Sacroiliac Joint Injection Arthrogram

Sacroiliac Joint Injection Arthrogram
Lumbar disc, facet joints and sacroiliac joints are 3 major sources of lower back pain. Theses structures can result in pain in the lower back, buttocks, leg, groin, hip or even the abdomen.

The Sacroiliac joint is a large synovial (fluid filled) joint formed by the junction of the sacrum and ileum. The joint allows a small amount of rotation and forward and backward movement. The greatest amount of movement occurs when individuals rise from a sitting or lying position to standing position. In middle age and beyond, fibrous adhesions (scar tissue) and degenerative changes result in gradual obliteration of (loss of) the synovial cavity which occurs in both sexes. This occurs earlier in men, and after menopause in women. The joint can dysfunction as a result of injury, abnormal weight bearing, leg length discrepancies, fractures, changes in walking patterns, pregnancy, and a host of other arthritic disorders. Pain can also be referred to the area by the lumbar discs.

To diagnosis pain from the sacroiliac joint, physical exam can be helpful, but it is not always reliable. Imaging studies such as x-rays, CT scan and MRI can be normal in patients who have problems from this area. Therefore, diagnosis of the offending joint requires intra-articular diagnostic block of the sacroiliac joint under fluoroscopy. The older, “blind” injection technique was completed without fluoroscopy (x-ray guidance), anesthetized only the interosseous sacroiliac ligament (band connecting two bones) and did not produce reliable results or pain relief. In some patients, the sacroiliac pain may also be diagnosed by blocking the nerves to the joint under fluoroscopic guidance.

The procedure is begun by numbing the skin with a local anesthetic. A needle is then placed under fluoroscopic guidance into the sacroiliac joint. A numbing medicine, such as novocaine is placed into the joint. This will help the physician identify the joint as the source of pain. Typically cortisone is also injected into the joint for the inflammation as well as to provide extended pain relief.

Once the pain is controlled, a trial of physical therapy or manual therapy is prescribed to correct the underlying mechanical problems.

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