Sacroiliac Joint Injection

The Sacroiliac Joint Injection with corticosteroid is employed for treating both acute and chronic sprains or capsulitis.

Acute or chronic sprain or capsulitis of sacroiliac joint is commonly observed in females, particularly during the prepartum or postpartum period, or as a result of a traumatic incident, such as a fall on the buttocks. Patients may experience pain following periods of rest or prolonged sitting or standing. Additionally, successful manipulation may alleviate acute discomfort but lead to persistent ligamentous pain over time.

These conditions are characterized by pain experienced in the buttock, groin, or sometimes extending down the posterior thigh to the calf. Additionally, patients may experience pain when stressing the posterior ligaments during hip flexion, oblique, and transverse adduction, as well as the anterior ligaments during hip flexion, abduction, and/or external rotation. Moreover, an asymmetry may be observed during the ‘walk’ test.

Equipment Needed

• Syringe: 2 ml
• Needle: Spinal, 22 gauge / 3–3.5 inches (75–90 mm)
• Kenalog 40: 20 mg
• Lidocaine: 1.5 ml 2%
• Total volume: 2 ml

Related Anatomy

The SIJ surfaces are tilted obliquely in a posteroanterior direction, with a sharper angle observed in females. The depressions at the upper part of the buttocks mark the location of the posterior superior iliac spines.

Administering injections into this joint can be challenging, but the most accessible entry point is typically located in a slight dip just below and slightly toward the center from the posterior superior iliac spines.

See Also: Pelvic Anatomy

Sacroiliac Joint Injection Technique:

1. Position the patient in a prone position with a small pillow for comfort.
2. Locate and mark the posterior superior iliac spine on the affected side.
3. Insert the needle about a thumb’s width medial and just below this bony landmark, aligning it with the level of the second sacral spinous process.
4. Obliquely advance the needle anterolaterally at an angle of approximately 45 degrees.
5. Continue advancing the needle between the sacrum and ilium until encountering a ligamentous resistance.
6. Administer the solution as a bolus within the joint if possible, or disperse it within the posterior capsule.

Patients are encouraged to engage in pain-free movements, such as performing a lunging motion with the foot up on a chair or moderate walking, to alleviate discomfort. It is important to avoid hip abduction positions and maintain a supported sitting posture. If the joint is unstable, a temporary belt can be worn for added support. Additionally, sclerosing injections may be considered to enhance ligamentous stability.

See Also: Hip Pain Causes

Notes

The SIJ Injection is not commonly used; typically, manipulation, mobilization, and exercise techniques effectively alleviate most chronic sacroiliac joint symptoms.

When performing Sacroiliac Joint Injection, the needle may encounter bone resistance, requiring careful maneuvering to accommodate variations in bone shape before entering the joint space.

Administering a small amount of solution can help make the process less uncomfortable. Repeating SI Joint Injection is uncommon, as the joint can often be successfully manipulated a week later, if needed.

diagnostic sacroiliac joint block has been shown to be a useful confirmatory tool in assessing sacroiliac (SI) joint–mediated pain. Sacroiliac joint injection with local anesthetic and steroids can be used as a possible therapeutic endeavor to manage pain and inflammation.

References & More

1. Injection Techniques in Musculoskeletal Medicine. A Practical Manual for Clinicians In Primary And Secondary Care. Fifth Edition.
2. Jung MW, Schellhas K, Johnson B. Use of Diagnostic Injections to Evaluate Sacroiliac Joint Pain. Int J Spine Surg. 2020 Feb 10;14(Suppl 1):30-34. doi: 10.14444/6081. PMID: 32123655; PMCID: PMC7041665 | Pubmed
3. Ab Aziz SNF, Zakaria Mohamad Z, Karupiah RK, Che Ahmad A, Omar AS. Efficacy of Sacroiliac Joint Injection With Anesthetic and Corticosteroid: A Prospective Observational Study. Cureus. 2022 Apr 11;14(4):e24039. doi: 10.7759/cureus.24039. PMID: 35547453; PMCID: PMC9090203. Pubmed
4. Wu L, Tafti D, Varacallo M. Sacroiliac Joint Injection. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513245/
5. Ab Aziz SNF, Zakaria Mohamad Z, Karupiah RK, Che Ahmad A, Omar AS. Efficacy of Sacroiliac Joint Injection With Anesthetic and Corticosteroid: A Prospective Observational Study. Cureus. 2022 Apr 11;14(4):e24039. doi: 10.7759/cureus.24039. PMID: 35547453; PMCID: PMC9090203. Pubmed