Sacroiliac Joint Injection
The sacroiliac joint is a diarthrodial joint that is located lateral to the spine and connects the hip to the sacrum on both sides of the body. There is a sacroiliac joint located on the right and on the left and these joints bear the weight of a patient’s upper body and extremities. Due to the fact that the joint has to be very stable, movement of the joint is limited. A thin layer of cartilage covers the surface of the ileum and sacrum. Synovial fluid fills the space between these two structures, which is enclosed within a fibrous capsule. Sacroiliac joint inflammation and dysfunction can result in chronic low back or leg pain.
Sacroiliac joint dysfunction can be difficult to diagnose as the symptoms often mimic other causes of back pain including disc herniation, facet syndrome, and radiculopathy. Sacroiliac joint injections serve two purposes: to diagnose the source of a patients’ pain and to provide pain relief. Various studies have shown that extra-articular and peri-articular steroid injections within the sacroiliac joint are more effective than placebo treatments for pain relief. Additionally, the studies have found that these pain relief benefits are sustained at a one-month follow-up appointment.
A diagnostic sacroiliac joint injection is performed when sacroiliac joint dysfunction is suspected. The area around the sacroiliac joint is numbed with a local anesthetic and a needle is then inserted using fluoroscopic guidance. Contrast dye is injected once the needle is in place to ensure proper needle placement and proper spread of medication. A numbing medication is then injected into the joint.
After the numbing medication is injected, patients are asked to try and reproduce their pain by performing certain movements. If the patient reports a significant reduction in their pain, a diagnosis of sacroiliac joint dysfunction is tentatively made. In order to confirm the diagnosis, a second injection should be performed at a later date.
A therapeutic sacroiliac joint injection is performed when a diagnosis of sacroiliac joint dysfunction has been established and the patient requires pain relief. This procedure is performed in the same manner as the diagnostic sacroiliac joint injection with the exception that a corticosteroid is also injected into the affected joint.
Many patients that are treated with a sacroiliac joint injection are expected to experience immediate pain relief. After the procedure is completed, patients are monitored for pain relief and adverse reactions.
If a patient experiences prolonged pain relief after receiving a therapeutic sacroiliac joint injection, they may start a physical therapy program to further reduce their pain and to help them achieve normal functioning. If a patient experiences significant pain relief following a sacroiliac joint injection, it may be repeated up to three times per year.
As with all medical procedures, there are risks associated with sacroiliac joint injections, including bleeding, infection, and allergic reactions to the medications. Additionally, a patient may experience temporary numbness or weakness in the legs that is caused by the anesthetic that is injected. Some patients may have a temporary increase in pain and injection site tenderness for a couple of days after the injection. Diabetics may notice an increase in their blood sugar levels that is the result of the corticosteroid that is injected.
Sacroiliac joint injections are often used for treating patients that suffer from chronic, non-specific back pain that is the result of irritation, inflammation, or injury of the sacroiliac joint. Sacroiliac joint dysfunction is tough to diagnose as the symptoms overlap with other injuries. Research has shown that up to 40-50% of patients with a confirmed diagnosis of sacroiliac joint pain are able to identify an event that likely contributed to their current episode of sacroiliac pain. These events may include a slip and fall, a motor vehicle accident, or repetitive stress on the joint.
It should be noted that acute events are not responsible for all episodes of sacroiliac joint pain. Research has found that there are a number of traits that are associated with an increased risk of developing sacroiliac joint pain, including leg length discrepancy, gait and biomedical abnormalities, transitional anatomy, scoliosis, persistent strain, and pregnancy.
Patients who suffer from sacroiliac pain often describe the pain as diffuse, lower back pain. Of concern when evaluating a patient with sacroiliac joint pain is their current level of impairment (strength, flexibility, balance, etc.). The level of impairment will help the patients’ physician determine whether the patient will be able to engage in a rehabilitation program without experiencing significant pain. Additionally, depending on the current level of impairment, the physician may recommend a trial of conservative treatment options before initiating this type of treatment.
Sacroiliac joint injections are an effective procedure for patients suffering from chronic lumbar back pain that is the result of inflammation or dysfunction of the sacroiliac joint. Sacroiliac joint injections are minimally invasive and can provide pain relief almost immediately for many patients. It is hypothesized that these injections provide pain relief as the result of their anti-inflammatory characteristics; however, the literature remains unclear. Patients suffering from chronic low back pain that originates from the sacroiliac joint should discuss the option of sacroiliac joint injections with their physician to determine if it is an appropriate option for their case.