oxide copolymers, poly(.epsilon.-caprolactone-co-L-lactic acid (PCL-LA), glycine/PLA copolymers, PLA copolymers involving polyethylene oxides (PEO), acetylated polyvinyl alcohol (PVA)/polycaprolactone copolymers, hydroxybutyrate-hydroxyvalerate copolymers, polyesters such as, but not limited to, aspartic acid and different aliphatic diols, poly(alkylene tartrates) and their copolymers with polyurethanes, polyglutamates with various ester contents and with chemically or enzymatically degradable bonds, other biodegradable nonpeptidic polyamides, amino acid polymers, polyanhydride drug carriers such as, but not limited to, poly(sebacic acid) (PSA), aliphatic-aromatic homopolymers, and poly(anhydride-co-imides), poly(phosphoesters) by matrix or pendant delivery systems, poly(phosphazenes), poly(iminocarbonate), crosslinked poly(ortho ester), hydroxylated polyester-urethanes, or the like. 
     Biologically active agents are those agents or mixture of agents which can be varied in kind or amount to provide a therapeutic level effective to mediate the formation or healing of bone, cartilage, tendon, or to reduce, inhibit, or prevent a symptom of a condition of the sacroiliac joint subsequent to placement of an embodiment of the fixation fusion insertion element within the sacroiliac joint such as infection or pain and without limitation can include agents that influence the growth of bone, demineralized bone matrix, stem cells, allografts, autografts, xenografts, bone forming protein whether naturally occurring, synthetic, or recombinate, growth factors, cytokines, bone morphogenetic protein  2 , bone morphogenetic protein  7 , analgesics, anesthetics, anti-inflammatory agents, antibacterials, antivirals, antifungals, antiprotozoals, anti-infectives, antibiotics such as aminoglycosides such as gentamicin, kanamycin, neomycin, and vancomycin; amphenicols such as chloramphenicol; cephalosporins, such as cefazolin HCI; penicillins such as ampicillin, penicillin, carbenicillin, oxycillin, methicillin; lincosamides such as lincomycin; polypeptide antibiotics such as polymixin and bacitracin; tetracyclines such as tetracycline, minocycline, and doxycycline; quinolones such as ciprofloxacin, moxifloxacin, gatifloxacin, and levofloxacin; anti-viral drugs such as acyclovir, gancyclovir, vidarabine, azidothymidine, dideoxyinosine, dideoxycytosine; analgesics, such as codeine, morphine, ketorolac, naproxen, an anesthetic, lidocaine; cannabinoids; antifungal agents such as amphotericin; anti-angiogenesis compounds such as anecortave acetate; retinoids such as tazarotene, steroidal anti-inflammatory agents such as 21-acetoxypregnenolone, alclometasone, algestone, amcinonide, beclomethasone, betamethasone, budesonide, chloroprednisone, clobetasol, clobetasone, clocortolone, cloprednol, corticosterone, cortisone, cortivazol, deflazacort, desonide, desoximetasone, dexamethasone, diflorasone, diflucortolone, difluprednate, enoxolone, fluazacort, flucloronide, flumethasone, flunisolide, fluocinolone acetonide, fluocinonide, fluocortin butyl, fluocortolone, fluorometholone, fluperolone acetate, fluprednidene acetate, fluprednisolone, flurandrenolide, fluticasone propionate, formocortal, halcinonide, halobetasol propionate, halometasone, halopredone acetate, hydrocortamate, hydrocortisone, loteprednol etabonate, mazipredone, medrysone, meprednisone, methylprednisolone, mometasone furoate, paramethasone, prednicarbate, prednisolone, prednisolone 25-diethylamino-acetate, prednisolone sodium phosphate, prednisone, prednival, prednylidene, rimexolone, tixocortol, triamcinolone, triamcinolone acetonide, triamcinolone benetonide, triamcinolone hexacetonide; or allograft cellular matrix containing viable mesenchymal stem cells such as OSTEOCEL PLUS available from NuVasive, Inc., 7475 Lusk Blvd., San Diego, Calif. 92121 USA, and any of their derivatives, whether separately or in combinations thereof. 
     The biologically active agent(s) can be dispersed throughout a biocompatible or biocompatible biodegradable material (or mixture of biocompatible materials or mixture of biocompatible biodegradable materials) by mixing biologically active agent(s) into the melted biocompatible or biodegradable polymer and then solidifying the resulting material by cooling, having the biologically active agent(s) substantially uniformly dispersed throughout. The biodegradable material or biocompatible material or mixture thereof can be selected to have a melting point that is below the temperature at which the biologically active agent(s) becomes reactive or degrades. Alternatively, the biologically active agent(s) can be dispersed throughout the biocompatible or biodegradable material by solvent casting, in which the biocompatible or biodegradable material is dissolved in a solvent, and the biologically active agent(s) dissolved or dispersed in the solution. The solvent is then evaporated, leaving the biologically active agent(s) in the matrix of the biocompatible or biodegradable material. Solvent casting requires that the biocompatible or biodegradable material be soluble in organic solvents. Alternatively, the insertion element can be placed in a solvent having a concentration of the biologically active agent(s) dissolved and in which the insertion element or the biocompatible or biocompatible biodegradable material located in the aperture elements, or applied to the external surface, swells. Swelling of the insertion element or portions thereof draws in an amount of the biologically active agent(s). The solvent can then be evaporated leaving the biologically active agent(s) within the biocompatible or biocompatible biodegradable material. As to each method of dispersing the biologically active agent(s) throughout the biocompatible or biodegradable biocompatible material of or coupled to the insertion element, therapeutic levels of biologically active agent(s) can be included in biocompatible biodegradable material to provide therapeutically effective levels of the biologically active agent to the sacroiliac joint to treat a particular sacroiliac joint condition. 
     Other non-active agents may be included in the biocompatible biodegradable material for a variety of purposes. For example, buffering agents and preservatives may be employed. Preservatives which may be used include, but are not limited to, sodium bisulfite, sodium bisulfate, sodium thiosulfate, benzalkonium chloride, chlorobutanol, thimerosal, phenylmercuric acetate, phenylmercuric nitrate, methylparaben, polyvinyl alcohol and phenylethyl alcohol. Examples of buffering agents that may be employed include, but are not limited to, sodium carbonate, sodium borate, sodium phosphate, sodium acetate, sodium bicarbonate, and the like, as approved by the FDA or other appropriate agencies in the United States or foreign countries, for the desired route of administration. Electrolytes such as sodium chloride and potassium chloride may also be included in the formulation. 
     K. Sensors and Display 
     The diagnostic system may include sensors for determining position changes from original positions of the pins or bars, which may give quantitative indication of the movement of the ilium  1005  or sacrum  1004  near the joint. The sensors may be placed near the joint. The pins or bars may be manipulated to cause either linear movement or angular movement of the joint. The pins or bars may be held at certain positions for a period of time to either reduce the pain or to cause or reproduce the pain in the patient. The system may include pressure sensors for measuring forces. The sensors may be placed near the joint. In particular, the sensor may be positioned in the plane of the joint, across the joint, or outside the joint. 
     If positioned in the plane of the joint, a portion of the joint may be removed for insertion of the sensor. In this instance, the sensor may be paddle shaped and may match a shape of a portion of the joint (e.g., intra-articular region). If positioned across the joint, a portion of the ilium and sacrum may be bored-out to provide a passageway for the sensor. If positioned outside the joint, the sensor may bridge the joint and be positioned partially on the ilium and partially on the sacrum. Or, the sensor may be positioned on the ligaments surrounding the joint. 
     The sensor may be a piezoelectric sensor or transducer. The sensor may sense and transmit measurements that correspond to movement (e.g., bending, twisting, elongation, compression) that may be further associated with pain or discomfort. The patient may, for example, log the points in time that correspond with pain and discomfort and the points may be correlated with the measurements of the sensor to diagnose the types of movements associated with the patient&#39;s pain. The sensor may transmit the measurements through an application on the patient&#39;s cell phone, for example. The movements associated with pain may be used by the doctor to diagnose an ailment of the sacroiliac joint. 
     The sensors or transducers may also be positioned on any of the devices described in this application. For example, the implant as shown in  FIG. 13B  may include a sensor positioned on the coupling member  80  that is positioned outside the joint. Alternatively, any of the implants, for example as shown in  FIGS. 43A-48D  may include a sensor or transducer on or integrated with the implant. In this way, the implant may be used, temporarily perhaps, while measurements of compression, distraction, and bending, among others, are taken during a period of time. The information associated with the measurements may be used by the doctor to further diagnose the need for a permanent fixation of the joint. 
     When used with the tools and systems described herein, the sensors and transducers may be useful in providing a vast amount of data across of a large span of time to the doctor for his or her use in diagnosing an ailment of the sacroiliac joint. Measuring distraction and compression, among other metrics, while in a doctor&#39;s office is certainly helpful, but obtaining more data over an extended period of time provides even more data that can be used in the diagnosis. 
     The system may also include a display that may reveal quantitative information, such as angle, displacement, or holding time. The sensors are in communication with the display to provide the quantitative information. The measured angles, displacements or holding time may be stored on a storage device. 
     Systems, devices and methods described herein may use oscillatory motion for the diagnosis of a sacroiliac joint ailment. In certain embodiments, a method of diagnosing a medical condition associated with a sacroiliac joint of a patient may include delivering a first member in close proximity to a sacroiliac joint region. The first member may be a pin as described herein an implant or anchor. Subsequently, a force may be applied to the first member. The force may include a periodic oscillation. The periodic oscillation may be applied through via an eccentric rotating mass actuator, a linear resonant actuator, a piezo module, or an electro-active polymer actuator, among others. The periodic oscillation may include a linear displacement comprising an amplitude within a range of about 0.25 mm to about 0.5 mm, about 0.4 mm to about 0.75 mm, about 0.6 mm to about 1 mm, about 0.8 mm to about 1.2 mm, or about 1 mm to about 2 mm. The periodic oscillation may include proportional amplitudes of displacement such that the periodic oscillation resembles a sinusoidal waveform. In certain instances, the displacement may occur in a direction along a longitudinal axis of the first member. In certain instances, the displacement may occur in a direction generally transverse to a longitudinal axis of the first member. And, in certain instances, the periodic oscillation is may be caused by an electrically or pneumatically driven motor comprising a drive shaft with an off-balanced mass coupled thereto. 
     Based on a patient&#39;s pain, discomfort, or alleviation of the pain or discomfort, a doctor may be able to diagnose a sacroiliac joint ailment based on the oscillatory vibrations delivered to the patient through the first member. 
     L. Delivery of the Implant 
     The following discussion will focus on delivering the implant into the sacroiliac joint region. The discussion will further focus on the implant and its relation to the various regions (e.g., intra-articular, extra-articular) of the sacroiliac joint. While the pins, described previously, are not shown in the following figures, it is intended that the implant may be delivered with or without the aid of the pins. 
     To begin, reference is made to  FIG. 49A , which is a lateral side view of a hip region  1002  of a patient showing a sacrum  1004  and an ilium  1005  with a nearest ilium  1005  removed to more clearly depict the intra-articular region  1044  and the extra-articular region  3007  of the sacroiliac joint  1000 . Preparing an access region from the patient&#39;s skin to the patient&#39;s bone is described in this and other applications, such as, U.S. patent application Ser. No. 12/998,712, filed May 23, 2011 entitled SACROILIAC JOINT FIXATION FUSION SYSTEM and Ser. No. 13/236,411, filed Sep. 19, 2011 entitled SYSTEMS FOR AND METHODS OF FUSING A SACROILIAC JOINT. These applications are hereby incorporated by reference in their entireties. As seen in  FIG. 49A , the implant  25  may include a distal end and be coupled with a distal end  35  of an implant arm  110 . The distal end of the implant  25  may be posteriorly delivered into the hip region  1002  with a general anterior trajectory. The implant in solid line is shown entering the posterior inferior access region  3090  of the extra-articular region  3007  of the sacroiliac joint  1000  along a trajectory TR 1 . Depending on the shape and configuration of the implant  25 , it may penetrate into both the ilium (nearest ilium not shown) and the sacrum  1004  and extend across the joint  1000 . 
     The dotted line depiction of the implant shows another trajectory TR 2  of the implant as it extends into the posterior inferior access region  3090  of the extra-articular region  3007  of the joint  1000 . In both trajectories TR 1 , TR 2 , the implant avoids penetration into the intra-articular region  1044  of the joint  1000 . The intra-articular region  1044  of the joint includes a capsule containing cartilage and synovial fluid. For this reason, implanting an implant within the extra-articular region  3007 , as opposed to the intra-articular region  1044 , avoids damaging to the capsule in the event that a permanent fusion procedure is unnecessary. That is, it may be desirable to avoid damaging the intra-articular region  1044  of the joint  1000  until a permanent fusion procedure within the intra-articular region  1044  occurs. 
     Accordingly, the doctor or medical professional may deliver the implant along trajectories TR 1 , TR 2  or at any points in between. Trajectory TR 1  is generally parallel to the caudal boundary segment  3093 . Trajectory TR 2  extends an angle AJ cranial of trajectory TR 1  towards a mid-section of the anterior boundary segment  3094 . In certain embodiments, the angle AJ may be between 5 degrees and 35 degrees. In certain instances, the angle AJ may be about 5 degrees. In certain instances, the angle AJ may be about 10 degrees. In certain instances, the angle AJ may be about 15 degrees. In certain instances, the angle AJ may be about 20 degrees. In certain instances, the angle AJ may be about 25 degrees. In certain instances, the angle AJ may be about 30 degrees. In certain instances, the angle AJ may be about 55 degrees. 
     Still referring to  FIG. 49A  and in certain embodiments of the implant (shown in  FIG. 48A-48B ), the implant may be delivered into the sacrum  1004  and ilium (nearest is hidden) in the region of the intra-articular region  1044  without damaging the capsule, cartilage, and synovial fluid of the joint. In these configurations, the distal opening of the implant occupies the joint space such that the capsule of the joint is not damaged or disturbed by the body of the implant. That is, the implant may be delivered such that it is in-line with the posterior inferior access region  2016  of the intra-articular region  1044 . A sacral side of the implant  25  may be delivered into the sacrum  1004  in the region just medial of the posterior inferior access region  2016  and an ilial side of the implant may be delivered into the ilium  1005  in the region just lateral of the posterior inferior access region  2016 . On the ilium  1005 , the ilial side of the implant may extend into the ilium between the posterior superior iliac spine  2004  and the posterior inferior iliac spine  2006 . 
     Turning to  FIGS. 49B-49C , which are lateral views of the hip region  1002  showing the patient&#39;s skin  1003  in dotted line, the implant  25 , being coupled with a distal end  35  of the shaft  110  of a delivery tool, is being delivered into the extra-articular region of the sacroiliac joint via a posterior approach.  FIG. 49B  shows the distal end of the implant  25  entering the extra-articular region  3007  of the joint. A trajectory TR 3  of the implant is oriented to extend through the posterior inferior access region  3090  and extend superior-anterior towards a mid-section of the anterior boundary segment  3094  of the extra-articular region  3007 .  FIG. 49C  shows the implant  25  extending into the caudal region of the extra-articular region  3007  of the joint. 
       FIG. 50 , which is a lateral side view of the hip region  1002  with a nearest ilium hidden from view to more clearly show the regions of the sacroiliac joint  1000 , depicts the implant  25  positioned in the extra-articular region  3007  of the sacroiliac joint  1000 . As seen in the figure, the implant is de-coupled from the shaft  110  of the delivery tool such that the implant  25  resides in the joint  1000 , extending into the posterior inferior access region  3090  of the extra-articular region  3007 . As stated previously, delivering the implant  25  in this region  3007  avoids disruption of the capsule, cartilage, and fluid within the intra-articular region  1044  of the joint  1000 . In this way, if it is determined that a permanent implant is not needed, the implant (i.e., in the extra-articular region  3007 ) may be removed and the joint  1000  has not been irreparably damaged by, for example, removing the cartilage. 
     Reference is now made to  FIG. 51 , which shows a posterior view of  FIG. 50  showing the implant  25  positioned in the sacrum and ilium above the intra-articular region  1044 . As seen in the figure and as described previously, the implant  25  extends across the extra-articular region  3007  of the joint and extends into the ilium  1005  between the posterior superior iliac spine  2004  and the posterior inferior iliac spine  2006 . 
     Once the temporary implant is delivered into the patient and the delivery tool is removed from the implant, the various surgical tools may be removed from the incisions and the incision may be sterilized and closed. The patient may move about and simulate movements that would previously cause pain (e.g., flexing at hips). The implant may remain in the patient for a given period of time (e.g., minutes, hours, days) to determine if fusion of the joint is effective in eliminating or alleviating the pain. In certain patients, for example, a petite individual with a low activity level, if the temporary implant relieves the pain, it may be suitable to allow the implant to remain in the patient&#39;s body. Perhaps no other fusion procedure is necessary. Or, perhaps a subsequent implant may be delivered into the joint to permanently fuse the joint. 
     In certain instances, the temporary implant may be removed by coupling the shaft of the delivery tool with the implant and removing the implant from its position within the joint. This procedure may be done just prior to delivering a permanent implant into the joint in either the intra-articular region or the extra-articular region. If a permanent implant is to be delivered into the joint region, the joint may be prepped for the procedure according to U.S. patent application Ser. No. 14/514,221, filed Oct. 15, 2014, which is hereby incorporated by reference in its entirety. It is noted that the temporary implant positioned within the extra-articular region need not be removed prior to insertion of a permanent implant in the intra-articular region of the joint. 
     M. Tools, Systems, and Methods for Bone Pin Delivery and Manipulation 
     The following is a description of various tools, systems, and methods for bone pin delivery and manipulation.  FIGS. 52A-52H  depict various views of a parallel pin guide  5200 . More particularly,  FIG. 52A  is an isometric front view of the parallel pin guide  5200  supporting a pair of dilators  5202 .  FIG. 52B  is a front view of the parallel pin guide  5200  supporting the pair of dilators  5202 .  FIG. 52C  is a cross-sectional view of the parallel pin guide  5200  supporting the pair of dilators  5202 .  FIG. 52D  is a top view of the parallel pin guide  5200  supporting the pair of dilators  5202 .  FIG. 52E  is a bottom view of the parallel pin guide  5200  supporting the pair of dilators  5202 .  FIG. 52F  is an isometric front view of the parallel pin guide  5200  separated from the pair of dilators  5202 .  FIG. 52G  is a side view of the parallel pin guide  5200  supporting the pair of dilators  5202 . And,  FIG. 52H  is a cross-sectional view of the parallel pin guide  5200  supporting the pair of dilators  5202 . 
     As best seen in  FIG. 52F , among others, the parallel pin guide  5200  may include a guide body  5204  having a pair of spaced-apart guide holes  5206  extending in a distal-proximal direction. One of the guide holes  5206  may include a sleeve  5208  extending distally from the guide body  5204 . A distal tip  5220  of the sleeve  5208  may include a conical taper. The guide holes  5206  may define a passageway there through for receiving a dilator  5202 . The dilators  5202  may include a distal tip  5210  that may be conically tapered, a ribbed proximal end  5212  for grip, and passageway  5214  extending there through. 
     The guide body  5204  may additionally include a pair of radiographic guides or apertures  5216  extending transversely through the body  5204 . An axis extending through the radiographic guides  5216  may be generally perpendicular to an axis extending through the guide holes  5206 . The radiographic guides  5216  may receive radiographic contrasting cylinders  5218  therein for aligning relative to a joint line of the sacroiliac joint during the surgical procedure while under radiographic guidance (e.g., C-arm fluoroscopy). Alternatively or additionally, the guide body (or bone pins  5302 , a handle coupled to the bone pins, or any other component of the system described here or throughout the present application) may be configured for a navigated stereotactic procedure. As an example, the system may be configured to be used with a Medtronic StealthStation™ Navigation System and TeraTrackers or similar system (e.g., any system comprising optical or electromagnetic tracking) in order to assist the physician in precisely locating anatomical structures and accurately placing certain components of the system (e.g., the bone pins, guide wires or any other tool or implant) into or onto the patient. As such the guide body or other tool may have an attachment site configured to support a tracking array comprising active (transmits its own infrared light, e.g., via light-emitting diodes) or passive (reflects infrared light supplied by an external illumination source) markers. 
     As seen in  FIGS. 52A-52E and 52G-52H , when the first and second dilators  5202  are positioned in the guide holes  5206  of the guide body  5204 , the ribbed proximal end  5212  of the dilators  5202  may extend from the proximal end of the guide body  5204 , and the distal tip  5210  of the first dilator  5202  extends beyond the distal tapered tip  5220  of the sleeve  5208 . The second dilator  5202  extends from the proximal end of the guide body  5204  in parallel alignment with the first dilator  5202 . 
       FIGS. 53A-53G  depict various views of a dual-axis pliers  5300 . More particularly,  FIG. 53A  is an isometric front view of a dual-axis pliers  5300 .  FIG. 53B  is an isometric rear view of the dual-axis pliers  5300 .  FIG. 53C  is an isometric exploded view of the dual-axis pliers  5300  from a first side.  FIG. 53D  is an isometric exploded view of the dual-axis pliers  5300  from a second side.  FIG. 53E  is an isometric front view of the dual-axis pliers  5300  supporting a pair of bone pins  5302  in a first parallel orientation.  FIG. 53F  is an isometric front view of the dual-axis pliers  5300  supporting a pair of bone pins  5302  in a second parallel orientation where the bone pins  5302  are spaced apart a farther distance than in the first parallel orientation.  FIG. 53G  is an isometric front view of the dual-axis pliers  5300  supporting a pair of bone pins  5302  in a third orientation where the pair of bone pins  5302  are angled relative to each other but within parallel planes. 
     As seen in  FIGS. 53A and 53B , the dual-axis pliers  5300  may include handles  5304  at a proximal end  5306 , a head  5308  at a distal end  5310 , and first and second pivot joints  5312 ,  5314  intermediate of the handles  5304  and head  5308 . A first handle  5304   a  may be integrally formed with a first head portion  5308   a , and a second handle  5304   b  may be integrally formed with a second head portion  5308   b . The dual-axis pliers  5300  may function as expanding pliers where inward movement of the handles  5304   a ,  5304   b  relative to each other causes the head portions  5308   a ,  5308   b  to move away from each other, or expand, and thereby (depending on the arrangement of the bone pins to the sacroiliac joint) causing a distractive force at the sacroiliac joint, e.g., when a line drawn between the pins is substantially perpendicular to the sacroiliac joint line or when a line drawn between the pins forms an acute angle relative to the joint line such action may cause a shearing force or motion at the joint or a rotational force or motion at the joint. Conversely, outward movement of the handles  5304   a ,  5304   b  relative to each other causes the head portions  5308   a ,  5308   b  to move closer to each other, or to contract, and thereby (depending on the arrangement of the bone pins to the sacroiliac joint) causing a compressive force at the sacroiliac joint, e.g., when a line drawn between the pins is substantially perpendicular to the sacroiliac joint line or when a line drawn between the pins forms an acute angle relative to the joint line such action may cause a shearing force or motion at the joint or a rotational force or motion at the joint. 
     Each of the head portions  5308   a ,  5308   b  of the dual-axis pliers  5300  may include a proximal head member  5316  having a through-hole  5318  extending there through and a distal head member  5320  with a through-hole  5322  extending there through. The through-holes  5318 ,  5322  are coaxial with each other and sized to accept a bone pin (e.g., schanz screw/pin) therein. The proximal head members  5316  may each include a thumb-screw  5324  with a portion of the shaft extending into the through holes  5318  so as to contact and retain the bone pin in a desired position relative to the head portion  5308   a ,  5308   b . While the thumb-screw  5324  is shown on the proximal head member  5316 , the thumb-screw  5324  may additionally or alternatively be positioned on the distal head member  5320 . 
     The pliers  5300  are referred to as dual-axis plier because the first and second pivot joints  5312 ,  5314  are oriented perpendicular to each other; the first pivot joint  5312  facilitates movement or rotation (e.g., expanding and contracting) of the head portions  5308   a ,  5308   b  about a first pivot axis FPA, and the second pivot joint  5314  facilitates movement or rotation (e.g., shearing) of the head portions  5308   a ,  5308   b  about a second pivot axis SPA. In this way, as seen in  FIGS. 53E-53F , the pliers  5300  may be used to expand a pair of bone pins secured to the pliers  5300  away from each other or closer to each other via rotation about the first pivot axis FPA. And, as seen in  FIG. 53G , the pliers  5300  may be used to rotation or shear a pair of bone pins secured to the pliers  5300  via rotation about the second pivot axis SPA. 
     Referring to  FIGS. 53C and 53D , the first and second pivot joints  5312 ,  5314  will be described. As seen in the figures, the dual-axis pliers  5300  may include a pivot assembly  5326  including a dual-cylinder body  5328 , a pivot pin  5330 , and a retention pin  5332  (similar to a cotter pin). The dual-cylinder body  5328  includes a barreled body  5340  with a first through-hole  5334  for receiving the first pivot pin  5336  there through. The dual-cylinder body  5328  may also include cylinder flange  5338  extending perpendicular to the barreled body  5340 . The cylinder flange  5338  may include a second through-hole  5342  perpendicular to the first through-hole  5334 . The second through-hole  5342  may receive the shaft of the pivot pin  5330  therein, and the retention pin  5332  may extend through the barreled body  5340  and into an opening in the tip of the pivot pin  5330  such that the pivot pin  5330  and dual-cylinder body  5328  are coupled to the second head portion  5308   b  of the pliers  5300 . As seen in  FIG. 53C , the second head portion  5308   b  includes a through-bore  5344  for receiving the pivot pin  5330  therein. 
     When the pivot pin  5330  is retained in the through-bore  5344  of the second head portion  5308   b , and when the pivot pin  5330  is also coupled to the dual-cylinder body  5328  via the retention pin  5332 , the cylinder flange  5338  of the dual-cylinder body  5328  is received within an enlarged portion of the through-bore  5344  such that the dual-cylinder body  5328  can rotate about the pivot pin  5330 , which defines the second pivot axis SPA. 
     As seen in  FIG. 53C , the first head portion  5308   a  includes a pair of inwardly extending knuckles or barrels  5346  with through-holes  5348  for receiving the first pivot pin  5336  therein. Each of the pair of knuckles  5346  includes a slot  5350  jutting into the knuckle  5346 . 
     The pliers  5300  may function so as to pivot only about the first pivot joint  5312 , or function to pivot about both the first and second pivot joints  5312 ,  5314 . To pivot about only the first pivot joint  5312 , a pair of thumb-studs  5352  may be selectively engaged with the slots  5350  of the knuckles  5346  so as to prevent rotation about the second pivot joint  5314  (the pivot pin  5330 ). As seen in  FIG. 53C , the thumb-studs  5352  may extend through openings  5354  (e.g., threaded) in the second head portion  5308   b , and may be retained from removal from the second head portion  5308   b  via e-clips  5356 . The thumb-studs  5352  may be pushed or threadedly advanced to contact the second head portion  5308   b , and in doing so the unthreaded tips of the thumb-studs  5352  may enter the slots  5350  of the knuckles  5346  on the first head portion  5308   a . With the tips of the thumb-studs  5352  within the slots  5350 , the pliers  5300  are permitted to pivot about the first pivot pin  5336  extending through the knuckles  5346  and the dual-cylinder body  5328  of the pivot assembly  5326  as the tips of the thumb-studs  5352  may slide within the slots  5350 ; but, in this orientation, the pliers  5300  are prevented from rotating about the second pivot joint  5314  defined by the pivot pin  5330  by contact of the tips of the thumb-studs  5352  against the upper and lower walls defined by the slots  5350 . 
     By pulling back on or unthreading the thumb-studs  5352 , relative to the second head portion  5308   b , the tips of the thumb-studs  5352  may disengage or pull-out from within the slots  5350  of the knuckles  5346 . In this orientation, the second head portion  5308   b  is permitted to rotate relative to the first head portion  5308   a  via the pivot pin  5330  and the cylinder flange  5338  of the dual-cylinder body  5328  (about the second pivot axis). It is noted, the second head portion  5308   b  may still rotate relative to the first head portion  5308   a  about the first pivot pin  5336  when the thumb-studs  5352  are disengaged from the slots  5350  of the knuckles  5346 . 
     As seen in  FIG. 53E , the dual-axis pliers  5300  is coupled to a pair of bone pins  5302  such that the bone pins  5302  are parallel to each other. As seen in  FIG. 53F , the handles  5304   a ,  5304   b  are moved closer to each other (rotated about the first pivot axis FPA of the first pivot joint  5312 ) so as to cause the first and second head portions  5308   a ,  5308   b  to move farther apart from each other while the bone pins  5302  are still parallel to each other. And in  FIG. 53G , the thumb-studs  5352  are disengaged (pulled away from the second head portion  5308   b ) from the slots  5350  of the knuckles  5346  (not seen in  FIG. 53G ) such that the pliers  5300  are pivotable about the second pivot axis SPA of the second pivot joint  5314 . As configured the dual-axis pliers allow the physician to selectively and reproducibly constrain manipulation or force delivery to certain desirable degrees of freedom. 
       FIGS. 54A-54C  illustrate various view of a clevis guide  5400 . More particularly,  FIG. 54A  is an isometric front view of a clevis guide  5400  supporting a pair of bone pins  5402  in a first parallel orientation.  FIG. 54B  is an isometric front view of the clevis guide  5400  supporting the pair of bone pins  5402  in a second parallel orientation where the bone pins  5402  are moved longitudinally relative to each other relative to their positions in the first parallel orientation.  FIG. 54C  is an isometric exploded view of the clevis guide  5400 . 
     As seen in the figures, the clevis guide  5400  may include a clevis  5404  having a pair of prongs  5406  at one end and a tool engaging structure  5408  (e.g., square-end handle quick connect adapter) at the opposite end. The clevis guide  5400  may couple to a pair of guide blocks  5410   a ,  5410   b , each of which may include a guide hole  5412   a ,  5412   b  extending longitudinally through the guide block  5410   a ,  5410   b . The guide blocks  5410   a ,  5410   b  may include a thumb-screw  5414   a ,  5414   b  that, when engaged, causes a tip of the shaft to extend into the guide holes  5412   a ,  5412   b  so as to contact and retain the bone pins  5402   a ,  5402   b  positioned therein. 
     Each of the guide blocks  5410   a ,  5410   b  may be supported relative to the prongs  5406  via a pair of pins  5416  that extend through apertures  5418  in the prongs  5406 . It can be seen in  FIGS. 54B and 54C  that the aperture  5418  nearest the body of the clevis  5404  is elongated so as to permit the pins  5416  to slide slightly distal-proximal, which permits the guide blocks  5410   a ,  5410   b  to remain in a parallel orientation during use. 
     In use, the clevis guide  5400  may be used to displace the bone pins  5402   a ,  5402   b  longitudinally relative to each other. For example,  FIG. 54A  depicts the guide blocks  5410   a ,  5410   b  in a neutral orientation where the blocks are parallel to each other and the tops and bottom surfaces of the blocks are, respectively, coplanar. From this orientation, the tool engaging structure  5408  may be moved down (assuming the bone pins  5402   a ,  5402   b  are secured to a patient&#39;s bone surface), which causes the most distal bone pin  5402   a  (the one farthest from the tool engaging structure  5408 ) to move up relative to the other bone pin  5402   b . With this type of movement, the proximal bone pin  5402   b  acts as a fulcrum. While not shown, the tool engaging structure  5408  may be moved upwards, which causes the most distal bone pin  5402   a  to move down relative to the other bone pin  5402   b.    
       FIGS. 55A-55G  depict exemplary steps in a surgical procedure.  FIG. 55A  is an inferior view of a sacrum  1004  and an ilium  1005  with a guide wire  5500  delivered into the sacrum  1004 .  FIG. 55B  is an inferior view of the sacrum  1004  and the ilium  1005  with a first dilator  5202  positioned over the guide wire  5500 .  FIG. 55C  is an inferior view of the sacrum  1004  and the ilium  1005  with the parallel pin guide  5200  positioned over the first dilator  5202 .  FIG. 55D  is an inferior view of the sacrum  1004  and the ilium  1005  with a pair of radiographic contrasting cylinders  5218  positioned through the radiographic guides  5216  of the parallel pin guide  5200 .  FIG. 55E  is a posterior view of the sacrum  1004  and the ilium  1005  showing the pair of radiographic contrasting cylinders  5218  parallel with each other and generally parallel with a joint line of the sacroiliac joint  1000 .  FIG. 55F  is an inferior view of the sacrum  1004  and the ilium  1005  with a second dilator  5202  positioned up against the ilium  1005  and through a guide hole  5206  of the parallel pin guide  5200 .  FIG. 55G  is an inferior view of the sacrum  1004  and the ilium  1005  with a second guide wire  5500  positioned through the second dilator  5202  and into the ilium  1005 .  FIG. 55H  is an inferior view of the sacrum  1004  and the ilium  1005  with the dual-axis pliers  5300  secured to a pair of pins  5502  (positioned in the sacrum  1004  and ilium  1005  where the guide wires  5500  were previously).  FIG. 55I  is an inferior view of the sacrum  1004  and the ilium  1005  with the clevis guide  5400  secured to the pair of pins  5502  (positioned in the sacrum  1004  and ilium  1005  where the guide wires  5500  were previously). 
     The systems disclosed above may include a digital and or analog indicators and readout. Additionally or alternatively, the systems may include various forms of motion control (e.g., between components of the system and or the patient or a frame in proximity to the patient) with accurate position/velocity/torque capabilities operating in either open or closed loop mode. For example, open loop stepping drives may send motion commands to stepper motors, but receive no information about the result while closed loop servo systems may have feedback devices at the motor shaft to verify or adjust the resulting motion. Additionally or alternatively, the systems may include: linear motion slides and actuators, drive couplings, sensors, encoders, rotary encoders for detecting position and speed, sensors for detecting proximity, pressure, temperature, level, flow, current and voltage, limit switches for detecting states such as presence or end-of-travel limits, discrete or analog outputs, optical rotary encoders, inductive proximity sensors, magnetic proximity sensors, capacitive proximity sensors, photoelectric sensors, laser sensors, area sensors, fiber optic sensors, color sensors, contrast sensors, fork sensors, ultrasonic proximity sensors, pressure sensors, pressure gauges, thermometers, temperature sensors and transmitters, level sensors and controllers, flow sensors, current &amp; voltage sensors (ac &amp; dc), ground fault sensors, limit switches, hmi (human machine interface) providing a textual or graphical view of system conditions and operations offering monitoring, control, status reporting and other functions, programmable controllers (providing accurate, reliable, easily-modified control with discrete and process functions including motion, data logging and web server access), mechanical power transmission components, mechanical drivetrains to create movement, gearboxes, timing belts/pulleys/bushings, shaft couplings, bore reducers, linear shafts, and linear shaft supports. 
     Neuromonitoring may be conducted simultaneously with the diagnostic procedure utilizing any of the systems or methods described herein in order to monitor the status of the nerves in proximity to the diagnostic or treatment site whether to assess the location of the pins or to assess the influence of joint movement or pin movement on the nerves. 
     The foregoing merely illustrates the principles of the embodiments described herein. Various modifications and alterations to the described embodiments will be apparent to those skilled in the art in view of the teachings herein. It will thus be appreciated that those skilled in the art will be able to devise numerous systems, arrangements and methods which, although not explicitly shown or described herein, embody the principles of the embodiments described herein and are thus within the spirit and scope of the present disclosure. From the above description and drawings, it will be understood by those of ordinary skill in the art that the particular embodiments shown and described are for purposes of illustrations only and are not intended to limit the scope of the present disclosure. References to details of particular embodiments are not intended to limit the scope of the disclosure.