SACROILIAC JOINT INJECTION
A sacroiliac joint injection is a treatment approach for patients who are suffering from sacroiliac joint pain. Patients that have persistent and nonspecific back pain can be attributed to due to irritation of the sacroiliac joint. The results of clinical trials have shown that injecting steroids into the tissue surrounding the joint or directly into the sacroiliac joint provides patients with more pain relief than placebo injections with reports of pain relief up to one month. SI Joint injections are effective for patient’s that have chronic low back pain and the pain is affecting daily movement and walking.
It is primarily used either to diagnose or treat low back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction. Pain in the low back/buttock area that becomes worse with sitting. Tenderness in the Sacroiliac joint, and positive results on at least one of three provocation tests: Gaenslen’s test, Patrick’s test, or Newton’s test.
In either strategy [diagnosis or treatment], the patient’s pain level is assessed by having the patient perform activities that would usually provoke pain. The percentage of pain relief is documented.
At least 75 percent improvement of the patient’s painful activity related symptoms. If a second diagnostic injection is positive, then the sacroiliac joint is considered the likely source of the patient’s painful symptoms.
A diagnostic sacroiliac joint injection is used to confirm a suspected diagnosis of sacroiliac joint dysfunction by anesthetizing the sacroiliac joint with local anesthetic (e.g. lidocaine) under fluoroscopy.
After the injection, the patient is asked to try and reproduce the pain by performing activities which are painful to him.
A relief of 75-80% for the normal duration of the anesthetic suggests a tentative diagnosis of sacroiliac joint dysfunction.
For confirmation, a second injection using a different anesthetic (e.g. Bupivacaine) is used to confirm the diagnosis.
If this second injection also results in 75-80% pain relief, then most likely, pain source is sacroiliac joint.
After informed consent has been obtained, the patient lies face down on his or her stomach on the radiography table. A pillow might be placed under the hips for patient comfort.
Anxiolytics may be used in anxious patients.
The skin overlying the sacroiliac joint injection is cleansed using Povidine-Iodine or chlorhexidine solution.
The needle insertion site is often numbed using local anesthetic.
The insertion of a single needle in the inferior aspect of the joint is preferred. Insert the needle in a medial-to-lateral direction.
The needle is advanced through the skin, capsule, and ligaments of the joint until it is introduced into the joint.
Approximately 1 mL of contrast is injected. It should outline the joint, which can be easily viewed under fluoroscopy
Two types of medications are typically injected:
For diagnostic purpose, a local anesthetic (lidocaine or bupivacaine) is injected into the joint and pain relief is gauzed.
For treatment, a corticosteroid [admixed with anesthetic for initial pain relief] which may help reduce inflammation within the joint and relieve symptoms for longer period [Several months to a year].
Patient is monitored for about 30 minutes for adverse/allergic reactions.
Sometimes your provider may recommend extra-articular or periarticular corticosteroid which have been found to provide significantly higher in various studies. This is said to be due to nociceptive fibers in the interosseous membrane and the surrounding ligaments.
This is significant if the pain is originating from soft tissues rather than joint itself.
Adverse effects seen with sacroiliac joint injection are minimal.
The most commonly reported immediate adverse effect is a vasovagal reaction.
Common adverse effects are:
-Temporary increase in pain
-Allergic reaction to a medication
-Bruising and/or soreness at the injection site