SI Joint Injection

The SI joint connects the large triangular-shaped bone at the end of the spine (the sacrum) to the two hipbones (iliac bones).


What is the sacroiliac (SI) joint?

The SI joint connects the large triangular-shaped bone at the end of the spine (the sacrum) to the two hipbones (iliac bones). The SI joints are designed for stability, not mobility. However, it is subject to degenerative and inflammatory arthritis as well as mechanical dysfunction.

How is SI joint pain diagnosed?

The history may reveal a precipitating injury, such as a fall, lifting a heavy object, or turning. The pain is a one-sided ache that radiates to the buttock, groin, and/or thigh area. It rarely goes below the knee. The pain is worsened by loading the joint, as occurs during prolonged sitting, standing, or bending. There is tenderness over the joint area, and the crossing the leg of the affected side typically reproduces the pain. The diagnosis is confirmed if an SI joint injection with numbing medicine takes away the pain completely.

What should I expect during an SI joint injection?

In an SI joint injection, the doctor will use X-ray guidance to visualize the joint. He or she will clean off the skin overlying the joint, then you will feel a pinch and burn while the doctor numbs up the skin. Then the doctor will place a needle into the joint itself. If the joint is inflamed, oftentimes the patient will experience a familiar zing of pain in the area. It is not uncommon for the patient to say “that’s the spot!”. Then, the doctor will confirm they are in the joint using contrast dye. Once confirmed, the doctor will injection numbing medicine and steroid into the joint.

What should I expect after an SI joint injection?

The SI joint injection is both diagnostic and therapeutic. If this is the cause of the pain, then it should feel better right away while the numbing medicine is working. The numbing medicine wears off after 6-12 hours, and patients may experience a return of their pain. The steroid medications take 3-7 days to treat the inflammation in the joint and give long-lasting relief.

Ok, I had an SI joint injection and my pain was better the first day but I did not experience any long-lasting relief. Now what?

This confirms that the SI joint is likely the pain generator, but it may be too degenerative or inflamed to respond to steroids. In this case, you may be a candidate for a procedure called an SI neurotomy.

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